Normal Labour/ Stages of Labour/ Mechanism of Labour

NORMAL LABOUR
Represented By Wasim Akram
Asst. Lecturer
BLOSSOM COLLEGE OF NURSING

DEFINITION
Normal labor is also termed spontaneous labor, defined as the
natural physiological process through which the fetus, placenta,
and membranes are expelled from the uterus through the birth
canal at term (37 to 42 weeks of gestation) without significant
medical intervention.

STAGES OF NORMAL LABOUR
First Stage
(Dilation Stage)
• Begins with the onset of
regular contractions and ends
to complete dilation (10 cm).
• Duration: 12 hours
(Primigravidae)
6 hours (Multiparae).
Second Stage
(Expulsion Stage)
• From complete cervical dilation
to the delivery of the baby.
• Duration: 2 hours
(Primigravidae)
30 minutes (Multiparae).
Third Stage
(Placental Stage)
• From the delivery of the baby
to the expulsion of the
placenta.
• Duration: 15 minutes in both.
Fourth Stage
(Recovery Stage)
• The initial postpartum period, usually the first one to two hours after birth, where
the mother is under observation and monitored for bleeding.
• The uterus begins to contract to its pre-pregnancy size.

CAUSES (FACTORS
INFLUENCING ONSET OF
LABOUR)
•Hormonal Changes:
Increase in estrogen and oxytocin levels, and decrease in progesterone levels.
•Uterine Stretching:
As the baby grows, the uterus stretches to accommodate it, potentially
triggering labour.
•Fetal Signals:
The maturing fetus sends signals to the mother’s body to start labour.
•Placental Aging:
As the placenta ages, it becomes less efficient, which can trigger labour.

SIGNS OF ONSET OF LABOUR
•Regular Contractions:
Contractions become regular, more frequent,
and more intense over time.
•Cervical Changes:
Effacement (thinning) and dilation (opening) of
the cervix.
•Bloody Show:
Passage of the mucus plug mixed with blood
from the cervix.
•Rupture of Membranes:
Also known as "water breaking," where the
amniotic sac ruptures, resulting in a gush or
slow leak of amniotic fluid.
•Pelvic Pressure:
Increased pressure in the pelvis as the baby
descends into the birth canal.
•BackPain:
Persistent lower back pain that may accompany
contractions.
•NestingInstinct:
A sudden burst of energy and a strong urge to
prepare for the baby’s arrival.
•Diarrhea:
Loose bowel movements can occur as the body
clears out to make room for labour.
•Lightening:
The baby drops lower into the pelvis, which may
ease breathing but increase pelvic pressure.

True Labour
False Labour (Braxton
Hicks Contractions)
•contractions:
•Regular and progressively closer
together.
•Increase in strength and duration.
•Not relieved by walking or resting.
•Dilation and effacement occur.
•Pain Location:
•Usually starts in the back and
radiates to the abdomen.
•Contractions:
•Irregular and do not get closer
together.
•Vary in intensity, usually mild.
•Often relieved by changes in
position or activity.
•No significant changes in dilation
or effacement.
•Pain Location:
•Usually felt in the front of the
abdomen.

EVENTS IN THE FIRST STAGE OF
LABOUR
• The first stage of labour is characterized by the dilation of the cervix and is
divided into two phases: the latent phase and the active phase.
• LATENT PHASE:
Onset of Regular Contractions
Cervical Effacement
Initial Dilation
Bloody Show
Mild Backache and Cramps

• ACTIVE PHASE:
Intensified Contractions
Rapid Cervical Dilation
Increased Discomfort and Pain
Rupture of Membranes
Pelvic Pressure
Nausea and Vomiting
Emotional Changes
Increased Bloody Show

• This stage involves active pushing and refers to the series of movements &
adjustments of the fetus.
• MECHANISM OF NORMAL LABOUR: (Cephalic Presentation)
•Engagement:
The descent of the fetal head into the pelvic inlet.
The fetal head typically enters the pelvis in the occiput transverse position.
•Descent:
Continues throughout labour: Descent is gradual and aided by uterine
contractions, maternal pushing, and the force of gravity.
•Flexion:
The fetal head flexes, allowing the smallest diameter to present first.
This reduces the diameter of the presenting part, facilitating easier passage
through the birth canal.
EVENTS IN THE SECOND STAGE OF
LABOUR

