Labor Consists of Regular, Frequent, Uterine Contractions Which Lead To Progressive Dilatation of The Cervix

Labor
Latent Phase Labor · Active Phase Labor · Progress of Labor · Descent · Mechanism of Normal Labor · Pelvic Evaluation
Labor consists of regular, frequent, uterine contractions which lead to progressive dilatation of
the cervix.
Normal Labor Curve
Latent Phase of Labor

Active Phase of Labor
The diagnosis of labor may not be obvious for several reasons:
 Braxton-Hicks contractions are uterine contractions occurring prior to the onset of

labor. They are normal and can be demonstrated with fetal monitoring techniques early
in the middle trimester of pregnancy. These innocent contractions can be painful,
regular, and frequent, although they usually are not.
 While the uterine contractions of labor are usually painful, they are sometimes only
mildly painful, particularly in the early stages of labor. Occasionally, they are painless.
 Cervical dilatation alone does not confirm labor, since many women will demonstrate
some dilatation (1-3 cm) for weeks or months prior to the onset of true labor.
Thus, in other than obvious circumstances, true labor will usually be determined by observing
the patient over time and demonstrating progressive cervical changes, in the presence of
regular, frequent, painful uterine contractions. False labor is everything else.
The cause of labor is not known but may include both maternal and fetal factors.
Latent Phase Labor

The first stage of labor is that portion leading up to complete dilatation. The first stage can be
divided functionally into two phases: the latent phase and the active phase.
Latent phase labor (also known as prodromal labor) precedes the active phase of labor. Women
in latent phase labor:
 Are less than 4 cm dilated.

 Have regular, frequent contractions that may or may not be painful.
 May find their contractions wax and wane
 Dilate only very slowly
 Can usually talk or laugh during their contractions
 May find this phase of labor lasting hours to days or longer.
Active Phase Labor

Active phase labor is a time of rapid change in cervical dilatation, effacement, and station.
Active phase labor lasts until the cervix is completely dilated. Women in active phase labor:
 Are at least 4 cm dilated.

 Have regular, frequent contractions that are usually moderately painful.
 Demonstrate progressive cervical dilatation of at least 1.2-1.5 cm per hour.
 Usually are not comfortable with talking or laughing during their contractions.

Ischial Spines
Fetal head at -1 station, 1 cm above the

level of the ischial spines
Progress of Labor
For a woman experiencing her first baby, labor usually lasts about 12-14 hours. If she has
delivered a baby in the past, labor is generally quicker, lasting about 6-8 hours. These averages
are only approximate, and there is considerable variation from one woman to the next, and
from one labor to the next.
During labor, the cervix dilates (opens) and effaces (thins). This process has been likened to the
process of pulling a turtleneck sweater over your head. The collar opens (dilates) to allow your
head to pass through, and also thins (effaces) as your head passes through.
The process of dilatation and effacement occurs for both mechanical reasons and biochemical
reasons.
The force of the contracting uterus naturally seeks to dilate and thin the cervix. However, for
the cervix to be able to respond to these forces requires it to be "ready." The process of
readying the cervix on a cellular level usually takes place over days to weeks preceding the
onset of labor.
Labor should be progressive. Serial vaginal examinations are used to plot the course of labor,
detect abnormalities and allow for intervention. While there are no set time intervals for
performing pelvic examinations, the cervix should progressively dilate during active phase
labor at a rate of no less than 1.2 cm/hour (for first babies) to 1.5 cm/hour (for subsequent
babies).
Descent
Descent means that the fetal head descends through the birth canal. The "station" of the fetal
head describes how far it has descended through the birth canal.
This station is determined relative to the maternal ischial spines, bony prominences on each
side of the maternal pelvic sidewalls.
"0 Station" ("Zero Station") means that the top of the fetal head has descended through the birth
canal just to the level of the maternal ischial spines.
This usually means that the fetal head is "fully" engaged (or "completely engaged"), because
the widest portion of the fetal head has entered the opening of the birth canal (the pelvic inlet).
If the fetal head has not reached the ischial spines, this is indicated by negative numbers, such
as -2 (meaning the top of the fetal head is still 2 cm above the ischial spines).
If the fetal head has descended further than the ischial spines, this is indicated by positive
numbers, such as +2 (meaning the top of the head is now 2 cm below the ischial spines).
Negative numbers above -3 indicate the fetal head is unengaged (floating). Positive numbers
beyond +3 (such as +4 or +5) indicate that the fetal head is crowning and about to deliver.
Women having their first baby often demonstrate deep engagement (0 or +1) for days to weeks
prior to the onset of labor.
Women having their second or third baby may not engage below -2 or -3 until they are in labor,
and nearly completely dilated.
Mechanism of Normal Labor

There are five classical steps in the normal mechanism of labor. They are: Descent, Flexion,
Internal Rotation, Extension, and External Rotation.
Usually, labor progresses in this fashion, if the fetus is of average size, with a normally
positioned head, in a normal labor pattern in a woman whose pelvis is of average size and
gynecoid in shape.
There is overlap of these mechanisms. The fetal head, for example, may continue to flex or
increase its flexion while it is also internally rotating and descending.
Read more detail about the Mechanism of Normal Labor
Platypoid
Gynecoid
Android
Anthropoid
Pelvic Inlets
Pelvic Evaluation
There are four basic pelvic shapes:
 Gynecoid
 Android
 Anthropoid
 Platypoid
A gynecoid pelvis is oval at the inlet, has a generous capacity and wide subpubic arch. This is
the classical female pelvis.
A platypoid pelvis is flattened at the inlet and has a prominent sacrum. The subpubic arch is
generally wide but the ischial spines are prominent. This pelvis favors transverse presentations.
An anthropoid pelvis is, like the gynecoid pelvis, basically oval at the inlet, but the long axis is
oriented vertically rather than side to side.Subpubic arch may be slightly narrowed. This pelvis
favors occiput posterior presentations.
An android pelvis is more triangular in shape at the inlet, with a narrowed subpubic arch.
Larger babies have difficulty traversing this pelvis as the normal areas for fetal rotation and
extension are blocked by boney prominences. Smaller babies still squeeze through.

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Labor

Normal Labor Curve

Latent Phase of Labor

 Braxton-Hicks contractions are uterine contractions occurring prior to the onset of

Latent Phase Labor

 Are less than 4 cm dilated.

Active Phase Labor

 Are at least 4 cm dilated.

Fetal head at -1 station, 1 cm above the

Mechanism of Normal Labor

Read more detail about the Mechanism of Normal Labor

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