Definition and Stages of Normal Labor

Subject: Midwifery II (Theory)

Overview

The fetus, placenta, and membranes are expelled through the birth canal after the 28th week of pregnancy, which causes labor. Labor is the term used to describe the sequence of events that take place in the genital organs in an effort to expel live embryos from the womb through the vagina into the outside world. Preterm labor, which can occur before 37 weeks, is referred to as such. The first stage of labor includes the latent phase, active phase, and transitional phase. The second stage includes the propulsive phase and the expulsive phase. The third stage is followed by the fourth stage.Labor discomfort, the appearance of a show, os dilatation, and the development of a "bag of waters" are all signs of true labor.

The fetus, placenta, and membranes are expelled through the birth canal after the 28th week of pregnancy, which causes labor.

Labor is the term used to describe the process by which the fetus, placenta, and membranes are expelled through the birth canal. Delivery is the process of removing a healthy fetus from the uterus. A cesarean section can be performed without the requirement for labor; it is not the same as labor. Vaginal delivery can be abdominal or assisted, or it can be spontaneous.

Labor is the term used to describe the sequence of events that take place in the genital organs in an effort to expel live embryos from the womb through the vagina into the outside world. Preterm labor, which can occur before 37 weeks, is referred to as such.

Stages of Labor

  • First Stage

It starts when labor pains start to feel uncomfortable and stops when the cervical os is fully dilated. This stage of labor is frequently referred to as the "cervical condition." It lasts an average of 6-7 hours for multiparae and 11–12 hours for primigravidae. There are three distinct phases.

  • Latent Phase
    • Contractions typically occur every 5-20 minutes, last 20-40 seconds, and are modest in strength, with a cervix dilation of 0-4 cm. The contractions become more frequent, around every 5 minutes, and form a regular pattern.
  • Active Phase
    • Contractions typically occur every 2-5 minutes, last 30-50 seconds, and are mild to moderate in strength. The cervix dilates by 4-7 cm.
  • Transitional Phase
    • Contraction occurs every 2-3 minutes, lasts 50-60 seconds, and is moderate to strong in strength.  The cervix dilates by 8-10 cm.
  • Second Stage 
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The ejection stage, which is triggered by prostaglandins and oxytocin, starts when the cervix is fully dilated and ends when the baby is delivered. It lasts 5–30 minutes in multiparae and roughly 1-2 hours in primigravidae.

  • Propulsive phase
    • Begin with complete dilatation and progress to the descent of the presenting section of the pelvic floor.
  • Expulsive phase
    • It is distinguished by maternal bearing down effects and concludes with infant delivery.
  • Third Stage
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It begins with the fetus being evacuated and concludes with the placenta and membranes being removed. Hemorrhage control is another area of emphasis at this stage. In both primigravidae and multiparae, it lasts for approximately 15 to 30 minutes. However, the duration is shortened to 5 minutes in active management.

  • Fourth Stage
    After the placenta and membranes have been thrown out, it is the stage of observation for at least an hour. The woman's general health as well as the uterus's activity must be carefully observed throughout this time.

False Labor

  • You don’t have any bloody show: Or you have vaginal discharge that is brownish rather than blood-tinged or pink. A brown discharge caused by sex or an internal exam may appear to be your mucus plug dislodging — but it most likely isn't.
  • You wake up in a pool of fluid that smells like ammonia, and the flow has stopped: That's most likely urine, not amniotic fluid, which has no odor. If your water breaks, a liquid will continue to leak; you will not be able to stop it as you would urinating.
  • You have irregular contractions: Braxton-Hicks contractions might easily lead you to believe that labor has begun. However, even if you're a week past your due date, you could be experiencing false labor pains, which are typical:
    • They are irregular (they do not occur at regular intervals)
    • They are not progressive (they do not become more severe, intense, or frequent with time).
    • Felt it more in the lower abdomen than the lower back.
    • Changes in posture or activities (if you shift positions, they disappear – try lying down on your side to see if the contractions stop)
    • Accompanied by your baby's movement

True Labor

  • Labour pain
    • Painless barton hicks contractions with uterine hardening occur throughout pregnancy. These contractions change in nature, becoming more strong, intermittent, and painful. The pain is usually felt in front of the abdomen or radiates to the thigh.
  • Appearance of show
    • There is a lot of cervical secretion when labor starts. Simultaneously, there is modest seeping of blood from cervical capillary vessel rupture from the raw decidual surface caused by membrane separation caused by splitting off the lower uterine segment. "Show" refers to the expulsion of a cervical mucus plug mixed with blood.
  • Dilatation of internal organs
    • When labor pains begin, the cervical canal dilates more in the upper part than in the lower, with the former accompanied by equivalent stretching of the lower uterine segment.
  • Formation of "bag of waters"
    • The lower pole of the fetal membrane becomes unsupported and tends to bulge into the cervical canal when the cervical canal dilates. It is referred to as a "bag of water" because it includes liquor that has passed the presenting portion. This sack becomes stiff and convex during uterine contraction and the concomitant rise in intra-amniotic pressure. The bulge may disappear completely after the contractions stop. This is nearly often a sign that labor has begun.

