Process of Labour Labour is the expulsion or extraction of viable fetus out of the uterus.

Delivery may be vaginal (either spontaneous or aided) or it may be abdominal. Labour is a series of events that takes in the genital organs in an effort to expel the viable products of conception out of the uterus through the vagina. Usually it occurs between 3 !"# weeks of pregnancy. $f labour occurs before 3% weeks& it is termed as preterm labour. 'xpulsion of conceptual products before # weeks is called abortion. Normal labour: (ormal labour ('utocia) occurs at term and is spontaneous in onset with the fetus presenting by the head. )he process is completed within *#!* hours and no complications arise by which the fetus& placenta and membrane are expelled through the birth canal. Dystocia is the term used to denote a difficult labour Factors affecting Labour Process Passages: )he passage is the ade+uate pelvic dimension& pelvic floor muscles& soft tissues of the cervix and vagina. Passenger: )he passenger is the ade+uate fetal dimensions like the fetal lie& fetal si,e& fetal position& fetal presentation and attitude.

Powers: )he mother exhibits both voluntary and involuntary powers to expel the fetus. -rimary powers are the uterine contractions and secondary powers are the maternal efforts taken to expel the fetus with the help of abdominal muscles and the diaphragm. Position. Upright position helps in descent of the presenting partand also reduces incidence of umbilical cord compression and improves cardiac workload Psyche of the mother: 'motional status of the mother also influences the outcome of labour.

Theories of Labor Onset

Labor normally begins when a fetus is sufficiently mature to cope with extrauterine life yet not too large to cause mechanical difficulty with birth. )he trigger that converts the random& painless /raxton 0icks contractions into strong& coordinated& productive labor contractions is unknown. $n some instances& labor begins before a fetus is mature (preterm birth). $n others& labor is delayed until the fetus and the placenta have both passed beyond the optimal point for birth (postterm birth). 1lthough a number of theories have been proposed to explain why labor begins& it is believed that labor is influenced by a combination of factors originating from the mother and the fetus. )he following are the causes for the onset of labor. Uterine muscle stretching. )he excessive stretching of the myometrium due to growing fetus results in release of prostaglandins -ressure on the cervix& which stimulates the release of oxytocin from the posterior pituitary

2xytocin stimulation& which works together with prostaglandins to initiate contractions 3hange in the ratio of estrogen to progesterone (increasing estrogen in relation to progesterone stimulates uterine contractions) -lacental age& which triggers contractions at a set point 4ising fetal cortisol levels& which reduce progesterone formation and increase prostaglandin formation 5etal membrane production of prostaglandin& which stimulates contractions Uterus becomes stretched and the pressure increases causing physiological changes. 1s pregnancy advances there is a gradual rise in oxytocin level (a hormone which is responsible for uterine contraction). )here is increased production of prostaglandin by fetal membranes and uterine decidua. )he mutual coordinated effects of oxytocin and prostaglandin initiate the rhythmic contractions of true labour.

Signs of Labor 6igns of true labor involve uterine and cervical changes. )he more a woman knows about true labor signs& the better& because then she will be better able to recogni,e them. )his is helpful both to prevent preterm birth and for the woman to feel secure knowing what is happening during labor. Lightening $n primiparas& lightening& or descent of the fetal presenting part into the pelvis& occurs approximately *7 to *" days before labor begins. )his changes a woman8s abdominal contour& because the uterus becomes lower and more anterior. Lightening gives a woman relief from the diaphragmatic pressure and shortness of breath that she has been experiencing and in this way 9lightens: her load. Lightening probably occurs early in primiparas because of tight abdominal muscles. $n multiparas& it is not as dramatic and usually occurs on the day of labor or even after labor has begun. 1s the fetus sinks lower in the pelvis& the mother may experience shooting leg pains from the increased pressure on the sciatic nerve& increased amounts of vaginal discharge& and urinary fre+uency from pressure on the bladder. Increase in Level of ctivity 1 woman may awaken on the morning of labor full of energy& in contrast to her feelings of chronic fatigue during the previous month. )his increase in activity is related to an increase in epinephrine release that is initiated by a decrease in progesterone produced by the placenta. 1dditional epinephrine prepares a woman8s body for the work of labor ahead. !ra"ton #ic$s %ontractions $n the last week or days before labor begins& a woman usually notices extremely strong /raxton 0icks contractions& which she may interpret as true labor contractions. -rimiparas may have great difficulty in distinguishing between the two forms of contractions. 1 woman may be admitted to the labor unit of a hospital or birthing center because false contractions so closely simulate true labor. &ipening of the %ervi" 4ipening of the cervix is an internal sign seen only on pelvic examination. )hroughout pregnancy& the cervix feels softer than normal& similar to the consistency of an earlobe (;oodell8s sign). 1t term& the cervix becomes still

