Stages of Labor

&
Mechanism of Labor

Submitted by:
Red Bryer Joaquin
Nr-23 (Grp.2)

Submitted to:
Prof. Celia M. Recel RN MAN

March 09, 2020

  Stages of Labor
First Stage of Labor

First Stage of Labor starts from the onset of regular labor contraction, beginning with
effacement and dilation of the cervix to complete dilation at 10 cm.

This stage of labor is divided into three phases.

 The latent phase starts during the onset of true labor contractions until cervical
dilatation.
 The active phase occurs when cervical dilatation is at 4 to 7 cm and contractions
last from 40 to 60 seconds with 3 to 5 minutes interval.
 The transition phase occurs when contractions reach their peak with intervals of
2 to 3 minutes and dilatation of 8 to 10 cm.

Second Stage of Labor

Second Stage of Labor starts when cervical dilatation reaches 10 cm and ends when

the baby is delivered. At this stage, the patient feels an uncontrollable urge to push.
The patient may also experience temporary nausea together with increased restlessness
and shaking of extremities. The nurse at this stage must coach quality pushing and
support delivery.

Third Stage of Labor

Third Stage of Labor or the placental stage starts from birth of infant

to delivery of placenta. It is divided into two separate phases: placental separation and
placental expulsion. Five minutes after delivery of baby, the uterus begins to contract
again, and placenta starts to separate from the contracting wall. Blood loss of 300-500
mL occurs as a normal consequence of placental separation. Placenta sinks to the lower
uterine segment or upper vagina. The placenta is then expelled using gentle traction on
the cord.

Here are the signs of placental separation:

1. Lengthening of umbilical cord

2. Sudden gush of vaginal blood
3. Change in the shape of uterus (globular in shape)
4. Firm uterine contractions
5. Appearance of placenta in vaginal opening
Fourth Stage of Labor

Fourth Stage of Labor , For immediate postpartum, the nurse checks the vital signs
and monitors for excessive bleeding. The first four hours after birth is sometimes
referred to as the fourth stage of labor because this is the most critical period for the
mother. The nurse is set to perform nursing interventions that would prevent the patient
from infection and hemorrhage. Also, they are being reminded of the importance
of breastfeeding, ambulation, and newborn care.

Stages Duration
Start End
of Labor Nullipara Multipara
10-12 hr
True labor but 6-20 6-8 hrs but 2-
Full cervical
First Stage contraction hrs is the 12 hrs is the
dilatation
s normal normal limit
limit
Onset of
regularly
perceived
uterine
contraction
Latent s 3 cm cervical
6 hrs 4.5 hrs
phase dilatation
Interval: 5-
30 mins

Duration:
20-40 secs
Stronger
uterine
contraction
s
Active 7 cm cervical
3 hrs 2 hrs
phase Interval: 3-5 dilatation
mins

Duration:
40-60 secs
Transitiona Uterine 10 cm cervical 3 hrs 1.5-2 hrs
l phase contraction dilatation
s reaching
 their peak

Interval: 2-3
mins

Duration:
60-90 secs
<2 hrs 0.5-1 hrs
Second Full cervical
Infant birth 3 hrs with 2 hrs with
Stage dilatation
epidurals epidurals
Third Placental deliver
Infant birth Maximum of 30 min.
Stage y
Mechanism of Labor
Adaptation or accomodation of the fetal head to the pelvic cavity and ultimate delivery of the
fetus involves positional changes .

Cardinal Movements of Labour: 8. EXPULSION

1. ENGAGEMENT
2. DESCENT
3. FLEXION
4. INTERNAL ROTATION 3 FACTORS INVOLVED IN LABOUR
5. EXTENSION  PELVIS
6. RESTITUTION  FETUS
7. EXTERNAL ROTATION  UTERINE FORCES
FETAL LIE
 The relation of the long axis of the fetus to that of the uterine ovoid
 Longitudinal lie is found in 99% of labours at term
 Longitudinal lie  cephalic presentation
 breech presentation

FETAL PRESENTATION
 The presenting part is the portion of the body of the fetus that is foremost in the birth canal
 The presenting part can be felt on vaginal examination

