CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107
CHAPTER 3: THEORIES OF LABOR ONSET AND SIGNS OF LABOR
THEORIES OF LABOR ONSET & SIGNS OF LABOR
THEORIES OF LABOR ONSET
• It is believed that labor is influenced by a combination of
factors originating from the mother and the fetus.
• These factors include the following:
1. Uterine muscle stretching, which results in release of
prostaglandins.
2. Pressure on the cervix, which stimulates the release of
oxytocin from the posterior pituitary.
3. Oxytocin stimulation, which works together with
prostaglandins to initiate contractions.
4. Change in the ratio of estrogen to progesterone
(increasing estrogen in relation to progesterone stimulates
uterine contractions)
5. Placental age, which triggers contractions at a set point
6. Rising fetal cortisol levels, which reduce progesterone
formation and increase prostaglandin formation.
7. Fetal membrane production of prostaglandin, which
stimulates contractions.
SIGNS OF LABOR
PRELIMINARY SIGNS OF LABOR
• All pregnant women should be taught these signs so that they
can recognize when labor is beginning.
1. LIGHTENING
• Descent of the fetal presenting part into the pelvis.
• In primiparas, it occurs approximately 10 to 14 days before
labor begins.
• As the fetus sinks lower in the pelvis, the mother may
experience shooting leg pains from the increased pressure on
the sciatic nerve, increased amounts of vaginal discharge, and
urinary from pressure on the bladder.
• This changes a woman’s abdominal contour as the uterus
becomes lower and more anterior.
• Gives a woman relief from the diaphragmatic pressure and
shortness of breath.
• In multiparas, it usually occurs on the day of labor or even after
labor has begun
2. INCREASE IN LEVEL OF ACTIVITY
• A woman may awaken on the morning of labor full of energy.
• This is related to an increase in epinephrine release that is
initiated by a decrease in progesterone produced by the
placenta.
• Additional epinephrine prepares a woman’s body for the work
of labor ahead.
3. BRAXTON HICKS CONTRACTIONS
• In the last week or days before labor begins, a woman usually
notices extremely strong Braxton Hicks contractions which she
may interpret as true labor contractions.
• Remind her that if false contractions have become strong
enough to be mistaken for true labor, true labor must not be
far away.
4. RIPENING OF THE CERVIX
• Is an integral sign seen only on pelvic examination.
• Throughout pregnancy, the cervix feels softer than normal,
similar to the consistency of an earlobe (Goodell’s sign)
• At term, the cervix becomes still softer (described as “butter-
soft”)
• Ripening is an integral announcement that labor is very close
at hand.
SIGNS OF TRUE LABOR
• Signs of true labor involve uterine and cervical changes.
1. UTERINE CONTRACTIONS
• The surest sign that labor has begun is productive uterine
contractions.
• Because contractions are involuntary and come without
warning, their intensity can be frightening in early labor.
• Helping a woman appreciate that she can predict can control
the degree of discomfort she feels by using breathing exercises
offers her a sense of control.
2. SHOW
• As the cervix softens and ripens, the mucus plug that filled the
cervical canal during pregnancy (operculum) is expelled.
• The exposed cervical capillaries seep blood as a result of
pressure exerted by the fetus.
• The blood mixed with mucus, takes on a pink tinge and is
referred to as “show” or “bloody show”.
• Women need to be aware of this event so that they do not
think they are bleeding abnormally.
3. RUPTURE OF MEMBRANES
• Labor may begin with rupture of the membranes, experienced
either as a sudden gush or as scanty, slow seeping of clear
fluid from the vagina.
• Two risks associated with ruptured membranes are:
1. Intrauterine infection
2. Prolapse of the cord which can cut off the oxygen supply
to the fetus.
• In most instances, if labor has not spontaneously occurred by
24 hours after membrane rupture and the pregnancy is at
term, labor is induced to help reduce these risks.
DIFFERENTIATION BETWEEN TRUE AND FALSE LABOR
CONTRACTIONS
FALSE CONTRACTIONS
• Begin and remain irregular
• Felt first abdominally and remain confined to the abdomen
and groin
• Often disappear with ambulation and sleep
• Do not increase in duration, frequency or intensity
• Do not achieve cervical dilatation
TRUE CONTRACTIONS
• Begin irregularly but become regular and predictable
• Felt first in lower back and sweep around to the abdomen in a
wave
• Continue no matter what the woman’s level of activity.
• Increase in duration, frequency, and intensity
• Achieve cervical dilatation
LAMAGON | BSN 2A