Aijiel Lysent D.

Talisik NCM 33 LEC- B2 October 8, 2020

Questions to answer:

1) When does normal labor start?

Normal labor starts between 37 and 42 weeks of pregnancy. This is when the fetus is
mature enough to adapt to the extrauterine environment, but not too large to cause mechanical
difficulty during birth.

2) How long is labor? 

On average, labor lasts 12 to 18 hours in a woman's first pregnancy. For multipara
mothers, labor tends to be shorter with an average of 6 to 8 hours.

3) Stages of labor? 

a. First stage: This is the longest stage of labor. It starts when true labor contractions begin and
ends with full cervix dilation.
b. Second stage: Usually lasts 30-90 minutes. It starts with the complete dilatation of the cervix
and ends with the birth of the baby.
c. Third stage: This is the shortest stage of labor which lasts between 5 and 30 minutes. This is
when placenta and membranes separate from uterus and is expulsed out of the mother’s body.
d. Fourth stage: This takes place after the expulsion of placenta. Usually lasts around 2 hours.

4) Mechanism of labor? 

Mechanism of labor is position of the fetus with respect to the birth canal during labor.
Specifically, these are:
a. Lie- is the relationship between the long axis of the fetus’ body and the long axis of
the mother’s body. It basically tells if the fetus is lying horizontally (transverse) or
vertically (longitudinal).
b. Presentation- tells the fetus’ body part that will contact the cervix first. It is
determined by combining fetal lie and the degree of fetal flexion.
c. Attitude or posture- describes the degree of flexion of fetus during labor or the relation
of the fetal parts to each other.
d. Position- is the relationship of the presenting fetal part to a specific quadrant and side
of a woman’s pelvis. Example of this is left occipitoanterior (LOA) position where the
the fetus is in vertex position with the occiput pointing to the left anterior quadrant of
the mother.
5) Management of labor? 
Upon admission: Identify the labor if it’s true labor or false. Conduct general assessment
of the mother and record patient’s history and vital signs. Assess heart
and lungs, and conduct urinalysis. Examine the mother’s abdomen,
vagina, and the station of the presenting body part of the fetus.
First stage of labor: Monitor fetal and maternal well-being, vital signs, uterine
contractions, and urinary bladder function. Manage mother’s oral
intake, position, and if applicable, IV fluids and amniotomy. Conduct
subsequent vaginal examinations.
Second stage: Instruct mother to take deep breath as soon as contraction begins. Tell her
to hold her breath before pushing during contractions. Take rest in between
contractions. Events in this stage are as follows: crowning, episiotomy,
Ritgen maneuver, delivery of the shoulders, clearing the nasopharynx of
the baby, and clamping of the cord.
Third stage: Inspect cervix and vagina for laceration. Perform surgical repair if needed.
“Traction on the umbilical cord must not be used to pull the placenta out of
the uterus”. Placental expulsion can take place naturally without medical
assistance, but there are times when manual removal of placenta is necessary.
Fourth stage: Uterine atony is more likely to happen at this stage. Check the birth-canal,
suture the wound (internal and external lesions), and RDV at the end of the
suture.

6) Danger during labor?

Maternal danger signs:
a. Rising/falling blood pressure- Normal maternal blood pressure should only rise
slightly in the second stage of labor due to her pushing effort. Abnormal rise/fall of
BP could indicate intrauterine hemorrhage.
b. Abnormal pulse- A maternal pulse rate greater than 100 beats/min during labor is
abnormal and could indicate hemorrhage.
c. Inadequate or prolonged contractions - It is abnormal if contractions get less frequent,
less intense, or shorter in duration, it may indicate uterine exhaustion.
d. Abnormal abdominal contour- presence of abnormal abdominal contour could indicate
that the bladder is full. Full bladder may hinder the fetal head to descend. Ask the
mother to void every 2 hours.
e. Increasing apprehension- increase of apprehension could divert the attention of the
mother towards her environment and the pain she’s experiencing instead cooperating.
Nurses should build rapport and provide support system.

Fetal danger signs:

a. High or Low Fetal Heart Rate - It is abnormal when the fetal heart is above 160
beats/min or below 110 beats/min. It could indicate fetal distress.
b. Low Oxygen Saturation- Normal oxygen saturation is between 40% and 70% and pH
level should not go down below 7.2.
 c. Hyperactivity- Fetus should barely moves during labor. Hyperactivity could indicate
hypoxia.
d. Meconium Staining- Meconium staining happens when there is a green color in the
amniotic fluid. It reveals that the fetus lost of rectal sphincter control and could
indicate hypoxia.

7) What is: "normal labor”?

- Normal labor is spontaneous in onset, low-risk at the start and remaining so throughout the
labor process and delivery. The infant is in the vertex position and is born between 37 and 42
weeks of pregnancy. Specific criteria of normal labor are the following:
1. Spontaneous expulsion,
2. of a single,
3. mature fetus (37 completed weeks to 42 weeks),
4. presented by vertex,
5. through the birth canal (vaginal delivery),
6. within a reasonable time (more than 3, less than 18 hours)
7. without complications to the mother
8. without complications to the fetus
References:

Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal & Child Health Nursing: Care Of The Childbearing &
Childrearing Family. Philadelphia : Wolters Kluwer.

Vidal, I. (n.a.). Normal labor and delivery. Retrieved from

https://soul.su.edu.ph/pluginfile.php/322614/mod_resource/content/1/Labor-and-delivery.pdf.pdf

World Health Organization. (2018, February). WHO recommendation on definitions of the latent and
active first stages of labour. Retrieved from https://extranet.who.int/rhl/topics/preconception-
pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-1st-
stage/who-recommendation-definitions-latent-and-active-first-stages-labour-0