Reyes, Janyn Marione A.


Labor is defined as the onset of regular painful contractions with progressive cervical effacement and dilatation of the cervix accompanied by descent of the presenting part.

The following criteria should be present to call it normal labor

  

Spontaneous expulsion, of a single,mature fetus (37 completed weeks – 42 weeks), presented by vertex, through the birth canal (i.e. vaginal delivery), within a reasonable time (not less than 3 hours or more than 18 hours), without complications to the mother, or the fetus

Signs and symptoms of labor .

or warnings. signs that labor is about to begin. women usually notice one or more premonitory. They are: Painful regular uterine contractions – as evidence by contraction at least one in ten minutes Show – as evidence by mucus mixed with blood Rupture of membranes – as evidence by leaking liquor Progressive shortening and dilatation of the      . Before labor begins.

Pathophysiology of normal spontaneous delivery .

FERTILIZATIO N Zygote Unicellular ( Intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes ) Series of Mitotic Cell division Cleavage ( In 24 hours become two cell organism ) In 72 hours become 16 cell organism called Morula The The inner layer gave outer rise to the embryo layer (embryoblast) gave rise to the Embryonic development placenta begins during second week continues through ( the 8th week trophobla st ) Separate into two parts by fluid from the uterus on the 4th day 3 Stages •1st stage – increase in cell number and with elaboration of cell products •2ndstage – morphogenesis / includes mass cell movement •3rdstage – differentiation or maturation of physiologic processes blastocytes ataches to endometrium on the 6th day Implantation Fetal Developmen t is from ninth week to birth Newborn baby via Vaginal Delivery Morula enters the uterus on the 3rd day through peristaltic movement .

Three stages of labor .

The first stage of labor is the longest for both nulliparous and parous women. with an average length of 5 to 10 minutes. The duration is about 1 to 1½ hours in nulliparas and about 30 to 45 minutes in parous women. FIRST STAGE It begins with the onset of true labor contractions and ends when the cervix is fully dilated (10 cm). which are unequal in length. lasting up to 30 minutes. This is the shortest stage. There is no difference in duration for nulliparous and parous. First stage of labor consists of two phases:.Labor can be divided into three stages. It begins after the birth of the baby and ends with the expulsion of the placenta and membranes.latent and active. THIRD STAGE The third stage is that of separation and expulsion of placenta and membranes and also involves the control of bleeding. . Cervical effacement and dilatation occur in the first stage SECOND STAGE The second stage of labor begins with complete dilatation of the cervix and ends with the birth of the baby.


Phases of the first stage of labor Latent phase – begins with onset of contracts and ends when cervix is 3 cm dilated and effaced Active phase – begins after the cervix is 3 cm dilated .

Active process Begins after 3 cm of cervical dilatation Period of active cervical dilatation (average rate 1 cm/hr) S-shaped curve which is used to define progress of labour It has 3 component a) acceleration . 4. 6.slow . 4. 3. c) deceleration .slow b) maximum . 5. 2. Begins with onset of contractions Slow progress Little cervical dilatation Progressive cervical effacement Ends once the cervix reaches 3 cm dilatation Durations ~ 8 hours for nulliparae ~ 6 hours for multiparae 3.LATENT Phase 1. ACTIVE Phase 1. 5.

stronger and closer together Mild-moderate intensity during contractions . EARLY LABOR   Cervical dilation of 0-3cm Contractions in the range of 5-20 minutes and lasting for about 30-45 seconds     S/S of early labor: Back ache and nesting urges Contractions progress over time by getting longer.A.

NURSING RESPONSIBILITIES - - Encourage mothers to rest Conserve patient energy Assist with relaxing activities such as deep breathing exercises .

contractions 3 – 5 minutes apart and lasting about 60 seconds S/S: Beginning of intense contractions Trembling Nausea Vomiting Mild discomfort in between contractions       . ACTIVE LABOR  Active labor is defined by cervical dilation of 48cm.B.

NURSING RESPONSIBILITIES     Encourage position changes Relaxing and slow breathing during contractions Hot/cold packs for pain Massage .

C. TRANSITION    Cervical dilation of 8-10cm Contractions are about 2-3minutes apart Last for approximately 60-90 seconds S/S Extremely intense contractions that occur with little rest in between Contractions may be accompanied by rectal pressure if the baby’s head is low Mothers will often have the most difficulty coping Shaking or trembling. N/V and intense emotions      .

NURSING RESPONSIBILITIES    Encourage position changes Verbal encouragement Reassure mother that she is close to the end and that all of the intense sensations are indeed normal .


Contractions: CONTRACTIONS 1: Regular 2: Increasing in frequency 3: Stronger .NORMAL LABOUR AND DELIVERY 1.

NORMAL LABOUR AND DELIVERY 2. the normal rate is 1 cm/hour . a slow process (8 hours in nulliparous and 3 hours in multiparous Active phase – this is active process of cervical dilatation. Cervical dilatation and effacement: Causes of cervical dilatation: Contraction and retraction of uterine musculature Mechanical pressure by the bulging membrane (fore water) The descend of the presenting part Phases of cervical dilatation Latent phase – the first 3 cm of dilatation.

Engagement of the presenting part: .NORMAL LABOUR AND DELIVERY 3.

Second stage of labor .

SECOND STAGE OF LABOR  begins when the cervix is completely effaced and dilated and ends when the infant is born. Descent phase C. Resting phase B. Crowning  . Has three phases: A.

RESTING PHASE     Occur for some women after 10cm of dilation A period of about 10-20 minutes without contraction or without an urge to bear down is often seen S/S Few noticeable contractions without an urge to bear down .A.

NURSING RESPONSIBILITIES    Encourage rest Review pushing positions Remind mother to empty bladder if unmedicated (diaper) .

DESCENT PHASE   Occurs with contractions 3-5minutes apart Lasting about 60 seconds S/S Contractions are accompanied by a strong urge to bear down several times with each contraction The baby’s head descends with each contraction and then recedes.    .B.

NURSING RESPONSIBILITIES   Encourage position changes as mother prefers or if no noticeable progress Rest in between contractions .

Ask if mother can have cool compress to perineum for comfort Remind her to slow her pushing to ease baby’s head out. .C. Extremely intense for the mother with a sense of stretching followed by burning. CROWNING     The baby’s head descends to the opening of the vagina and does not recede with contractions.

Third stage of labor .

It have TWO Phases a) Separation phase b) Expulsion phase Duration – usually 15 minutes or less (if actively managed). Average blood loss – 150 to 250 ml. 4. Begins after DELIVERY of the baby and ends with DELIVERY OF THE PLACENTA / MEMBRANES.   3. . 2.1.

.NURSING RESPONSIBILITIES   Offer encouragement. Initiate breastfeeding – promotes bonding. congratulate mother on her effort and enjoy the baby.


Factors that influence the progress of labor Power Passenger Passage .

The end!  .

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