Labor

and
Delivery
By: Ma. Kizianne Krystel Manio
 Labor
Labour is the term for the changes
in anatomy and physiology in the
female reproductive tract that
prepare the fetus and the
placenta for delivery. Labour
heralds the end of the baby’s time
in the uterus and the beginning
of adaptation to life outside the
mother.
A normal labour has the following characteristics:

• Spontaneous onset (it begins on its own, without

medical intervention) .
• Rhythmic and regular uterine contractions .
• Vertex presentation (the ‘crown’ of the baby’s
head is presented to the opening cervix.
• Vaginal delivery occurs without active
intervention in less than 12 hours for a
multigravida mother and less than 18 hours for a
primigravida (first birth) . No maternal or fetal
complications
How do you know that true labour has
begun?

True labour is characterized by regular,

rhythmic and strong uterine contractions that
will increase progressively and cannot be
abolished by antipain medication. Pain
symptoms may be relieved a little if the
woman takes painkilling drugs, but true
labour will still progress.
What is adequate uterine
contraction?
If true labour is progressing, there will be
adequate uterine contraction, evaluated on the
basis of three features — the frequency, the
duration and the intensity of the contractions:
The frequency of uterine contractions will be 3-5
times in every 10 minute period. Each
contraction lasts 40–60 seconds; this is known as
the duration of contractions. The woman tells
you that her contractions feel strong; this is the
intensity of contractions.
Distinguishing true labour from false
labour

There is a condition termed false

labour, which may be felt one or two
weeks ahead of true labour. It is
characterised by irregular contractions
which are less painful than in true labour
and they don’t progress.
Mercury
 There is no way to be sure
when a woman’s labour will begin,
but there are some signs that it will
start soon. Babies often drop lower
in the mother’s belly about 2 weeks
before birth, which is known as
lightening; commonly, mothers feel
that the baby is no longer lying
‘high’ in the abdomen, and not
pushing her stomach upwards. If
she has had babies before, this baby
may not drop until labour begins.
Stages
of
labor
The first stage of labour (the cervical
opening stage)

The first stage of labour is

characterized by progressive opening of
the cervix, which dilates enough to let the
baby out of the uterus. For most of the
pregnancy, nothing can get in or out of the
cervix, because the tiny opening in it is
plugged with mucus.
 During pregnancy the cervix is long and firm, but the
immediate effect of uterine contraction is to dilate the cervix
and shorten the lower segment of the uterus, so the edges of the
cervix are gradually drawn back and are taken up. This process
is called effacement.
The cervix then dilates (the diameter gradually
increases) – this is known as cervical
dilatation.

Each time the uterus contracts, it pulls a

little bit of the cervix up and open. Between
contractions, the cervix relaxes. The first stage is
divided into two phases: the latent and the
active phase, based on how much the cervix has
dilated.
Latent Phase

The latent phase is the period between

the start of regular rhythmic contractions
up to cervical dilatation of 4 cm. The latent
phase ends when the rate at which the
cervix is dilating speeds up (it dilates more
quickly). This signals the start of the active
phase.
 Active phase
The active phase is said to be when the
cervix is greater than 4 cm dilated.
Contractions become regular, frequent and
usually painful. The rate of cervical dilation
becomes faster and it may increase in
diameter by as much as 1.2 to 1.5 cm per
hour, but the minimum dilation rate should
be at least 1 cm per hour.
Second Stage of Labour
-begins when the cervix is fully dilated
(10 cm) and is completed when the baby is
completely born. After the cervix is fully
dilated, the mother typically has the urge to
push.
Fetal descent, efforts in ‘bearing
down’ with the contractions of the uterus
move the baby out through the cervix and
down the vagina.
What happens during second stage of labour?

During second stage, when the baby is high

in the vagina, you can see the mother’s genitals
bulge during contractions. Her anus may open a
little. Between contractions, her genitals relax.
What happens during second stage of labour?
Mechanisms of normal labour
The seven cardinal movements are the series of
positional changes made by the baby which assist its passage
through the birth canal
Engagement is when
the fetal head enters
into the pelvic inlet.
Descent is used to
describe the
progressive downward
movement of the fetal
presenting part
through the pelvis.
Mechanisms of normal labour
Flexion occurs during
descent and is brought
about by the resistance
felt by the baby’s head
against the soft tissues
and bones of the mother’s
pelvis.

