You may know that you are getting close to labor if your due date is approaching, your baby has moved into the vertex position, or your doctor has noticed your cervix beginning to dilate. Signs that you are going into labor include feeling regular contractions and pain in the belly and lower back. You may experience some contractions before going into true labor—the difference is that contractions that signal labor are regular and get stronger. Additionally, you may see a “bloody show,” a bloody mucous discharge. Your water may also break. Your “water breaking” is when the amniotic sac that surrounds the baby in the womb ruptures. When this happens, you will notice a watery discharge or sensation. Show
First Stage or Early Labor The first stage of labor, also called early labor, is by far the longest. It begins at the onset of labor and continues until the cervix is fully dilated. Cervical dilation is critical—the cervix is an extremely
narrow passageway between the uterus and vagina that needs to stretch and thin to allow the baby to fit through. For reference, the cervix needs to grow from one inch, the size of a small grape, to ten inches, the size of a grapefruit, during this stage. So this is easily the longest stage of delivery. This early stage is divided into two phases, the latent and the active phases. It usually takes around 20 hours from start to finish for first-time mothers. The latent phase of labor lasts anywhere from five to twenty hours or more and is complete when the cervix is dilated to about 4 centimeters. Cervical dilation is measured by feeling the cervical opening with two fingers. Contractions are mild, and pain is minimal during this phase. Most mothers stay home during the latent phase, as it is the longest phase and medical attention is not usually needed. The active phase of labor lasts an average of two to eight hours
during which time contractions become stronger and more rhythmic, signaling that it’s time to go to the hospital. Throughout the active phase, the cervix becomes fully dilated to 10 centimeters and the baby’s head descends into the pelvis. Pain Gets Worse Over This Stage Unfortunately, labor gets more and more painful as the cervix nears complete dilation. Widening from 6 centimeters to 10 centimeters, called the transition phase, can be especially difficult because it often happens within an hour. Pain management methods like epidurals and pain medications may be used from the active phase onward. Doctors and nurses in the delivery unit closely monitor fetal heart rate and cervical dilation during the first stage of labor. This is so that they can intervene if the baby becomes distressed or the labor is not progressing. If the amniotic sac has not ruptured, doctors may perform an amniotomy to rupture the membrane. Second Stage or Active Labor The second stage, also called active labor, is the pushing stage of labor. The second stage is the most painful stage of labor. The baby passes through the cervix, through the pelvis and birth canal, and out through the vaginal opening. On average, it takes one to three hours from the time that the cervix
becomes fully dilated to the birth of the baby. Because the baby’s head has moved from the uterus to the birth canal, uterine contractions must be replaced by the mother pushing herself (which is a big reason why stage two is the most painful stage of labor). Midwives, doulas, and family members may be especially important during active labor to help coach the mother through the hard work of pushing. During the second stage, doctors watch carefully for signs of complications affecting either the mother or child. They closely monitor the baby’s heart rate and position to make sure that he or she is not in distress or stuck. Third Stage of Labor The third stage consists of the delivery of the placenta, also known as afterbirth. The duration of the third stage is short. Usually, it takes only a few minutes for the placenta to follow the baby. While waiting for the placenta, doctors continue to check on the health of the baby and mother, including the baby’s heart rate and vital signs. If the placenta is not delivered, it must be surgically removed to prevent serious health complications. 5.1.1 General recommendationsPersonnel should wear personal protective equipment (gloves, goggles, clothing and eye protection) to prevent infection from blood and other body fluids. Ensure a calm reassuring environment and provide the woman as much privacy as possible during examinations and delivery. Encourage her to move about freely if desired and to have a person of her choice to accompany her. Anticipate the need for resuscitation at every birth. The necessary equipment should be ready at hand and ready for use. 5.1.2 Diagnosing the start of labour– Onset of uterine contractions: intermittent, rhythmic pains accompanied by a hardening of the uterus, progressively increasing in strength and frequency; Repeated contractions without cervical changes should not be considered as the start of labour. Repeated contractions that are ineffective (unaccompanied by cervical changes) and irregular, which spontaneously stop and then possibly start up again, represent false labour. In this case, do not rupture the membranes, do not administer oxytocin. Likewise,
cervical dilation with few or no contractions should not be considered the start of labour. Multiparous women in particular may have a dilated cervix (up to 5 cm) at term before the onset of labour. 5.1.3 Stages of labourFirst stage: dilation and foetal descent, divided into 2 phases1) Latent phase: from the start of labour to approximately 5 cm of dilation. Its duration varies depending on the number of prior deliveries. Figure 5.1 - Dilation curve
in the primipara (in a multipara, the curve is shifted to the left) Second stage: delivery of the infantBegins at full dilation. Third stage: delivery of the placentaSee Chapter 8. 5.1.4 First stage: dilation and descent of the foetusThe indicators being monitored are noted on the partograph (Section 5.2). Uterine contractions– Contractions progressively increase in strength and frequency: sometimes 30 minutes apart early in labour;
