Parturition

and Labor
Parturition – Process of giving birth
• The precise initiating signal in human parturition is
unidentified, but current concepts favor a
multicomponent process:

1. Increase in prostaglandins – increases myometrial

cell Ca++ levels and trigger uterine contractions
2. A Drop in the level of progesterone
3. Increase frequency of oxytocin pulses, increase in
myometrial oxytocin receptor
4. Increase circulating catecholamines due to increase
maternal stress
Four Phases of Parturition

- Based on major uterine and cervical changes

- Phase 0 – Prelude
- Phase 1 – Preparation
- Phase 2 – Labor
- Phase 3 - Recovery
Phase 0 – Prelude

- Time of contractile tranquility (uterine

unresponsiveness) and cervical rigidity

- From before implantation until late in gestation

- Progesterone
Phase 1 – Preparation

• Changes in myometrium and cervix

• Signs during the last days:

1. Increase frequency of painless contractions
2. Increased responsiveness of myometrium to
stimuli
3. Ripening of the cervix
4. Development of the lower uterine segment
Phase 2 – Labor

• Period of active uterine contractions which

bring about the cervical effacement and
dilation, fetal descent, and delivery of the
conceptus

• Three Stages
Uterine Contractions

• False Labor/Braxton Hicks contractions

– Irregular
– Long interval
– Shorter Duration
– Discomfort is confined to the lower abdomen and
groin
– Intensity is unchanged, may disappear
Uterine Contractions

• True Labor

– Regular
– Interval decreases gradually
– Longer duration
– Discomfort commence in the fundal region and
then radiates over the uterus and to the lower
back
– Intensity increases
Cervical effacement
– The progressive shortening and thinning of the
cervix during labor

Cervical dilatation
– The increase in diameter of the cervical opening
measured in centimeters
Signs of Labor

• Lightening
– Occurs a few weeks prior to active labor
– Fundic height decreases
– “the baby is dropped”
– Resulting of the formation of the lower uterine
segment allow the fetal head to descend
• Show
- Extruded plug of mucus which filled up the
cervical canal throughout pregnancy
Stages of Labor

• The first stage of labor from onset of labor to full

cervical dilatation

• The second stage of labor is from full cervical

dilatation to the delivery of the infant

• The third stage of labor from delivery of the infant to

the delivery of the placenta
First Stage of Labor
• Begins with regular uterine contractions and ends
with compete cervical dilatation (10cm)
First Stage of Labor

• Active Phase

– Increased rapidity of cervical dilation

– Signaled by the dilatation of the cervix from 4 to
10 centimeters
– Contractions become longer (lasting 60 to 90
seconds), more severe, and more frequent
(usually 3 to 4 minutes apart)
– Most women feel the urge to push during this
phase.
First Stage of Labor

• Latent Phase

– Usually the longest and least intense phase of

labor
– Contractions are becoming more frequent (usually
5 to 20 minutes apart) and somewhat stronger
– The cervix dilates (opens approximately three or
four centimeters) and effaces
– The mother-to-be is usually admitted to the
hospital during this phase
Second Stage of Labor

• Often referred to as the “pushing” stage

• The woman becomes actively involved by

pushing the baby through the birth canal to
the outside world

• Shorter than the first stage, and may take

between 30 minutes to two hours for a
woman’s first pregnancy
Second Stage of Labor

• Begins with complete cervical dilatation and

ends with the delivery of the fetus
Second Stage of Labor

• When the baby’s head is visible at the opening

of the vagina, it is called “crowning”
Third Stage of Labor
• Involves the separation and expulsion of the
placenta
Abnormal Labor Indicators

Indicators Nullipara Multipara

Prolonged Latent Phase >20h >14h

Average second stage 50min 20min

Prolonged second stage without (with) epidural > 2h (>3h) > 1h (>2h)

Prolonged dilation < 1.2cm/h < 1.5cm/h

Prolonged descent < 1cm/h < 2cm/h

Arrest of dilation > 2h > 2h

Arrest of descent > 2h > 1h

Prolonged third stage > 30min > 30min

In general, abnormal labor is the result of
problems with one of the 3 P’s.

– Passenger (infant size, fetal presentation)

– Pelvis or passage (size, shape and adequacy of the

pelvis)

– Power (uterine contractility)

Fetal Presentation

• Cephalic presentation – means head first. This is the

normal presentation
• Breech presentation – means fetal butt is coming out
first
• Transverse lie – means the fetus is oriented from one
side of the mother to the other and neither the head
nor the butt is coming out first
• Compound presentation - means that a fetal hand is
coming out with the fetal head
• Shoulder presentation - means that the fetal
shoulder is trying to come out first
Phase 3 – Recovery

• Terminates in uterine involution and restored

fertility

• Duration is dependent on breastfeeding

– Prolactin reduces responsiveness of the ovaries to
FSH
– Prolactin inhibits LH secretion by pituitary