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Things to remember
  • After the 28th week of pregnancy, the fetus, placenta, and membranes are evacuated through the birth canal, resulting in labor.
  • Labor refers to the series of actions that occur in the genital organs in an attempt to expel viable products of conception from the womb through the vagina into the outside world.
  • It can happen before 37 weeks, which is known as preterm labor.
  • The stages of labor are as follows: the first stage, which comprises the latent phase, the active phase, and the transitional phase; the second stage, which contains the propulsive phase and the expulsive phase; the third stage, and finally the fourth stage.
  • True labor characteristics include labor pain, the appearance of a show, dilatation of the internal os, and the formation of a "bag of waters."
Questions and Answers

After 28 weeks of pregnancy, the fetus, placenta, and membranes are naturally ejected via the birth canal during labor.

The process through which the fetus, placenta, and membranes are ejected through the birth canal is referred to as labor. A viable fetus is extracted from the uterus through delivery. It is not the same as labor; an elective caesarean section can be performed without labor. Vaginal delivery can be assisted or spontaneous, or it can be abdominal.

 

Stages of Labour

  • First Stage

It stars from the onset of the labour pain and ends with full dilatation of the cervix. It is also known as the "cervical state" of labour. Its average duration is 11-12 hours in primigravidae and 6-7 hours in multiparae. It has three sub-phase.

  • Latent Phase :

Contractions are usually every 5-20 minutes, lasting 20-40 sec and of mild intensity and cervix dilates from 0-4 cm. The contraction progress to about every 5 minutes and establish a regular pattern.

  • Active phase
  • Contractions are usually every 2-5 minutes
  • Lasting 30-50 seconds and mild to moderate intensity
  • Cervix dilates from 4-7 cm
  • Transitional phase
  • Contraction comes every 2-3 minutes
  • Lasting 50-60 seconds and intensity moderate to strong
  • Cervix dilates from 8-10 cm
     
  • Second Stage of Labour

The expulsion stage (stimulated by prostaglandins and oxytocin) begins when the cervix is fully dilated and ends when the baby is born. Its average duration is 1-2 hours in primigravidae and 5-30 minutes in multiparae.

  • Propulsive Phase

Starts from full dilatation up to the descent of the presenting part of the pelvic floor.

  • Expulsive Phase

It is distinguished by maternal bearing down effects and ends with delivery of the baby.

  • Third Stage

IIt starts after the fetus is ejected and concludes with the membranes and placenta being ejected. Bleeding control is an issue at this point as well. In both primigravidae and multiparae, it lasts an average of 15 to 30 minutes. However, in active management, the time is cut to 5 minutes.

  • Fourth Stage

After the placenta and membranes are ejected, it is the stage of observation for at least an hour. The general health of the lady and the uterus's activities should be closely monitored at this time.

False Labour

Three major signs of false labour

  • You don’t have any bloody show: Or you have some vaginal discharge, but it’s brownish instead of blood-tinged or pink. Sex or an internal exam can result in a brown discharge that might seem like your mucous plug dislodging — but it probably isn’t.
  • You wake up in a pool of fluid that smells like ammonia, and the flow has stopped: Oops — that’s probably urine, not amniotic fluid, which has no odor. If your water breaks, a liquid will continue to trickle out; you won’t be able to stop it as you would if you were urinating.
  • You have irregular contractions: Braxton-Hicks contractions can easily fool you into thinking labor has started. But even if you’re a week past your due date, you could still be having false labor contractions, which are usually:
  • Irregular (they don’t happen at regular intervals)
  • Not progressive (they don’t get more severe, intense, or frequent with time)
  • Felt more in the lower abdomen, instead of in the lower back
  • Responsive to a change in position or activity (if you change positions, they go away — so try lying down on your side to see if the contractions stop)
  • Accompanied by movement from your baby

True Labour

Features of true labour

  • Labour pain

Throughout pregnancy, the uterus hardens and there are painless barton hicks contractions. These contractions alter in nature, intensify, become sporadic, and are accompanied by discomfort. The pain frequently radiates to the thigh or is felt in front of the abdomen.

  • Appearance of Show

There is a lot of cervical secretion as labor starts. In addition, there is a small amount of blood oozing from the cervix's capillaries on the raw decidual surface as a result of membrane separation brought on by the lower uterine segment's separation from the cervix. "Show" is the term for the discharge of a cervical mucus plug mixed with blood.

  • Dilatation of Internal OS

With the onset of labour pain, the cervical canal begins to dilate more in the upper part than in the lower, the former being accompanied by the corresponding stretching of the lower uterine segment.

  • Formation of "bag of waters"

The lower pole of the fetal membrane becomes unsupported and has a tendency to protrude into the cervical canal as a result of the cervical canal's enlargement. It is known as "bag of water" because it includes liquor that has past the presenting part. This sack becomes stiff and convex during uterine contraction, which causes the intra-amniotic pressure to increase. After the contractions stop, the bulge could totally go away. This practically guarantees that labor has begun.

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