Internal rotation occurs

while the baby is still
completely inside the
mother.
Mechanisms of normal labour
Extension of the baby’s
head and neck occur – the
neck extends, so the chin
is no longer pressed
against the baby’s chest,
and the top of the head,
face and chin are born
External rotation, baby
must rotate so that baby’s
face moves from facing
the mother’s backbone to
facing either of her inner
thighs.
Mechanisms of normal labour
Almost immediately after
external rotation, the anterior
(foremost) shoulder moves out
from under the pubic bone
(diagram 7). The mother’s
perineum becomes distended
by the posterior (second)
shoulder, which is then also
born (diagram 8).
The rest of the baby’s body is then
born (expulsion), with an upward
motion of the baby’s body assisted by
the care provider.
Third stage of labour

The third stage of labour begins with

the birth of the baby and ends with the
delivery of the placenta and fetal
membranes. Normally, it should last less
than 30 minutes.
Natural processes during the third stage
1. Separation of the placenta: The placenta separates
from the wall of uterus. As it detaches, blood from the tiny
vessels in the placental bed begins to clot between the
placenta and the muscular wall of the uterus (the
myometrium).

2. Descent of the placenta: After separation, the placenta

moves down the birth canal and through the dilated cervix

3. Expulsion of the placenta: The placenta is completely

expelled from the birth canal
Active management of third stage of labour

Active Management Of Third Stage of

Labour (AMTSL) is the key to reducing
the risk of the complications

The term ‘active management’ indicates

that you are not waiting for spontaneous
placental delivery.
Six steps of AMTSL in sequence

Step 1 Check the uterus – is there a

second baby?
Immediately after the birth of the baby, check for the
presence of a second baby by palpating the uterus
through the mother’s abdomen. When you feel
certain that the uterus does not contain a second
baby, and you can feel that it has reduced in size to no
larger than at 24 weeks of gestation, go to step 2.
Step 2: Administer a uterotonic drug to help the
uterus contract

The commonly used uterotonic drugs in obstetric

practice are:
• misoprostol (tablets)
• oxytocin (injectable)
• ergometrine (injectable).

These drugs help the uterus to continue contracting

strongly and rhythmically after the baby is born: they
facilitate placental delivery and help to prevent excessive
bleeding from a relaxed (atonic) uterus.
Step 3: Apply controlled cord traction with
counterpressure

When the uterus is well

contracted it will feel very
hard. This should occur 2– 3
minutes after the
administration of one of the
uterotonic drugs. Then
controlled cord traction with
counter pressure is used to
help to expel the placenta.
How to do controlled cord traction with counterpressure
Delivery of the
placenta marks the
end of the third stage
of labour. At this time
the uterus should be
hard, round and
movable when you
palpate the abdomen.
 Step 4: Massage the uterus
Right after the placenta is delivered, rubbing the uterus is a
good way to contract it and stop the bleeding. Many women
need their uterus rubbed to help it to contract

Rub the uterus

immediately after the birth,
then every 15 minutes for 2
hours, then every 30
minutes. Show the woman
how to rub her own uterus,
or a relative may help.
Step 5: Examine the placenta and fetal membranes
You must look carefully at the placenta to be sure that
none of it is missing.

If a portion of the maternal surface

(bottom of the placenta, see Figure 6.5)
is missing, or there are torn
membranes with blood vessels,
suspect that retained placenta
fragments remain in the uterus and
refer the mother quickly.
*It is dangerous for the mother if any parts of the
placenta or membranes are left behind in the
uterus. She is more at risk of postpartum
haemorrhage if a piece of the placenta is retained
in the uterus
Step 6: Examining for cuts, tears and bleeding

This is the last step and is important to avoid

postpartum hemorrhage.
Fourth stage of labour

The first four hours immediately following

placental delivery are critical, and have been
designated by some experts as the fourth stage of
labour. This is because after the delivery of the
placenta, the woman can have torrential vaginal
bleeding due to failure of uterine contractions to
close off the torn blood vessels where the placenta
detached from the uterine wall.
What is postpartum haemorrhage?

Postpartum haemorrhage (or PPH) is

defined as excessive bleeding from the
reproductive tract at any time following the baby’s
birth and up to six weeks after delivery. Some 70-
90% of PPH cases occur within the first 24 hours
after delivery and are due to failure of the uterus to
contract properly after the placenta detaches.
Classification of postpartum haemorrhage

Classifications based on the timing of bleeding are:

• Primary postpartum haemorrhage is
excessive bleeding occurring during the third
stage of labour, or within 24 hours of delivery. .
• Secondary postpartum haemorrhage (also
known as late postpartum haemorrhage)
includes excessive bleeding occurring between
24 hours after delivery of the baby and 6 weeks
postpartum.
THANK
YOU!