closer together (every 2 to 3 minutes) at the end of labour. General condition of the patient– Monitor the heart rate, blood pressure and temperature every 4 hours or more often in case of abnormality. Foetal heart rateFoetal heart rate monitoringUse a Pinard stethoscope or foetal Doppler, every 30 minutes during the active phase and every 5 minutes during active second stage, or as often as possible. Listen to and count for at least one whole minute immediately after the contraction. Normal foetal heart rate is 110 to 160 beats per minute. Management of abnormal foetal heart rate– In all cases: − If the foetal heart rate is less than 100 beats/minute: − If the foetal heart rate is more than 180 beats/minute: If the abnormal foetal heart rate persists or the amniotic fluid becomes stained with meconium, deliver quickly. If the cervix is fully dilated and the head engaged, perform instrumental delivery (vacuum extractor or forceps, depending on the operator’s skill and experience); otherwise consider caesarean section. Dilation during active phase– The cervix should remain soft, and dilate progressively. Dilation should be checked by vaginal examination every 4 hours if there are no particular problems (Figures 5.2). Figures 5.2 - Estimating cervical dilation Amniotic sac– The amniotic sac bulges during contractions and usually breaks spontaneously after 5 cm of dilation or at full dilation during delivery. Immediately after rupture, check the foetal heart rate and if necessary perform a vaginal examination in order to identify a potential prolapse of the umbilical cord
(Section 5.4). Once the membranes are ruptured, always use sterile gloves for vaginal examination. Foetal progress– Assess foetal descent by palpating the abdomen (portion of the foetal head felt above the symphysis pubis) before performing the vaginal examination.
– Use reference points on the foetal skull to determine the position of the head in the mother's pelvis. It is easier to determine the position of the head after the membranes have ruptured, and the cervix is more than 5 cm dilated. When the head is well flexed, the anterior (diamond-shaped) fontanelle is not palpable; only the sagittal suture and the posterior (triangular) fontanelle are. The posterior fontanelle is the landmark for the foetal occiput, and thus helps give the foetal position. In most cases, once the head is engaged, rotation of the head within the pelvis brings the foetal occiput under the mother's symphysis, with the posterior fontanelle along the anterior midline. 5.1.5 Second stage: delivery of the infantFundal pressure is always contra-indicated. This stage is often rapid in a multipara, and slower in a primipara. It should not, however, take longer than 2 hours in a multipara and 3 hours in a primipara If there is a traditional delivery position and no specific risk for the mother or child has been established, it is possible to assist a delivery in a woman on her back, on her left side, squatting or on all fours (Figures 5.4). Figures 5.4 - Delivery position – Rinse the vulva and perineum with clean water. Figures 5.5 - The different stages of occiput-anterior delivery Figures 5.6 - Progressive delivery of the head During this final phase—an active one for the birth attendant—the woman should stop all expulsive efforts and breathe deeply. With one hand, the birth attendant controls the extension of the head and moves it slightly side-to-side, in order to gradually free the parietal protuberances; if necessary (not routinely), the chin can be lifted with the other hand (Figure 5.7). Figure 5.7 - Bringing the perineum under the chin – At the moment of delivery, the perineum is extremely distended. Controlling the expulsion can help reduce the risk of a tear. Episiotomy (Section 5.8) is not routinely indicated. In an occiput-posterior delivery (Figure 5.8), where perineal distension is at a maximum, episiotomy may be helpful. Figure 5.8 - Occiput-posterior delivery – The head, once delivered, rotates spontaneously by at least 90°. The birth attendant helps this movement by grasping the head in both hands and exerting gentle downward traction to bring the anterior shoulder
under the symphysis and then deliver it then, smooth upward traction to deliver the posterior shoulder (Figures 5.9). Figures 5.9 - Delivery of
shoulders – Place the neonate on mother's chest. For neonatal care, see Chapter 10, Section 10.1. 5.1.6 Oxytocin administrationAdminister oxytocin to the mother immediately and then deliver the placenta (Chapter 8, Section 8.1.2). 5.1.7 Umbilical cord clampingSee Chapter 10, Section 10.1.1. When does latent phase of labor begin?The latent phase of labour is the very beginning part of the first stage of labour. The latent phase begins with a long, firm cervix that is closed accompanied by irregular contractions and ends with a thin, paper like cervix that is soft and 4cm dilated accompanied by regular contractions.
What does the latent phase of labour do?What can help during the latent phase of labour?. Make sure your companions help you achieve a calm, tranquil environment.. Try relaxing in a warm bath.. Distract yourself by listening to music or watching TV.. If the contractions are becoming uncomfortable, try using a TENS machine.. When does the latent phase of labor end?How long does the latent phase last? Another common question: “Now the latent phase has started, how long will it last?” It depends. Some women will feel these “ouch” contractions for days, others for only hours. Here's the good news: Usually laboring for your first birth takes the longest (12 to 18 hours).
What is the first stage of labor?During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour. At the start of labour, your cervix starts to soften so it can open. This is called the latent phase and you may feel irregular contractions.
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