•Internal Rotation:
The head rotates 90 degrees to align
with the anteroposterior diameter of
the pelvis.
This aligns the fetal head with the
mother’s pelvic anatomy, making
descent through the mid-pelvis and
outlet more efficient.
•Extension:
As the head reaches the vulva, it
extends to pass under the pubic
symphysis.
The fetal head is born as the occiput,
then the face, and finally the chin
emerges.
•Restitution:
After the head is born, it rotates to align with
the shoulders.
This adjustment aligns the fetal head with the
body, which is still inside the mother.
•External Rotation:
The shoulders rotate within the pelvis to align
with the anteroposterior diameter.
This movement facilitates the passage of the
shoulders through the birth canal.
•Expulsion:
The anterior shoulder slips under the pubic
bone, followed by the posterior shoulder and
the rest of the body.
The baby is fully delivered, marking the end of
the second stage of labour.

EVENTS IN THE THIRD STAGE OF
LABOUR
• The third stage of labour begins after the birth of the baby and ends with the
delivery of the placenta and membranes.
• Initial Uterine Contraction:
• After the baby is delivered, the uterus continues to contract, helping to
shear the placenta away from the uterine wall.
• Separation of the Placenta:
• The placenta detaches from the uterine wall due to uterine contractions.
• Signs of placental separation include:
A sudden gush of blood.
Lengthening of the umbilical cord.
A change in the shape and position of the uterus, which becomes more
globular and firmer.

• Expulsion of the Placenta:
• The detached placenta moves down
through the birth canal and is
expelled.
• Expulsion can be assisted by:
• Maternal efforts such as gentle
pushing.
• Controlled cord traction
performed by the healthcare
provider (in active
management).
• Examination of the Placenta:
• The placenta and membranes are
examined post-delivery to ensure
they are complete.
• Ensuring no fragments are left in the
uterus is crucial to prevent
postpartum hemorrhage.
• Contraction and Retraction of the Uterus:
• Continued uterine contractions help compress blood vessels,
reducing blood loss.
• The uterus contracts to a smaller size, aiding in reducing
postpartum bleeding.
• Control of Bleeding:
• The healthcare provider ensures bleeding is controlled,
which may involve:
• Uterine massage to encourage contraction.
• Administration of uterotonic drugs (e.g., oxytocin) to
promote uterine contractions and minimize blood loss.
• Monitoring and Care of the Mother:
• Vital signs (blood pressure, heart rate) and the amount of
vaginal bleeding are closely monitored.
• The perineum and birth canal are inspected for lacerations
or tears, which are repaired if necessary.
• The mother's physical and emotional well-being are
assessed, and she is made comfortable.

EVENTS IN THE FOURTH
STAGE OF LABOUR
• Observation and Monitoring:
Regular monitoring of blood pressure,pulse, and respiration.
Ensuring the uterus remains firm and contracted; fundal massage may be
performed.
Assessing the amount and nature of vaginalbleeding(lochia).
• Management of Bleeding:
Administeringmedications like oxytocin to maintainuterine contractions.
Promoting uterine contraction and expulsion of clots.
• Assessment of the Perineum:
Examining for lacerations or tears and performingsutures if necessary.
Managing any swelling, bruising, or hematomas.
• The fourth stage of labor begins after the delivery of the placenta and lasts for about one to two
hours postpartum.
• This stage involves monitoring the mother to ensure her well-being and the stabilization of
physiological functions.

• Early Postpartum Care:
Monitoring urine output and ensuringthe bladder is not distended.
Assisting with breastfeeding to promote bonding and stimulate
uterine contractions.
Providing reassurance and addressing concerns.
• Mother-Baby Bonding:
 Encouraging immediate skin-to-skin contact.
 Supporting early breastfeeding.
• Pain Management:
Administeringpain relief as needed.
Providingwarm blankets, hydration,and comfortable positioning.
• Education and Counseling:
Educating about signs of complications and when to seek help.
Offering guidance on breastfeedingtechniques.
• Monitoring for Complications:
Observing for signs of excessive bleeding.
Watching for signs of infection, such as fever or severe pain.

Normal Labour/ Stages of Labour/ Mechanism of Labour

Normal Labour/ Stages of Labour/ Mechanism of Labour

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