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4 - Basic Concepts of Labor

BD2310 - Introduction to Midwifery Care

Wiwiek Elsada Nainggolan S.Tr.Keb., M.Tr.Keb

Dilma’aarij Riski Agustia, S.Tr.Keb., M.K.M

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Overview
The basic concept of pregnancy discusses what the definition of labor itself is, then the
mechanism of labor, factors that affect labor and the mechanism of labor.
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Objectives
After this discussion, students are expected to be able to:
• Definition of labor
• Theory of labor
• Factors affecting labor
• Signs and mechanisms of labor
BACK COURSE TOPIC 03

• Definition of labor
Content
• Theory of labor
• Factors affecting labor
• Signs and mechanisms of labor
BACK COURSE TOPIC 04

INTRODUCTION TO THE BASIC CONCEPTS OF

LABOR
Maternal mortality rate (MMR) is one of the indicators
to measure the health status of women. Many factors
cause MMR in Indonesia including low coverage of
health workers, inadequate health facilities, maternal
and environmental factors.
The role of midwives must be able to provide good
midwifery care in a professional and qualified manner.
BACK COURSE TOPIC 04

Definition of Labor
• Labor is the process of opening and thinning of the cervix
and the fetus descending into the birth canal then ends with
the expulsion of a full-term / viable baby outside the womb
followed by the expulsion of the placenta through the birth
canal or not, with assistance or without assistance.
• Labor is normal if the process occurs at full term (36-37
weeks).
• Labor begins with parturition (uterus contracting and
causing changes to the cervix).
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Theory of the labor process

1. Theory of decreased progesterone hormone levels

2. Oxytocin theory

3. Prostaglandin theory

4. Theory of the placenta getting old

5. Uterine distension theory

6. Mechanical irritation theory

7. Fetal cortisol theory

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Theory of the labor process
1. Theory of Decreased Progesterone
Hormone Levels
• During pregnancy the hormones
progesterone and estrogen increase during
pregnancy.
• Progesterone → relaxes the uterine muscles
• Estrogen → increases uterine muscle
vulnerability
• At 7 months UK, estrogen increases and
progesterone decreases so that at the end of
pregnancy there are labor contractions.
04
2. Oxytocin Theory
• As labor approaches, there is an increase
in oxytocin receptors in the uterine
muscles, which are easily stimulated
when oxytocin is injected and cause
contractions.
• This oxytocin causes the formation of
prostaglandins and labor can take place.
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Theory of the labor process

3. Prostaglandin Theory 4. Theories of the Placenta Growing Old
• Prostaglandins produced by deciduas are • As the placenta ages, progesterone
one of the reasons for the onset of labor. levels decrease, causing blood
• This is due to the presence of high levels vessels to spasm and contractions.
of prostaglandins in both the amniotic
fluid and peripheral blood of the pregnant
woman before delivery or during labor.
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Theory of the labor process

5. Uterine Distention Theory
• As the UK increases, the uterine muscles
will stretch further. The enlarged and
stretched uterus causes ischemia of the
uterine muscles, disrupting utero-
placental circulation and causing
contractions..
6. Mechanical Irritation Theory
• Behind the cervix lies the cervical
ganglion (flexus fanker hauser), if this
ganglion is shifted and pressed, for
example by the fetal head, contractions
will arise.
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Theory of the labor process
7. Fetal Cortisol Theory
• The production of cortisol from the fetal
adrenal glands before labor affects the
increase of estrogen from the placenta, to
balance cortisol in the blood, the
hypothalamus and pituitary will send
signals to the adrenal glands to
reduce/increase cortisol production.
04
• In relation to this theory, pregnancies with
anencephalus often have delayed labor
because the hypothalamus and
suprarenal gland are not formed, which
are the triggers for labor.
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Factors Affecting Labor

• Many related factors lead to the onset of labor
Passage (the birth
Power Passanger Others
canal)
His (uterine contractions) Fetus Pelvic hard parts Mother's psyche
Straining/mother's energy Placenta Soft parts of the pelvis Birth attendants
Amniotic fluid
(hydramnios)
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Signs and Mechanisms of Labor

