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INTRAPARTUM
PRELIMINARY SIGNS OF LABOR
1. LIGHTENING
- Descent of the fetal presenting part into
the pelvis
- Occurs approximately 10 - 14 days
before labor begins (primipara)
- Lightening gives the woman relief from
the diaphragmatic pressure and shortness
of breath she has been experiencing, and
thus “lightens” her load
- It can occur the day labor begins / after
the start of labor in multiparas
- Increases pressure on the bladder, which
may cause urinary frequency
- Uterus may cause pressure on the sciatic
nerve with resultant leg pains
2. BRAXTON-HICKS CONTRACTIONS
- Are irregular; can be diminished with
increased activity, eating, drinking or
changing position, something that can’t be
done with the contractions of labor
- Are typically painless; if the woman feels
pain from the contractions, it’s felt only in
the abdomen and groin - never in the back
- don’t cause effacement and dilatation of
the cervix
3. CERVICAL CHANGES
- Usually occur several days before
initiation of labor
- Cervix soften (ripens), begins to efface,
and dilates slightly
- At term, the cervix becomes further
softer and described as “BUTTERSOFT”
and tips forward
4. BURST OF ENERGY
- Due to increase in epinephrine release
that is initiated by a decrease in
progesterone produced by the placenta
- Epinephrine prepares the woman’s body
for the work of labor ahead
- Client may perform housecleaning
activities called “nesting” instinct
5. LOSS OF WEIGHT
- The pregnant woman may lose 1 - 3lb (.5
-1.4 kg) up to 3 days before labor begins
- The levels of estrogen and progesterone
are altered, possibly resulting in an
increase in voiding and subsequent fluid
loss
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Labor initiation & theories

FACTORS INITIATING LABOR
1. UTERINE STRETCHING
2. CHANGES IN ESTROGEN & PROGESTERONE BALANCE
3. OXYTOCIN STIMULATION
4. PLACENTAL AGE
5. INCREASE FETAL CORTISOL LEVEL
6. CERVICAL PRESSURE
7. PROSTAGLANDIN PRODUCTION BY THE FETUS
8. SEASONAL AND TIME INFLUENCES

THEORIES
1. OXYTOCIN STIMULATION
2. PROGESTERONE WITHDRAWAL
3. FETAL-MATERNAL COMMUNICATION
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Duration - Is the interval from the beginning of a contraction to its end

Intensity - Refers to the strength of a contraction
Interval - Refers to the period from the end of a contraction to the beginning of the
following contraction

B. CERVICAL CHANGES
- Two changes that occur in the cervix during labor
1. EFFACEMENT - is the shortening and thinning of the cervical canal
- occurs due to the longitudinal traction from the contracting uterine fundus
- in primipara, effacement occurs before dilatation begins
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- In multipara, dilatation may occur first before effacement

2. DILATATION - Refers to the enlargement of the cervical canal to permit passage of the
fetus
- Dilatation occurs for two reasons:
• Uterine contractions gradually increases the diameter of the cervical canal by pulling the
cervix up
• The fluid-filled membranes press against the cervix

PSYCHE
- Refers to the psychological state or feelings that women bring into labor with
them. When the woman feels confident in her ability to cope and finds ways to work
with the contractions, the labor process is enhanced.
However, the laboring woman becomes fearful or has intense pain; she may
become tense and fight contraction. This situation often becomes a cycle of fear,
tension, and pain that interferes with the progress of labor.
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STAGES & DURATION OF LABOR

1. FIRST STAGE /FETAL STAGE
- Begins with true labor contractions and ends with
full dilatation and effacement of the cervix
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2. SECOND STAGE / CERVICAL STAGE

- Period from full dilatation and effacement of the cervix to brith of the infant
- Perineum starts to bulge and appear tense
- Stool may be expelled due to pressure
- The woman is encouraged to use her abdominal muscles to bear down during contraction
RITGEN MANEUVER
- An upward pressure from the coccygeal region to extend the head during vaginal delivery
- Usually done by a midwife in the second stage during uterine contraction and/or during
the
crowning process
McROBERT’s MANEUVER
- An obstetrical maneuver used to assist in childbirth
- It is employed in case of shoulder dystopia during childbirth and involves hyper flexing
the
mother’s legs tightly to her abdomen

