The Normal Labor

The Labor
• Labor is the physiological process
in which products of conception
(the fetus, membranes, umbilical
cord, and placenta) is passed from
the uterus to the outside world
between 37 and 42 completed weeks
of pregnancy.
2

• The period begins with the onset of
regular uterine contractions (UCs)
and lasts until the expulsion of the
placenta; we called the Intrapartum.
• Delivery is the birth of baby itself.
• Delivery can occur in two ways,
vaginally or by a cesarean delivery.
3

Normal Labor Signs
1. Pre-labor (1 - 4 weeks before labor):
• Baby’s head drops down and
lightening feels
• Increased back pain and cramps
• Abdominal pain
• Joints feel looser
• Diarrhea
• Cervix effacement and dilation (opening
and thins out of cervix) 4

2. Early labor (Hours before labor):
• Bloody show: vaginal discharge
becomes thicker and pink.
• Water breaks: rupture and break of
the amniotic sac.
• Uterine contractions (UCs): painful,
regular, strong contraction.
5

True vs. False Labor
6
FalseTrue
Irregular
Regular, become closer and
strongerContraction
May last 1 – 2 min.Last 30 – 60 sec.Timing
Upper abdomenLower abdomen and backContraction position
Go away with changing
position, walking, hot bath
Get stronger with changing
positionPosition
No changesDilation and effacementCervix
No significant changesDrops into pelvisFetus

Factors affecting Labor (5 P’s)
In every labor; there are five essential factors affect the
process. These are easily remembered as the five P’s:
1. Passenger: the fetus
2. Passageway: the pelvis and birth canal
3. Powers: the uterine contractions
4. Position: maternal postures and physical
positions
5. Psyche: the response of the mother
7

1.Passenger (The Fetus):
The fetus relationship to the passageway is the major
factor in the birthing process. The relationship includes:
• Fetal skull and size
• Number of fetuses
• Position of feus
− Fetal lie: relationship of fetal spine to maternal spine;
longitudinal (vertical) or transverse (horizontal)
− Fetal presentation: part of fetus that enters pelvis first
− Fetal attitude: relationship of fetal body parts to each other;
flexion (normal) or extension (abnormal)
− Fetal position: fetal direction in the pelvis
− Fetal station: position of the baby's head relative to the lower
bone of pelvis called the ischial spines 8

Fetal Attitude 10
Complete extension
(abnormal)
Complete flexion
(normal)

2. Passageway (The pelvis):
• The passage includes the bony pelvis, the soft
tissues of the cervix, and the vagina.
• The maternal pelvis is the greatest determinant in
the vaginal delivery of the fetus.
• During the first stage of labor, the cervix opens
(dilates) and thins out (effaces) to allow the baby
to move into the birth canal.
• The cervix must be 100 percent effaced and 10
centimeters dilated before a vaginal delivery.
13

3. Powers:
• Powers refer to the involuntary Uterine
Contractions (UCs) and voluntary pushing of
fetus.
• Contractions are a tightening and relaxing of the
muscles in the abdomen and the back.
• Uterine Contractions have two major goals:
1. To dilate the cervix
2. To push the fetus through the birth canal
• After each contraction there is a uterine
relaxation that allows blood flow to the uterus.
16

4. Position:
Maternal position during labor and birth.
5. Psyche:
The psychological state of the mother and her
response. We should give her the support and
health care, and allow the family to give her
the support.
17

18
A. Positions for labor B. Positions for pushing

Mechanism of Labor
In the normal labor; there are series of changes in position
and attitude of the fetus to accommodate himself to the
pelvic to pass easily through the birth canal:
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
7. Expulsion
19

1. Engagement
The greatest diameter of the fetal head passes
through the pelvic inlet.
2. Descent
Movement of the fetus through the birth canal
during the first and second stages of labor
3. Flexion
The chin of the fetus moves toward the fetal chest
which reduce the fetal head diameter from nearly 12
to 9.5 cm.
20

4. Internal rotation
The rotation of the fetal head until the longest
diameter of the fetal head match the longest
diameter of the maternal pelvic.
22

5. Extension
The fetal head passes beneath the synthesis
pubis and passes out of the birth canal making
the crowning.
23

6. External rotation (Restitution)
After the head has delivered, the shoulders
rotate internally to fit the pelvis.
24

7. Expulsion
The shoulders and remainder of the body are
delivered
25

The Stages of Labor
1. 1st stage (cervix dilation): begins with onset of
labor and ends with complete cervical dilation.
2. 2nd stage (baby delivery): begins with complete
dilation of cervix and ends with delivery of baby.
3. 3rd stage (placenta delivery): begins after
delivery of baby and ends with delivery of
placenta.
4. 4th stage (postpartum): begins after delivery of
the placenta and is completed 4 hours later.
26

First stage:
• This is the onset of labor to complete
dilation of cervix.
• A typical pattern for the latent phase
contractions begins by lasting about 40
seconds and coming every ten minutes. By
the time; the contractions will last for more
than a minute and come every 30 seconds.
27

First stage:
• This stage divided into two phases:
1. Latent phase: contractions become
frequent, very strong, and painful. Cervix
dilates about 4 cm.
2. Active phase: dilatation of the cervix from 6
to 10 centimeters. Contractions become
regular, longer, more severe, and more
frequent In most cases, the active phase is
shorter than the latent phase.
28

Second stage:
• It starts when the cervix is completely opened
and ends with the delivery of the baby.
• The second stage is often referred to as the
"pushing" stage when the mom push the baby
outside to the world.
• When the baby's head is visible at the opening of
the vagina, it is called "crowning."
• The second stage is shorter than the first stage,
and may take between 30 minutes to 3 hours for
a woman's first pregnancy.
30

Third stage:
• Is the delivery of the placenta; which
occurs after the birth of the baby and the
umbilical cord is clamped.
• Once the baby has been delivered, it may be
left for two to three minutes before cut the
umbilical cord.
• The mother may experience some bleeding.
• This stage usually lasts just a few minutes
up to a half-hour.
32

34
clamp and cut of the umbilical cord

Fourth stage:
• The hour to four hours after delivery, and
sometimes for about six weeks, or with the
stabilization of the mother.
• The baby should be assessed and the
mother should have regular assessments
for uterine contraction, vaginal bleeding,
heart rate and blood pressure, and
temperature, for the first 24 hours after
birth.
36

The Normal Labor

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The Normal Labor