softer (described as 9butter!soft:). 4ipening is an internal announcement that labor is very close at hand.

'terine %ontractions

)he surest sign that labor has begun is productive uterine contractions. /ecause contractions are involuntary and come without warning& their intensity can be frightening in early labor. 0elping a woman appreciate that she can predict her pattern and therefore can control the degree of discomfort she feels by using breathing exercises offers her a sense of control. Show 1s the cervix softens and ripens& the mucus plug that filled the cervical canal during pregnancy (operculum) is expelled. )he exposed cervical capillaries seep blood as a result of pressure exerted by the fetus. )he blood& mixed with mucus& takes on a pink tinge and is referred to as 9show: or 9bloody show.: <omen need to be aware of this event so that they do not think they are bleeding abnormally. &upture of the (embranes Labor may begin with rupture of the membranes& experienced either as a sudden gush or as scanty& slow seeping of clear fluid from the vagina. 6ome women may worry if their labor begins with rupture of the membranes& because they have heard that labor will then be 9dry: and that this will cause it to be difficult and long. 1ctually& amniotic fluid continues to be produced until delivery of the membranes after the birth of a fetus& so no labor is ever 9dry.: 'arly rupture of the membranes can be advantageous if it causes the fetal head to settle snugly into the pelvis= this can actually shorten labor. )wo risks associated with ruptured membranes are intrauterine infection and prolapse of the umbilical cord& which can cut off the oxygen supply to the fetus. $n most instances& if labor has not spontaneously occurred by #" hours after membrane rupture and the pregnancy is at term& labor is induced to help reduce these risks. During the last few weeks of pregnancy number of changes occur in women. <alking is more difficult as the fetal head enters into the pelvis )here is fre+uency of micturition

)here is backache due to relaxation of sacroiliac of >oints )here may be spurious or false pains )ifferentiation !etween True an* False Labor %ontractions False %ontractions /egin and remain irregular. 5elt first abdominally and remain confined to the abdomen and groin. 2ften disappear with ambulation and sleep. Do not increase in duration& fre+uency& or intensity. Do not achieve cervical dilatation. True %ontractions

/egin irregularly but become regu

5elt first in lower back and sweep abdomen in a wave.

3ontinue no matter what the wom

$ncrease in duration& fre+uency& a

1chieve cervical dilatation.

Features of true labour pain: *. Uterine contractions (labour pains) occur in regular intervals& #. $ntensity of labour pain increases with time 3. )he labour pain is located in back and abdomen. ". <alking intensifies the pain. ?. -ain is not affected by mild sedatives. @. -ain results in progressive& cervical dilation Stages of labour: First stage of labour: )his is the stage of dilatation of the cervical 26. $t begins with the onset of true labour contractions to full dilatation of the cervix. Duration of first stage

is an average of *3 hours for nullipara and %.? hours for multipara. )he first stage is clinically manifested by progressive uterine contraction& progressive taking up of the cervix and ultimate rupture of membranes. Secon* stage of labour: $t is the stage of fetal expulsion. $t begins with full dilation of cervical 26 and ends with the birth of the baby. 6econd stage lasts for one to one and half hours for nullipara and #7 to "? minutes in multipara. Thir* stage of labour: $t is the stage of separation and expulsion of the placenta and membranes. $t begins with birth of the baby until the expulsion of placenta and membranes. )he third stage may last from few minutes to thirty minutes. Fourth stage: )he fourth stage lasts from the delivery of placenta and membranes until the postpartum condition of the women has become stabili,ed. )his stage is usually one hour after delivery. $n this stage the mother must start breast! feeding her infant.