THIRD STAGE / PLACENTAL STAGE -

begins with the brith of the infant and ends
with delivery of the placenta
Two Phases:
• PLACENTAL SEPARATION
- Occurs automatically as the uterus
resumes contraction
- Signs of separation:
Lengthening of the cord
Sudden gush of vaginal blood
Change in the shape of the uterus
- Two mechanisms of placental delivery:
Schultze
Duncan
• PLACENTAL EXPULSION
- Pressure should never be applied to a
uterus in a non-contracted state or the
uterus may invert and lead to hemorrhage
https://youtu.be/Byn5YtY4PYU
FOURTH STAGE - Period of recovery 1-4
hours after delivery
- The woman is observed frequently for signs of
hemorrhage or other complication

Maternal & fetal adaptation to labor

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MATERNAL PHYSIOLOGIC ADAPTATION

CARDIOVASCULAR SYSTEM
• Cardiac Output
- Contraction greatly decreases blood flow to the uterus
- Pushing increases cardiac output to as much as 40-50% above the prelabor state causing
rise in systolic pressure an average of 15 mmHg
- Average blood loss with birth is 300 - 500ml and is not detrimental to most women
- First hour after delivery the average woman’s heart rate adjusts well
HEMATOPOIETIC SYSTEM
- There is a sharp increase of the leukocytes average of 25,000 - 30,000 / mm3 due to
trauma
RESPIRATORY SYSTEM
- The woman is at risk for hyperventilation and dehydration
TEMPERATURE REGULATION
- Increased muscular activity may result in slight elevation of temperature
- Diaphoresis occurs to cool and limit excessive warming
FLUID BALANCE
- Intravenous fluid replacement is necessary if labor is prolonged; at risk for dehydration
MUSCULOSKELETAL SYSTEM
- Increased back pain or irritating nagging pain at the pelvis
URINARY SYSTEM
- Concentrated urine; specific gravity may rise
- Pressure from fetal presenting part may reduce the bladder tone and ability of the bladder
to sense filling
- Ask the woman to void every 2 hours > also promotes fetal descent
GASTROINTESTINAL SYSTEM
- Inactive
- Prolonged gastric emptying time may lead to nausea and vomiting
- May have clear liquids, unless there is a likelihood for cesarean
NEUROLOGIC AND SENSORY RESPONSES
- Responses are related to pain
MATERNAL PSYCHOLOGICAL RESPONSES
- Labor is hard work that puts a demand on the woman’s coping resources
FATIGUE
FEAR

FETAL RESPONSES TO LABOR

CARDIOVASCULAR SYSTEM
- Fetal heart rate may decrease by as much as 5 bpm during a contraction
- Amount of oxygen and nutrients are reduced during a contraction
RESPIRATORY SYSTEM
- The act of passing through the birth canal is beneficial to the fetus in 2 ways:
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Process of labor stimulates surfactant production

Vaginal squeeze helps clear the respiratory passageway of mucus

IMMEDIATE ASSESSMENT OF THE WOMAN IN

STAGE ONE
1. For an INITIAL INTERVIEW, obtain information about the following areas:
- EDC
- Baseline date of maternal vital signs & frequency, duration, and intensity of contractions
- Rupture of membranes
- Time the woman last ate
- Past pregnancy history and previous pregnancy outcomes
- Her birth plans
2. LEOPOLD’S
MANEUVERS
- Are systematic method of
observation and palpation to
determine fetal presentation
and position
PROCEDURE:
Prepare the client
- Explain procedure
- Instruct the client to empty
bladder

A. Perform the FIRST maneuver

- Stand at the foot of the client, facing head, and place both hands flat on her abdomen
-Palpate the superior surface of the fundus
B. Perform the SECOND maneuver
- Face the client and place the palms of each hand on either side of the abdomen
- Palpate the sides of the uterus. Hold the left hand stationary on the left side of the uterus
while the right hand palpated the opposite side of the uterus from top to bottom
C. Perform the THIRD maneuver
- Gently grasp the lower portion of the abdomen just above the symphysis pubis between
the thumb and index finger and try to press the thrums and finger together.
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D. Perform the FOURTH maneuver

- Place fingers on both sides of the uterus approximately 2 inches above the inguinal
ligaments, pressing downward and inward in the direction of the birth canal. Allow fingers
to be carried out downward

