STAGES OF LABOR

Comparison of Length of Labor in Primigravida & Multigravida

Stages of labor Primigravida Multigravida

First stage 12.5 hours 7hours,& 20 minutes
Second stage 80 minutes 30 minutes
Third stage 10 minutes 10 minutes
Total 14 hours 8 hours
First stage of labor- FROM TRUE LABOR PAINS TO COMPLETE
DILATATION OF CERVIX

 >UTERINE CONTRACTION-
 Phases of uterine contraction
 INCREMENT/CRESCENDO- increase intensity of the contraction, longest
phase than the two
 Acme /apex- height or peak of contraction
 Decrement /decrescendo – decrease intensity of contraction
 > Bloody show – appear 24-48 hours before labor begins
Dilatation- process by which external cervical enlarges from few
millimeter to full dilatation ( 10 cm )

 Effacement- shortening and thinning of the cervix by retraction.

 > primigravida – effacement occurs before dilatation
 > multigravida – dilatation may precede before effacement
 In general multigravida deliver 6 hours earlier than primigravida
 Precipitate labor- labor completed in less than 3 hours.
Prolonged labor
primigravida- labor completed more than 18 hours
Multigravida- more than 12 hours

 Position of fetus can be assessed through:

 1. Leopold maneuver
 2. Vaginal examination
 3. Auscultation of FHB
Fetal assessment during labor

 FHR- 120 – 160 bpm

 FH Pattern
 Early deceleration- monitor.Cause by compressions of head.
 Late deceleration – O2 left side.
 Variable deceleration- O2 left side. It is cause by cord compression.
 Signs of fetal distress – unstable FHB , meconium stained, prolapsed cord
Second stage of labor – from full dilatation of cervix up to delivery of
the baby

 1. Latent or early phase- start of regular contraction ,

mild and short lasting 20-40 seconds, dilatation and
effacement occurs , 0-3 cm
 2. Active phase-cervical dilation occurs rapidly from 4 to
7 cm, ( 1 cm in primi per hour and 2 cm in multi per hour )
contraction grow stronger 40-60 second every 3-5 mins.
 This phase last 3 hours in nullipara and 2 hours in
multipara
 3. Transition phase –
 >contraction is at peak in intensity,
 > duration 60-70 seconds very 2-3 minutes
 > cervical dilation 7-10 cm.
 > mother experience intense pain
 > vaginal examination should be done every 4 hours.
Mechanisms ( cardinal movements of labor )

 1. Descent- downward movement of the biparietal diameter of

fetal head within the pelvic inlet.
 2. Flexion – as descent occurs, head bends forward onto the chest
making the smallest anteroposterior diameter
(suboccipitobregmatic diameter) is presented to the brim canal.
 3. Internal rotation- head enters the pelvis with the
anteroposterior diameter in diagonal/transverse position.
 4. Extension – as occiput is born, the back of the neck stops
beneath the pubic arch and acts as a pivot for the rest of the
head. Fetal head passes under the symphysis pubis and is
delivered occiput first , followed by chest and chin
 5. External rotation – after the head, it rotates anteroposterior
position, assumes to enter the outlet back to the diagonal or
transverse position of the early part of labor.Head rotates to
full alignment with neck and shoulder for shoulder delivery.
To accommodate shoulder the head goes back to its position.
 6. Expulsion- once the shoulders are out, the rest of the body are
spontaneously born because of smaller size. When the body of the
baby emerged from mother/s body birth is complete. This time is
recorded as the time of birth.
Third stage of labor- placental stage

 > from birth of baby to expulsion of placenta

 Signs of placental separation:
 1. Cullen’s sign- earliest sign, uterus change in shape from discoid
to globular
 2. sudden gush of vaginal blood
 3. lengthening of umbilical cord
Types of placental delivery

 1. Shultz method- placenta separates from the center to the edge,

placenta is delivered with the fetal surface first like an inverted
umbrella. 80 % of placenta are delivered
 2. Duncan method – placenta separates from the edge to the
center. Maternal surface of placenta is seen first.
 Normal blood loss vaginal delivery 300 to 500 ml. Cesarean
section 500-1000 ml.
 Nursing care during Postpartum

 Puerperium refers to the postpartum period or the 6 weeks period

after birth.
 > time of maternal changes ( retrogressive involution of uterus and
vagina )
 >progressive production of milk for lactation
 >restoration of normal menstrual cycle
 > beginning of parenting role
Specific Body Changes during Postpartum

A. Reproductive System
> uterus regresses 1 fingerbreadth or 1 cm per day until by the end of 2 nd week
postpartum
> endometrial surface sloughed off as lochia
1. Lochia rubra- dark red, 1-3 days after delivery consist of blood, cellular debris
from decidua
2. Lochia serosa- pinkish brown, 3-10 days, mostly serum, some blood, tissue debris
3. Lochia alba- yellowish white, 10-14 days, leukocytes, decidua, epithelial cells,
mucus
Involution- process whereby the reproductive organs return
to their nonpregnant state.

 Involution of uterus involves 2 processes.

 1. area where the placenta was implanted is sealed off to prevent
bleeding- accomplished by contraction of uterus immediately after
delivery of placenta.
 2. reproductive organ is reduced to approximately pr-pre-gestational
state.
 B. Cervix- closes slowly ,becomes flabby immediately
after birth, external os from round to slit like opening, admit
1 finger by the end of 1 week after delivery.
 C. Vaginal / Perineum- edematous after delivery observe for
–redness, edema, ecchymosis , discharges and hematoma.
Smooth walled for 3-4 weeks and rugae reappear.
 D. Ovulation /Menstruation
first cycle is anovulatory , nonlactating mother menses may
resume 6 to 10 weeks ( ave.4-6 wks)
if lactating less predictable, may resume 12 to 24 weeks( 3-
6 months) lactational amenorrhea
E. Breast

 Nonlactating-
 Prolactin level fails rapidly > still secrete colostru,m for 2-3 days

Lactating mother –
 High level of prolactin
 Initial secretion of colostrum between 48-96 hours (2- 4 days)
 Milk “ let-down reflex “ caused by oxytocin from posterior pituitary gland
released by sucking
Psychological changes of Postpartal Period

 Behavioral Adaptation of Puerperium

 Taking-In phase- (Dependent)1-3 days period, mother is passive due
to discomforts, needs help with daily activities
 Taking hold phase-(Dependent-Independent )- 3-7 days, identifies
own needs, begin to reassert herself, can perform task of motherhood,
becomes independent role and participative.
 Letting Go (Independent) finally redefines her role, accepts the real
one, assumes independent role and responsibility.