THEORIES of LABOR

Combination of factors from mother

and fetus are responsible for the
initiation and completion of labor
process:
A. Fetal Adrenal response theory.
Hippocrates, the father of
medicine, was the first person to
propose this theory that certain
hormones produced by the fetal
adrenal and pituitary gland
initiates labor contractions.
B. Oxytocin Stimulation Theory.
Near terms oxytocin production
by the posterior pituitary gland
increases. Oxytocin stimulates
contractions.
Results the uterus becomes ↑
sensitive to oxytocin.
C. Uterine Stretch Theory:
• According to the theory,
“any hollow muscular organ
when stretched to capacity
will contract and empty…”
• The uterus becomes ↑
distended by the growing
fetus, placenta and amniotic
fluid, distention of the uterus
creates pressure on the nerve
endings which stimulates
contractions.
 D. Progesterone Deprivation Theory:
• Progesterone helps maintains
pregnancy progesterone by its
relaxant effect on the smooth
muscles of the uterus preventing
uterine contractions.
• As pregnancy nears term, the
production of progesterone by
the placenta ↓, this decline in
progesterone allows the uterine
contractions to occur.
E. Prostaglandin Theory:
• When the fetus reached
maturity, the fetal
membrane produce large
amounts of arachidonic
acid which is converted by
maternal decidua into
prostaglandins, a hormones
that initiates uterine
contractions.
F. Theory of the Aging
Placenta:
• As the placenta “ages”, it
becomes less efficient,
producing ↓ amount of
progesterone.
• This progesterone allows the
concentration of
prostaglandin and estrogen to
rise steadily.
Signs of labor: Weeks
before real labor
“False Labor”
Braxton-Hicks: Irregular
intermittent contractions;
“false labor”; DO NOT
initiate true labor.
 Lightening “The Baby
Dropped”: Fetus settles into pelvic
cavity or pelvic brim or inlet.
• Lightening results in:
 Relief of dyspnea
 Increase frequency of urination
 Leg pain
 Increase vaginal discharge
 Decreased fundal height
• Floating is when the head is still
movable above the pelvic inlet
on the palpation.
• Engagement is the descent of
the biparietal plane of the fetal
to a level below that of the
pelvic inlet.
• Fixation is the descent of the
fetal head to the inlet to a level
that it can no longer be moved.
Ripening of the Cervix: cervix
effaces [thins] & dilates slightly.
• The cervix must soften in order
for it to be readily dilatable.
• Baby's head in pelvis pushes
against cervix causing
relaxation and effacement.
 Increase Level of Activity (Burst of
Energy):
• Initiated by low progesterone level,
the adrenalin secrets large amounts of
epinephrine or adrenalin starting two
weeks prior to labor.
• Nesting instinct; cleans house, sets up
nursery.
• Advice the mother not to use this
energy to save it for labor and delivery.
 Weight Loss:
• For about 2-3 pounds weight
loss two weeks before labor-
due to decline in progesterone
level. (progesterone promotes
fluid retention)
 Show:
• The blood released from
these ruptured capillaries
mix with operculum (mucus
plug) giving it pinkish
coloration.
• The blood tinged mucus,
called show, is dislodged
from the cervical canal.

Rupture of the Membrane:
• A gush or steady trickle of
clear fluid from the
vagina.
• Rupture of the membrane is
caused by the pressure
of uterine contractions and
dilatation of the cervix.
Signs True Labor: closer to
time of delivery
 Uterine Contractions: regular &
frequent compared to
Braxton-Hicks. Increase in
intensity, frequency and
duration.
 Bloody Show: pink tinged
secretions d/t softening cervix.(
mucous plug)
 Rupture of Membranes: (ROM)
Labor in 24 hrs. Multiparas sooner.
Big gush or slow trickle.
 Clear/odorless. Green/brown,
danger sign
 Meconium aspiration >
distress/infection.
 Immediate medical attention.

PROM or prolonged ROM –

intrauterine infection [pathogens
reach fetus]
 True vs False Labor:
False Labor True Labor
No increase in intensity, In crease in intensity,
duration and frequency of frequency and duration
uterine contraction
Contraction disappear with Ambulation increases
ambulation contractions
Discomfort remain in the Discomforts radiates to the
abdomen lower back or lumbosacral
area
Contraction stops when Contraction persists even if
woman is sedated woman is sedated
Absence of cervical Progressive cervical
dilatation dilatation
 Duration of Labor
Stage of Labor Primi Multi

1st stage 10-12 hours 6-8 hours

2nd stage 30 min-2 hours 20-90 min.
Ave: 50 minutes Ave. 20 min.

3rd stage 5-20 min 5-20 min

4th stage 2-4 hours 2-4 hours