CEPHALIC PRESENTATION
Head is flexedsharply - vertex presentation
Partially flexed - bregma presenting (sinciput presentation)
Partially extended - brow presentation
Head is extended sharply - face presentation

ATTITUDE
 Posture of the fetus -folded on itself to accommodate the shape of the uterus
 Flexed head, thighs, knees &feet
 The arms crossed over the chest
 Face presentation -extended concave contour of the vertebral column

POSITION
The relation of an arbitrary chosen point of the fetal presenting part to the four quadrants of
maternal pelvis
The chosen point
 Vertex presentation - occiput
 Face presentation - mentum
 Breech presentation - Sacrum
Each presentation has two positions Rt or Lt
Each position has 3 varieties : Ant, transverse, post
MECHANISM OF LABOUR IN VERTEX PRESENTATION
 Vertex - 95%
The fetus enters the pelvis in transverse or oblique diameter
LOT - 40%
ROT - 20%
OP - 20%

1. ENGAGEMENT
 The greatest diameter of the head passes through the pelvic inlet
 In vertex presentation, when the engagement occurs the lowermost portion of the vertex
would be at level of ischial spines
 It may occur in the last few weeks of pregnancy in primi , only after the commencent of labour
in multipara
 the fetal head may be freely movable above the pelvic inlet , referred to as floating head

The sagittal suture frequently is deflected either posteriorly toward the sacral promontory or
anteriorly toward the symphysis - asynclitism.
 If the sagittal suture approaches the sacral promontory, more of the anterior parietal bone
presents itself to the examining fingers, and the condition is called anterior asynclitism.
 If, however, the sagittal suture lies close to the symphysis, more of the posterior parietal bone
will present, and the condition is called posterior asynclitism.
 2. DESCENT
 In nullipara engagement takes place before the onset of labour & further descent may not
occur till the 2nd stage
 In multipara descent begins with engagement
 It is gradually progressive till the fetus is delivered

Descent is brought about by

(1) pressure of the intrauterine fluid,
(2) direct pressure of the fundus upon the breech with contractions,
(3) bearing-down efforts of maternal abdominal muscles, and
(4) extension and straightening of the fetal body.

3. FLEXION
 The descending head meets resistance from either the pelvic floor or walls of the pelvis
 The shorter suboccipito-begmatic is substituted for the longer occipito-frontal diameter
 4. INTERNAL ROTATION
 Here the occiput mover from the position towards the symphysis pubis,Less commonly
towards the hollow of sacrum
 In LOA or LOT positions it occurs from the left to right
 Occiput is forced into a gutter,formed by two halves of the levator ani muscle which is in
downward and forward direction, by the effect of the contraction and relaxation of the uterus.

Forward incline of the walls of pelvic cavity

 Impetus given by ischial spines
 Effective uterine contraction

Internal rotation brings the diameter of engagement to the longest of pelvic outlet
 Transverse position ,occiput rotates
through 90º
 In anterior position  45º

CROWNING
 Max diameter of the head stretches the vulvul outlet without any recession of the head even
after the contraction is over
 5. EXTENSION
 When the flexed head reaches the vulva it undergoes extension
 the base of the occiput will be in direct contact with the inferior margin of the symphysis pubis
 The head is born by further extension as the occiput, bregma, forehead, nose, mouth & chin
pass successively over the perineum
 After delivery of the head it returns to the position it occupied at engagement ,
 Neck is untwisted, chin rotates towards right side in LOA position

Extension results from two forces

 Effect of uterine contraction from above and elastic resistance of the pelvic floor below

6. EXTERNAL ROTATION
 After the untwisting of the neck next movement is the internal rotation of shoulders,Then the
fetal body will rotate to bring one shoulder anterior behind the symphysis pubis ( bisacromial
diameter into the APD of the pelvic outlet)
 EXTERNAL ROTATION of the head occurs simultaneously with this movement

7. EXPULSION
 Once the shoulders rotated into AP diameter of the outlet ,descent continues wit uterine
contractions until ant shoulder hitches under the sym pubis &post shoulder sweeps over
perineum
 By lateral flexion of the fetal body the post shoulder will be delivered & the rest of the body
will follow