3. Vaginal examination
To determine the extent of cervical effacement and dilatation and to confirm the
presentation, position, and degree of descent
- Examination during a contraction is more painful
- Palpating membrane during a contraction may cause them to rupture
- DO NOT PERFORM VAGINAL EXAM in the presence of FRESH BLEEDING
4. SONOGRAPHY
- To determine the diameter of the fetal skull and to determine presentation, presenting
part, and degree of descent of the fetus
5. VITAL SIGNS
• Temperature - Obtain every 4 hours if membrane is intact and every hour if membrane
has ruptured
• Pulse & respiration
- Should be taken every 4 hours
- Persistent pulse rate of more than 100bpm
suggests dehydration or hemorrhage
- Observe hyperventilation
• Blood Pressure
- Should be taken every 4 hours
- Take BP between contractions
6. LAB ANALYSIS
- Blood and urine samples
7. MONITORING UTERINE CONTRACTIONS
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- Labor watch
- Intensity of contractions

INITIAL FETAL ASSESSMENT

1. AUSCULTATION OF FETAL HEART SOUNDS
- Fetal heart sounds are best heard through the fetal back
- May be intermittent or continuous
- Count FH every 30 min during beginning labor, every 15 min during active labor, and
every 5 min during the second stage
2. EXTERNAL ELECTRONIC MONITORING
- Can be used to monitor both uterine contractions and FHR
- Watch for supine hypotension syndrome
3. FETAL HEART RATE PATTERN
• Baseline FHR
- Is measured between uterine contractions during 10-min period
- Normally accepted baseline is between 120 - 160 bpm
- Rates between 110-120 are usually acceptable if all other signs are reassuring
• VARIABILITY
Two types:
Short term - refers to the moment-to-moment changes in the FHR
Long term - refers to the wider fluctuations that EFM tracing look wavy over time

• PERIODIC CHANGES
Accelerations - are temporary normal increases in FHR due to fetal movement or
compression of the umbilical vein during contraction
Decelerations
Early Decelerations - are periodic decreases in
FHR resulting from pressure on the fetal head during contractions
- Is also known as Reassuring Periodic Change
- The wave of the FHR change is inverse to the contraction waveform, with the lowest point
of the deceleration occurring with the peak of the contraction, thus serving as the mirror
image of deceleration
Late Decelerations - are those that are delayed until 30
- 40 sec after the onset of a contraction and continue beyond the end of the contraction
- This is an ominous pattern in labor suggesting
UTEROPLACENTAL INSUFFICIENCY
- Immediate steps to correct the situation:
If oxytocin is used, stop or slow the
administration. Place the woman on left lateral
position. Administer IVF and O2. Prepare for
possible prompt birth of the fetus
Variable Decelerations - occur at unpredictable
times
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These indicate cord compression which may also be ominous in terms of feta well-being
- Cord compression may occur due to cord prolapsed but also occur because the fetus is
lying on the cord. Tends to occur after the membrane has ruptured or
with oligohydramnios
- Exhibits a U or W shaped waves

- Woman should be placed on

Trendelenburg position to relieve pressure
on cord
- Administer IVF and O2
- If not relieved by these measures,
amnioinfusion may be prescribed
Both late and variable decelerations are
considered as NON-REASSURING PERIOD
CHANGE

NURSE’S ROLE DURING EACH STAGE OF LABOR

1. FIRST STAGE (Latent Phase)
- Assess status every hour
- Assess the woman’s psychological state. She may be
talkative and express feelings of confidence and excitement
Preventing Fetal & Maternal Injury
- Monitor vital signs and labor progress both maternal and
fetal status every hour
- Mild tachycardia may be associated with anxiety or the
stress of labor contractions
Promoting Comfort:
- If membranes are intact and engagement has occurred, allow the woman to ambulate
- Assist the woman with comfort measures and position change
- Encourage left lateral position
- If medication such as narcotic is given, a woman should remain in bed approximately 15
min after to avoid fall
- Bladder care and voiding at least every 2 to 4 hours
Relieving Anxiety
- Encourage verbalization
- Ask for concerns
- Allow the woman to gain control of situation by maybe allowing involvement of partner
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- Be keen on non-verbal cues

