Labor & its stages

FIRST STAGE OF LABOR--THREE PHASES

Early. In this phase, the mother feels slow, rhythmic contractions. The contractions
last from 30 to 45 seconds with the intensity gradually increasing. The frequency of
contractions is from 5 to 20 minutes. There is some cervical effacement. Dilation is
from 2cm. "Bloody show" is present. The mother was able to walk, talk, laugh during
this phase..
Active. In this phase, the contractions become stronger and last longer, for 45 to 60
seconds. The frequency is from 3 to 5 minutes. The cervix dilates 7 cm... She, then,
becomes involved with bodily sensations and tends to withdraw from the
surrounding environment. She is not able to walk, but, desires companionship and
encouragement.
Transient. In this phase, the contractions are sharp, more intensified, and last from
60 to 90 seconds. The frequency is from 2 to 3 minutes. The cervix dilates from 8 to
10 cm. The mother express feelings of frustration irritability. Her focus becomes
internal. She has difficulty comprehending surroundings, events, and instructions.
There is an increase in bloody show as a result of the rupture of capillary vessels in
the cervix and the lower uterine segment. The mother feels an urge to push or to
have a bowel movement. This is the most severe and difficult phase was for the
mother.
Oriented the patient to the surroundings (that is, room, call bell).
In this phase opstractic history taken (previous C/S)
At this stage V/S were taken ,position the mother in semi lateral ,encourage her to
go to the bathroom and walk .the mid wife done abdominal examination
Draw blood for (Hgb), (Hct), and type and X-matching were drawn , clean urine
sample for protein, glucose ,and bacteria were obtained.
Second Stage
Continues reassess the UCs, FHR, progress of labor.
Teach mother how to perform birthing exercise and how to make effective bushing.
Prepare the mother for labor (perennial care) .
Continuous assess the CTG and Pantograph
Poor pushing
Third stage
Episiotomy is Applied R.M.L
5 U of oxytocin IM after delivery of anterior shoulder
Cut umbilical cord
Delivery of placenta
Check placenta
Evacuate the uterus from the clots
Fourth stage
Asses V/S every 15 m for one hour , then every 30 for one hour ,and then for 1
hour(V/S stable and within normal range)h
Assess fundal height, position, and its tone hin the umbilical midline well contracted

Monitor amount of lochia( mild lochia)

Assess the perineum
Palpate the bladder, encourage mother to void
Massage the fundus if boggy )
Encourage and assist with breast feeding as soon possible
Monitor Hgb, Hct level
Encourage the mother to void her bladder after the labor by 1 hour
ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA
Our overview of the reproductive system begins at the external genital area
or vulvawhich runs from the pubic area downward to the rectum. Two folds of

fatty, fleshy tissue surround the entrance to the vagina and the urinary opening: the
labia majora, or outer folds, and the labia minora, or inner folds, located under the
labia majora. The clitoris, is a relatively short organ (less than one inch long),
shielded by a hood of flesh. When stimulated sexually, the clitoris can become erect
like a man's penis. The hymen, a thin membrane protecting the entrance of the
vagina, stretches when you insert a tampon or have intercourse.

INTERNAL REPRODUCTIVE STRUCTURE

The Vagina

The vagina is a muscular, ridged sheath connecting the external genitals to

the uterus, where the embryo grows into a fetus during pregnancy. In the
reproductive process, the vagina functions as a two-way street, accepting the penis
and sperm during intercourse and roughly nine months later, serving as the avenue
of birth through which the new baby enters the world .
The Cervix
The vagina ends at the cervix, the lower portion or neck of the uterus. Like
the vagina, the cervix has dual reproductive functions.
After intercourse, sperm ejaculated in the vagina pass through the cervix,
then proceed through the uterus to the fallopian tubes where, if a sperm encounters
an ovum (egg), conception occurs. The cervix is lined with mucus, the quality and
quantity of which is governed by monthly fluctuations in the levels of the two
principle sex hormones, estrogen and progesterone.
When estrogen levels are low, the mucus tends to be thick and sparse, which
makes it difficult for sperm to reach the fallopian tubes. But when an egg is ready
for fertilization and estrogen levels are high the mucus then becomes thin and
slippery, offering a much more friendly environment to sperm as they struggle
towards their goal. (This phenomenon is employed by birth control pills, shots and
implants. One of the ways they prevent conception is to render the cervical mucus
thick, sparse, and hostile to sperm.)
Uterus
The uterus or womb is the major female reproductive organ of humans. One
end, the cervix, opens into the vagina; the other is connected on both sides to the
fallopian tubes.
The uterus mostly consists of muscle, known as myometrium. Its major
function is to accept a fertilized ovum which becomes implanted into the
endometrium, and derives nourishment from blood vessels which develop

exclusively for this purpose. The fertilized ovum becomes an embryo, develops into
a fetus and gestates until childbirth.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the
ovaries of female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the
ovum to escape and enter the Fallopian tube. There it travels toward the uterus,
pushed along by movements of cilia on the inner lining of the tubes. This trip takes
hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally
implants in the endometrium when it reaches the uterus, which signals the
beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are
produced. The process by which the ovum is released is called ovulation. The speed
of ovulation is periodic and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, where it travelled down
the oviduct to the uterus, occasionally being fertilised on its way by an incoming
sperm, leading to pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs
(cilia) to help the egg cell travel.

INDICATIONS FOR THE PROCEDURE

CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical incision is

made through a mothers abdomen and uterus to deliver one or more babies.
It is usually performed when a vaginal delivery would put the babys or
mothers life or health at risk; although in recent times it has been also
performed upon requests for births that would otherwise have been normal.

Caesarian section (CS) is recommended when vaginal delivery might

pose a risk to the mother or baby. Reasons for CS include:

Precious (high risk) fetus

Prolonged labor or failureto progress (dystocia
Apparent fetal distress
Apparent maternal distress
Complications (pre-eclampsia, active herpes)
Catastrophes such as cord prolapse or uterine rupture
Multiple births
Abnormal presentation (breech or transverse positions)
Failed induction of labor
Failed instrumental delivery
The baby is too large (macrosomia)

Placental problems (placenta previa, placental abruption/

placenta accrete)
Umbilical cord abnormalities
Contracted pelvis
Sexually transmitted infections such as genital herpes
Previous caesarian section
Old age
Breech Presentation