Labor

 Normal Labor 

DEFINITION 

Labor is the process in which viable product of the conception such as fetus and placenta come out ot the uterine cavity through the vaginal canal.

TYPE OF LABOR

1. Normal labor

2. Abnormal labor

1. Normal labor :- 

• It is also known a eutocia
• It starts spontaniously.
• Presentation of fetus is vertex type. 
• Termination of the labor process occurs spontanuously.
• Labor assosiated complication are absent. 
• In primigravida, its duration is about 14-16 hours. Whereas in multipara, it is about 8-10 hrs.
• 2. Abnormal labor
• It is known as dystosia.
• When labour process does not start spontenuosly.
• When labor process does not termination spontenously.
• When labour process ocur prolonged .
• When presentation of fetus is of any type other than vertex.
• When the labor process associated with any complication, like maternal distress, fetal distress etc. 

True Labor Pain and False Labor Pain 

Causes of Labour 

1. Oestrogen stimulation theory
2. Progestron withdrawal theory 
3. Oxytocin theory 
4. Prostaglandin theory
5. Streatching of the uterus 

Sign of true labour

•  Presece of painful and rhythmic uterine contraction 
• Progresive diletation of the cervix 
• Progresive effecement of the cervix 
• Presence of SHOW
• Formation of water bag

Mechanism Of Normal Labour

The Positional changes occuring on the fetal head in an orderly way by which it accommodates or adapts itself with the various diameter of the pelvis.  During its journey through it maternal pelvis. Are known as mechanism of labour.

Mechanism of labour in LOA position 

1. Engagement
2. Desecnt of the presenting part 
3. Flexion of the head 
4. Internal rotation 
5. Crowning 
6. Extension 
7. Restitution
8. External rotation
9. Expulsion of the shoulder and trunk

1. Engagement :- 

• Engagement is the positive sign of pregnancy. 
• When the widest diameter of the fetal head passasses through the pelvic brim. It is known as engagement.
• During engagement the baby drops down so it causes visible changes in the shape of the women abdomen.
• 2. Descent of the presenting part
• After engagement the fetal presenting part gradually descent deeply into the pelvis, if known cephalopelvic disproporsion is present.
• Folowing factor play in important role in the desent of the fetal head. 
• A. Uterine contraction and retraction,
• B. Voluntary effort by mother 
• 3. Flexion of the head 
• Flexion of the head is helpful in its downward movement as it reducess the size and shape of the plane of the advancing diameter of the fetal head.
• 4. Internal Rotation 
• The movement of internal rotation is very essential for the complitation of labor process as the fetal head reacheses the pelvic floor. 
• 5. Crowning 
• After the movement of internal rotation the fetal head gradually and continuously descends in the birth canal and it starts showing up through the vaginal inroitus with each uterine contraction. 
• 6. Extention 
• After internal rotation, one more movement is required for the delivery of the fetal head, known as extension.
• 7. Restitution 
• After delivery of the fetal head by extention, movement of restitution take place for intwisted the neck. This movement occurs in just opposite direction to that of internal rotation. For example during internal rotation in LOA position fetal head rotates from left to right side at an angle of 45 degree. 
• 8. External Rotation 
• After restitution internal rotation of the shoulder occurs so that these could be located in the anterioposterior diameter of the pelvic. The internal rotation of shoulder occurs at an angle of 45 degree. 
• 9. Expulsion of the shoulder and trunk.
• After dilivery of the shoulder by lateral flexion the trunk and rest of the body are delivered smoothly.

STAGES OF LABOUR

There are four stages of labour process. 

1. First stage of labour
2. Second stage of labour 
3. Third stage of labour
4. Fourth stage of labour 

First Stage of labour

It is also known as cervical stage. The first stage of labour starts with the onset of true labour pain and complete with the full diletation of the cervix. 

Duration :- In primigravida , is about 12-14 hours.

                      In Multipara it is about 6-8 hours

There are three sub stages of the First stage of labor

1. Latent phase
2. Active phase 
3. Transition  Phase

A. Latent phase :- This stage starts with the onset of true labour pain and completes when the cervix is about 2.5 cm dialated. In starting uterine contraction appear after about 15-20 Min. Later this intervial reducess 5-7 Min .

Initially duration of contraction is about 10-20 Sec which increases upto 30-40 sec by the end of this phase. 

Duration :- 

                        Primigravida :- -6-8 hrs

                        Multipara        :- 4-5 hrs

B. Active phase :- It is also known as acceleration phase. It start when cervical dilatation is about 2.5 cm and ends when the dilitation is about 8 cm. 

Duration of contraction :- During this phase, uterine contraction reappear after every 3-5 min whereas duration is about 

60 Sec. 

Duration :- 

                    Primigravida :-  4-5 hrs

                    Multipara        :- 2-3 hrs

C. Transition Phase :- It is the last and smallest Substage of the first stage of labour. During this phase frequency, duration and intensity of the uterine contraction increased very rapidly. 

Duration:- 

                    Primigravida :-  2 hrs

                    Multipara        :- 1-1.5 hrs

Physiological changes during first stage of labour. 

• Presence of painful uterine contraction 
• Full dilatation of the cervix 
• Cervical effecement 
• Formation of lower uterine segment 
• Presence of SHOW 
• Formation of bag of water 
• Rupture of mamebrain 
  
• Change in VItal sign 

MANAGEMENT OF FIRST STAGE OF LABOUR

First stage of labour is the preparatory stage in which birth canal is prepared so that intrauterine fetus could pass through it into the external world.

During this stage, the women should be monitered carefully.

PURPOSE OF MANAGEMENT

• To ensure birth of a live and healthy baby.
• To diagnose labour cmplication in early stage.
• Prevent maternal and fetal complication.
• To reduce maternal mortality and infant mortality.

PRINCIPLES:-

• If the general health status of the women and her fetus is good there is satisfactory. 
• Provide psychological support of the women 
• If any abnormilities is detected then imideate informe to the doctor 
• During management, Use strict aseptic technique 
• Avoid to performe unnecesserly vaginal examination 

PREPRATION OF LABOUR ROOM 

• Temprature of the labour room should be between 25-28 degree celcius. 
• Collect the all require article near the labour table 
• All the article should be sterile 
• Labour room should be well lighted and peaceful environment.
• Pregnant women should be provided hospital Gown. 
• Examination of the women and providing care, Complete privacy should be maintained 
• Birth attendence should be use a required personal protective equipments. 

MANAGEMENT OF FIRST STAGE LABOUR CAN BE DIVIDED INTO TWO PART

A. Close monitoring of the women

B. Supportive care

A. Close monitoring of the women