Providing Patient Teaching:
- Latent phase is an excellent time to teach the woman and partner about labor process
- Teach basic relaxation technique
- Briefly describe the frequency and purpose of nursing assessments and interventions
common to each stage of labor
FIRST STAGE (Active phase)
- Assessment of labor progress every 30 min both maternal and fetal status
- Note if the woman is becoming more introverted, restless, or anxious; if she is feeling
helpless or fear of losing control
- Assess the presence and character of pain every hour
- Evaluate breathing pattern frequently
- Assess for signs of hyperventilation, which include tachypnea, feeling of lightheaded ness
or dizziness, complaints of tingling around the mouth or in fingers, and carpopedal spasm
Preventing Trauma during labor:
- Report any signs of fetal distress that do not respond to position changes
- Report heavy bleeding or failure of the uterus to relax well between contractions
- Continue bladder care, if the woman is unable to void, prepare for a sterile in-and-out
catheterization procedure
Providing Pain Management:
- Active phase is the time when pain relief measures are most often implemented
- Narcotics or analgesia may be administered
- Respect the woman’s preference for pain control
- Institute non-Pharmacologic pain management such as distraction and relaxation
techniques, effleurage, back rubs, or application of pressure during contractions
- Change soiled linens and gowns to minimize infection
- Provide frequent perineal care especially every after invasive procedure involving the
vagina and after elimination
Reducing Anxiety:
- Assist the woman to implement anxiety reduction plan agreed upon during early labor
- Continue to encourage the woman to verbalize her concerns
- If her method of pain relief is not working, remind her that she can change her mind
about pain relief options
Promote Effective Coping Strategies:
- Allow “rituals” (routine) to help woman cope with contractions
Promoting Effective Breathing Pattern:
- Frequently reinforce breathing techniques
- Make an eye contact and perform the breathing patterns with the woman to help keep her
focus
- If hyperventilation occurs, breathing into cupped hands or a paper bag usually relieves
the problem
Maintaining Integrity of the Oral Mucosa:
- Frequent mouth care
- Suggest brushing of teeth or gargle with normal saline
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- Provide ice chips, sips os clear liquids, or hard candy if allowed

Preventing Infection:
- Frequent vaginal examination is discouraged, especially if membrane has ruptured
- Invasive procedure such as urinary catheterization should be kept to a minimum
- Strict adherence to sterile technique when performing invasive procedure is critical
FIRST STAGE (TRANSITION PHASE)
- Look for increase amount of blood show and a strong urge to push
- The woman often express irritability, restlessness, and will feel out of control. She may
tremble, vomit, or cry
- It is important to assess for hyperventilation during this phase
- Check labor progress every 3o min both maternal and fetal status
- VARIABILITY SHOULD BE PRESENT BUT THERE SHOULD BE NO LATE
DECELERATIONS OR OTHER SIGNS OF FETAL DISTRESS
Managing Pain:
- Narcotics are not given at this advanced stage a too sleepy neonate taking the first breath
- Frequent position changes
- Continue providing comfort measures
Promoting Effective Breathing Patterns:
- Explain the importance of resisting the urge to push until the cervix if fully dilated
- Pushing efforts before the cervix if fully dilated can result in cervical lacerations or can
cause edema of the cervix and slow dilatation
Promoting A Sense of Control:
- Accept behavioral changes of the laboring woman
- Provide intensive psychological support
Supporting the woman through fatigue:
- Assist woman to relax to conserve energy
Preparing the room for delivery:
- Prepare the table maintaining surgical asepsis
- Make sure supply and medications for birth are readily available
- Check infant resuscitation area
2. SECOND STAGE OF LABOR (Expulsion of the fetus)
- Monitor labor progress every 15 min maternal and fetal status
Positioning for Birth:
- Variety of positions can be used like Lateral or Sims’ position, dorsal recumbent, semi-
sitting, and squatting
Promoting Effective Second Stage Pushing:
- Encourage the woman to push with contractions and rest between them
- Allow her to push when she feels the urge and use the position and technique she feels
are best for her
- May use short pushes or long sustained ones
- Holding her breath during a contraction may interfere bloody supply to the uterus
Perineal Cleaning:
- Use warmed antiseptic and rise with designated solution after birth
- Clean from vagina outward
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Episiotomy:
A surgical incision of the perineum made to prevent tearing

Preparing the Delivery of the Newborn:

- Pressure should never be applied to the fundus of the uterus because uterine rupture
may occur
- Suction as soon as the newborn’s head is out
- Note the time of birth
Cutting, Clamping the Cord:
- Clamp the cord after pulsation has stopped
- Note the number of umbilical blood vessels
- Introducing the infant
Do not massage the uterus when it is soft right after the birth of the newborn or it may
result to uterine inversion
3. THIRD STAGE OF LABOR (Delivery of the Placenta)
- Monitor for signs of placental separation, which generally occur within 5 to 20 minutes of
delivery
- Oxytocin
Obtain blood pressure before administration
Inspect placenta if intact prior to the administration
Preventing Fluid Loss:
- Monitor vital signs, fundus, and lochia every 15 mins
- Monitor intravenous fluids to ensure patency and prevent development of dehydration
Maintaining Safety and Preventing Trauma:
- Monitor for sudden change in status like shortness of breath, chest pain, or tachypnea
4. FOURTH STAGE OF LABOR
- The new mother is at higher risk for hemorrhage during the first 2-4 hours of postpartum
period
- Monitor vital signs every 15 min for the first hour, every 30 min for the second hour, and
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every hour for the succeeding third and fourth hour

- Fundus should be well contracted, at the midline, and approximately 1cm below the
umbilicus after delivery
- Assess lochia for color and quantity
- Monitor for signs of infection
- The woman should void within 6 hours after delivery
- Assess level of comfort; cramping from uterine contractions and perineal pain
- Mother is fatigued and ravenously hungry
- It is normal that she may demonstrate dependent behavior
Providing Care Immediately After Delivery:
- Inspect and cleanse the perineum
- Place a blanket over a new mother
- Remove both legs from the stirrups at the same time
Promoting Parent-Newborn Attachment
- Hand the newborn the mother as soon as the newborn is stable
- If father is present at the delivery, encourage him to hold and interact with the newborn
- Place the newborn skin-to-skin against her body
- Initiate breastfeeding
Maintaining Adequate Fluid Volume:
- Continue to monitor for signs of fluid volume deficit
- Massage fundus every 15 min
- Offer food and fluids to the mother
Promoting Urinary Elimination:
- Assist her to void to the bathroom
- Have her dangle her feet for several minutes before assisting her to a standing position
- Straight catheterization if there is suprapubic distention or discomfort from full bladder or
until 6 hours have passed without voiding
Minimizing Pain:
- May be given NSAIDs and oral narcotic analgesic
- Apply ice pack to the perineum
Reducing Fatigue:
- Promote rest to the new mother
OBSTETRIC PROCEDURES
1. EPISIOTOMY
- Surgical incision of the perineum used to enlarge the vaginal outlet
- Used to prevent the perineum from tearing, which can occur with birth
- Helps to release the pressure on the fetal head that accompanies birth
MIDLINE EPISIOTOMY
- Involves an incision that’s made in the middle of the
perineum
- Advantageous because it’s associated with easier
healing, decrease blood loss, and decrease postpartum
discomfort
MEDIOLATERAL EPISIOTOMY
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- Involves an incision begun at the midline and then angled to one side away from the
rectum
- Advantageous because of the decrease risk of rectal mucosa tears
Advantages:
- prevents tearing (laceration) of the perineum
- Can be repaired more easily than a tear and heals faster
- Enlarges the vaginal outlet to facilitate manipulation or use of forceps
Disadvantages:
- May interfere with maternal-neonatal bonding if discomfort is severe
- Creates a potential site of infection
- May make the patient hesitant to void or have a bowel movement
2. AMNIOTOMY
- Refers to the artificial rupture of the amniotic sac
- Performed when the membranes haven’t ruptured spontaneously, as a means of
augmenting or inducing labor, allowing the fetal head to contact the cervix more directly,
and increasing the efficiency of the contractions
- May be done to allow internal fetal monitoring and to access the fetus for fetal blood
sampling
- Before an AMNIOTOMY is done, the following must be present:
The fetus must be in the vertex position with the fetal head at +2 station or lower and a
bishop score of at least 8
(Bishop score accounts: cervical dilatation, effacement, station)
- The cervix must be dilated at least 3 cm
- The procedure is virtually painless for the patient and the fetus because there are no
nerve endings in the membranes
- After the woman is placed in a dorsal recumbent position, the membranes are torn with a
hemostat or punctured with an Amniohook (a long, thin instrument similar to a crochet
hook) inserted into the vagina, and if the tear or puncture has been performed properly, the
amniotic fluid will gush out

