Normal Labor and Delivery Asja Ćosić Mentor: A. Žmegač Horvat

Labor labor main stages of labor series of rhythmic, progressive contractions of the uterus gradually move the fetus through the cervix and birth canal main stages of labor first stage: labor proper – contractions cause the cervix to dilate and to thin and pull back (efface) cervix merges with the rest of the uterus second stage: delivery of the fetus third stage: delivery of the placenta

Labor within 2 weeks before or after the estimated date of delivery after 36 weeks a cervical examination is performed to estimate when labor will start labor lasts - 12 to 18 hours in a woman's first pregnancy - 6 to 8 hours in subsequent pregnancies main signs of the start of labor are: back pain contractions in the lower abdomen at regular intervals at first contractions may be weak, irregular, and far apart with time, they become longer, stronger, and closer together bloody show: a small discharge of blood mixed with mucus from the vagina about 72 hours before contractions start rupture of membranes: the amniotic fluid flows out through the vagina

FIRST STAGE from the beginning of labor to the full dilation of the cervix to about 4 inches (10 cm) initial (latent) phase active phase

FIRST STAGE - Initial (Latent) Phase contractions become progressively stronger and more rhythmic discomfort is minimal the cervix thins and opens to approx. 4 cm lasts an average of 8½ hours (up to 20 hours) in a first pregnancy and 5 hours (up to 12 hours) in subsequent pregnancies

FIRST STAGE - Active Phase cervix opens to the full 10 centimeters fetal presenting part begins to descend into the mother's pelvis mother feels urge to push as the baby descends, but she should resist it 5 to 7 hours in a first pregnancy and 2 to 4 hours in subsequent pregnancies

SECOND STAGE from the complete opening of the cervix to delivery of the fetus 45 to 60 minutes in first pregnancy 15 to 30 minutes in subsequent pregnancies during this stage, the woman pushes

CARDINAL MOVEMENTS IN LABOR Engagement Descent Flexion Internal Rotation Extension External Rotation Expulsion

THIRD STAGE from delivery of the fetus to delivery of the placenta usually lasts only a few minutes but may last up to 30 minutes maternal blood loss is limited by contraction of the uterus can be managed either expectantly or actively

Fourth stage can refer to the immediate puerperium, or the hours immediately after delivery of the placenta

Admission to a Hospital or Birthing Center strength, duration, and frequency of contractions are noted weight, blood pressure, heart and breathing rates, and temperature are measured urine and blood samples are taken for analysis abdomen is examined to estimate the size, position and presentation of the fetus vaginal examination is done to determine whether the membranes have ruptured and how dilated and effaced the cervix is intravenous line – to prevent dehydration and for therapy, if needed oxytocin or prostaglandin are used to induce labor fetal monitoring: electronic monitoring is used to continuously monitor fetal heartbeats and uterine contractions (CTG)

References: http://www.merck.com/ http://en.wikipedia.org/wiki/Childbirth