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

2. 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

3. 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 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

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

11. 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)

12. References: http://www.merck.com/