Advantages:
- It helps to induce or augment labor
- It provides access to the fetus
Disadvantages:
- There’s an increase risk of umbilical cord
prolapse
- Patient is at risk for infection
- If the patient has hydramnios, abruptio
placenta may occur as a natural / after effect
of the procedure
- As the uterus collapses due to the draining
fluid, the area of placental attachment shrinks
- The placenta no longer fits its implantation
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site, resulting in a decrease in surface area where fetal oxygenation occurs, possible
adversely affecting the fetus
3. FORCEPS DELIVERY
- Forceps are steel instruments used to assist with delivery and to relieve fetal head
compression
- Consist of 2 blades connected together; blades are slipped into position one at a time
- Commonly used forceps: Kjellands’s, Elliot, Piper, Tucker McLean, Simpson’s
Forceps delivery may either be low-forceps or mid-forceps
- Low forceps (outlet) delivery is performed when the fetus’ head reaches the perineum;
typically the fetal head is at +2station or more
Mid-forceps delivery is performed when the fetal head is engaged but is at less than +2
station; because of the increase risks of birth trauma, this type of delivery is rarely done
- For a forceps delivery to be performed, the following must be present:
Ruptured membranes
Fully dilated cervix
Empty bladder
Absence of cephalopelvic disproportion
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Advantages:
- It shortens the 2nd stage of labor when adverse fetal and
maternal conditions exist
Disadvantages:
- Increases perinatal morbidity and mortality (mid-forceps
delivery)
- Increases neonatal birth trauma and depression
- Increases incidence of perineal lacerations, postpartum
hemorrhage, and bladder injury
4. VACUUM EXTRACTION
- An alternative forceps delivery; facilitates descent of the
fetal head
- A plastic vacuum cup is applied t the fetal head, negative
pressure is exerted and traction is applied to deliver the
head

Advantages:
- It’s associated with a lower incidence
of vaginal, cervical, and 3rd and Ruth
degree lacerations
- It’s also associated with less
maternal discomfort because the cup
doesn’t occupy additional space in the
birth canal
- Little anesthesia is needed compared with the required for forceps delivery; subsequently,
the neonate is born with less respiratory depression
Disadvantages:
- Vacuum extraction is associated with a market capture succedaneum of the neonate’s
head, lasting as long as 7 days after birth
- Tentorial tears are possible from extreme pressure
- Renewed bleeding from the scalp can occur if used for a fetus that has undergone fetal
blood sampling
- Just in preterm neonate is problematic because of the extreme softness of their skulls
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5. VERSION
Also called EXTERNAL CEPHALIC VERSION,
refers to a manual attempt to turn afetus
from one presentation to another
- Usually used to turn a fetus in the breech
presentation to a cephalic one
- After locating the breech and vertex of the
fetus, gentle pressure is applied to the
abdomen to turn the fetus
- Tocolytics agents to relax the uterus and
epidural anesthesia to relieve pain may be administered
Advantages:
- It’s a non-invasive procedure
- May decrease the number of cesarean deliveries
Disadvantages:
- The patient may feel extreme pressure during the manual turning
- Rh iso-immunization is possible if minimal bleeding occurs, thus necessitatin
6. CESAREAN BIRTH
Refers to the removal of the neonate
from the uterus through an abdominal
incision
Indications:
- Cephalopelvic disproportion
- Uterine dysfunction
- Malposition / malpresentation
- Previous uterine surgery
- Complete or partial placenta Previn
- Pre-existing medical condition (DM or Cardiac disease)
- Prolapsed umbilical cord
- Fetal distress
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2 TYPES OF CESAREAN BIRTH

- Scheduled
- Emergency - done for reasons such as placenta previa, abruptio placenta, fetal distress or
failure to progress in labor
2 TYPES OF INCISIONS
Transverse incision
- Also known as the “bikini cut” or low segment incision, is preferred and most common
incision
- It’s associated with a decrease incidence of peritonitis and post-op adhesions
- Blood loss is minimal
- Incision is made through the lower portion of the uterus that’s minimally active with
contractions, making the incision less likely to rupture during future labors
- Vaginal birth after cesarean delivery is possible with this incision
Classic /Vertical incision
- Is used when adhesions from previous cesarean delivery exist, when the fetus is in a
transverse lie or when the placenta is anteriorly implanted
- The incision is made through the abdomen, high on the uterus
- This type of incision may be used for patients with placenta previa because the incision
can be made without cutting the placenta
- The chances of vaginal birth after cesarean birth with this type of incision are low because
of the incision’s location in the major active contracting portion of the uterus

Vaginal Birth After Cesarean Birth:

- A patient who has had a previous low-transverse
cesarean delivery may attempt a vaginal birth,
provided that no medical or obstetric
contraindication to labor or history of prior uterine
rupture exists
- The incidence of dehiscence of a firmer low-
transverse uterine incision dehiscence during an
attempted vaginal birth after cesarean birth is less
than 1%