STAGES OF LABOR

Comparison of Length of Labor in Primigravida & Multigravida

Stages of labor Primigravida Multigravida

First stage 12.5 hours 7hours,& 20 minutes
Second stage 80 minutes 30 minutes
Third stage 10 minutes 10 minutes
Total 14 hours 8 hours
First stage of labor- FROM TRUE LABOR PAINS TO COMPLETE
DILATATION OF CERVIX

 >UTERINE CONTRACTION-
 Phases of uterine contraction
 INCREMENT/CRESCENDO- increase intensity of the contraction, longest
phase than the two
 Acme /apex- height or peak of contraction
 Decrement /decrescendo – decrease intensity of contraction
 > Bloody show – appear 24-48 hours before labor begins
Dilatation- process by which external cervical enlarges from few
millimeter to full dilatation ( 10 cm )

 Effacement- shortening and thinning of the cervix by retraction.

 > primigravida – effacement occurs before dilatation
 > multigravida – dilatation may precede before effacement
 In general multigravida deliver 6 hours earlier than primigravida
 Precipitate labor- labor completed in less than 3 hours.
Prolonged labor
primigravida- labor completed more than 18 hours
Multigravida- more than 12 hours

 Position of fetus can be assessed through:

 1. Leopold maneuver
 2. Vaginal examination
 3. Auscultation of FHB
Fetal assessment during labor

 FHR- 120 – 160 bpm

 FH Pattern
 Early deceleration- monitor
 Late deceleration – O2 left side
 Variable deceleration- O2 left side
 Signs of fetal distress – unstable FHB , meconium stained, prolapsed cord
Second stage of labor – from full dilatation
of cervix up to delivery of the baby
 1. Latent or early phase- start of regular contraction , mild
and short lasting 20-40 seconds, dilatation and effacement
occurs , 0-3 cm
 2. Active phase-cervical dilation occurs rapidly from 4 to
7 cm, ( 1 cm in primi per hour and 2 cm in multi per hour )
contraction grow stronger 40-60 second every 3-5 mins.
 This phase last 3 hours in nullipara and 2 hours in
multipara
 3. Transition phase –
 >contraction is at peak in intensity,
 > duration 60-70 seconds very 2-3 minutes
 > cervical dilation 7-10 cm.
 > mother experience intense pain
Mechanisms ( cardinal movements of labor )

 1. Descent- downward movement of the biparietal diameter of fetal

head within the pelvic inlet.
 2. Flexion – as descent occurs, head bends forward onto the chest
making the smallest anteroposterior diameter (suboccipitobregmatic
diameter) is presented to the brim canal.
 3. Internal rotation- head enters the pelvis with the anteroposterior
diameter in diagonal/transverse position.
 4. Extension – as occiput is born, the back of the neck stops
beneath the pubic arch and acts as a pivot for the rest of the
head. Fetal head passes under the symphysis pubis and is
delivered occiput first , followed by chest and chin
 5. External rotation – after the head, it rotates anteroposterior
position, assumes to enter the outlet back to the diagonal or
transverse position of the early part of labor.Head rotates to
full alignment with neck and shoulder for shoulder delivery.
To accommodate shoulder the head goes back to its position.
 6. Expulsion- once the shoulders are out, the rest of the body are
spontaneously born because of smaller size. When the body of the
baby emerged from mother/s body birth is complete. This time is
recorded as the time of birth.
Third stage of labor- placental stage

 > from birth of baby to expulsion of placenta

 Signs of placental separation:
 1. Cullen’s sign- earliest sign, uterus change in shape from discoid
to globular
 2. sudden gush of vaginal blood
 3. lengthening of umbilical cord
Types of placental delivery

 1. Shultz method- placenta separates from the center to the edge,

placenta is delivered with the fetal surface first like an inverted
umbrella. 80 % of placenta are delivered
 2. Duncan method – placenta separates from the edge to the center.
Maternal surface of placenta is seen first.
Rooming In

 Hospital that offers rooming –in -is “baby friendly”- keeping the
newborn and mother together will form a sound mother-child
relationship.
 Complete rooming-in the mother and child are together 24 hours.
 Partial rooming-in the baby remains in the room of the mother during
day time then placed in the nursery near the mother’s room.