• Signs of labor beginning
• Lightening (baby's head in PAP and fall of fundus uteri)
• His onset (false hiss, irregular arrival, short duration and no cervical
change)
• Signs of onset of labor
• His (contractions) of labor → is regular, frequent and the length of his is
45-60 seconds and there are changes in the cervix
• Discharge of mucus mixed with blood (show) → comes from the cervical
canal there is tearing of blood vessels when the cervix is open
• Ketuban breaks on its own → although not always, but if the ketuban has
broken within 24 hours the baby must be born
• Dilatation or effacement → gradual opening of the cervical canal due to
hiss, and flattening/shortening of the cervical canal.
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Signs and Mechanisms of Labor

• In the normal labor mechanism there are 7 cardinal movements:
1. Engagement: entry of the largest part of the fetal head into the PAP.
2. Descent: the descent of the fetal head into the birth canal.
3. Flexion: the process of flexion, the chin is brought closer to the fetal
chest.
4. Inner axis turn: begins in the plane at the level of the ischiadic spina.
5. Extension: when the head reaches the perineum, it is deflected
anteriorly by the perineum. Then the head comes out following the axis
of the birth canal due to extension
6. External axis rotation: the shoulder should rotate internally so that it is
aligned with the anteroposterior diameter of the pelvis.
7. Expulsion: after the shoulder comes out. The head and shoulders are
lifted above the mother's pubic bone and the baby is expelled with a
lateral flexion movement towards the pubic symphysis.
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Signs and Mechanisms of Labor
KALA I
• This period starts from the opening between 0 - 10 cm.
• Consists of latent phase (opening 0-3 cm and lasts 8 hours)
and active phase (opening 4-complete, lasts 6 hours).
• In this phase hiss increases gradually, i.e. within 10 minutes
there are 3 or more hiss with a duration of 40-60 seconds.
• On average from the active phase, there is an opening of 1
cm per hour for primigravida, and 2 cm for multigravida.
• The total occurrence of this phase of kala I averages 12
hours for primigravida and 7 hours for multigravida.
04
KALA II
• This period starts from complete opening (10 cm) until the
baby is born.
• This process lasts 2 hours in primigravida, and 1 hour in
multigravida.
• Main signs of stage II:
• His was strong, 2-3 minute intervals of 50-100" duration.
• Amniotic rupture at opening followed by urge to defecate
as Frankenhauser's flexus is compressed.
• His and the mother's straining pushed the baby's head
open, the subocciput acted as a hypomoglion and the
forehead, face, chin passed through the perineum.
• There is a turn of the external paski, then after that the
baby's labor is assisted
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Signs and Mechanisms of Labor

KALA III KALA IV
• This period starts from the birth of the baby until the • This period begins with the birth of the placenta until 2 hours
placenta is delivered. after the baby is born.
• Uterine contractions stop 5-10 minutes • Stage IV is intended to observe postpartum hemorrhage for
• It should not last more than 30 minutes, if more then it up to the first 2 hours.
should be given more treatment / referred. • Observations made include:
• Signs of placenta detachment: • Mother's level of consciousness
• Uterus becomes round • Vital signs, BP, RR and pulse checks
• Uterus is pushed to the bottom as the placenta is • Uterine contractions
detached to the lower segment of the uterus • Bleeding
• The puast cord increases in length
• Normal bleeding occurs
• Placenta detaches 6-15 minutes from baby's birth
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Image of Mechanism of Labor

KALA I KALA II
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Image of Mechanism of Labor

KALA III KALA IV
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Unit Summary
• After this discussion, students are expected to be able to:
• Definition of labor
• Theory of labor
• Factors affecting labor
• Bunches and mechanisms of labor
 Quiz
https://forms.gle/wTEp424jmjiaWbaXA

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 Video
https://youtu.be/q1jmVN3ILpY?feature=shared

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 Question & Answer

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 Reference
• Cunningham, F Gary, Obstetri Williams Volume 1 Edisi 23, Jakarta : EGC ,
2012
• Bayu Fijri. 2021. Pengantar Asuhan Kebidanan. Yogyakarta: Bintang
Pustaka Madani
• Varney, H , Buku Ajar Asuhan Kebidanan Edisi 4 Volume 2 , Jakarta : EGC ,
2008
• Annisa UI Mutmainnnah, dkk. Asuhan Persalinan Normal dan Bayi Baru
Lahir. Yogyakarta : penerbit ANDI. 2017

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