Stages of Labor

There are three stages of labor. The first stage occurs from the time true labor begins until the cervix
is completelydilated and effaced. During the second stage the baby is delivered. The third stage
follows the birth of the baby through the birth of the placenta.

• First Stage

• Second Stage

• Third Stage

• Labor and Delivery Checklist

First Stage

The first stage of labor is the longest. There are three phases within the first stage;

• Early or latent phase

• Active phase

• Transition phase

At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child,

this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first

stage lasts around 6-7 hours.

Early Labor

During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is

the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic

and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness,

cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting.

Most women spend these hours at home, or they may be checked at the hospital and sent home until

labor becomes more active. You may feel eager, excited and social. It is important that you conserve

your energy for the work of labor.

Active Labor

Active labor is marked by regular contractions that become longer, stronger and closer together over
time. Most providers recommend that you go to the hospital when your contractions are five minutes

apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of

one contraction to the beginning of the next.

Your physician will want to know:

• How far apart are the contractions?

• How long they are lasting, and how intense?

• Are you using breathing techniques to manage the pain?

• Has your "bag of water" broken? Your provider will want to know the time this

occurred, and any color or odor.

• Has there been any discharge, such as a bloody show?

If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician

may want to be contacted sooner.

When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing

anything else. Your labor partner's support is important at this phase. Contractions are growing

stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60

seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If

you have learned breathing techniques, begin using them now, if you haven't already. Pain medication

is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this

stage. Please see pain management for more information.

Transition

Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to

two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be

intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is

concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the

end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born.

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Second Stage
During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to

up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina

and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel

movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it

is time to push. It is important that you not push until instructed. Pushing too early will cause the

cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at

the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be

removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and

may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical

cord. The cord is clamped and cut.

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Third Stage

The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the

shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to

deliver the placenta. You will be observed closely for the next few hours to make certain that your

uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower

abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your

new baby.

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Labor and Delivery Checklist

1. Prior to labor, discuss the following issues with your physician or nurse practitioner:

• What do I do if I think I am in labor?

• What pain management options are available?

• When is an episiotomynecessary?

• What are some reasons you might perform a cesarean delivery?

2. If you have not done so, take a hospital tour so you are familiar with the place where

you will give birth.

3. Arrange for help to care for you and the baby after birth, if you can.
 4. Shop and prepare food for the first weeks when you are home with the baby, and

collect take-out menus.

5. Review Preparing for Baby checklist.

6. Make sure you always have gas in the car.

7. Pack your bags. See what to pack for the labor room.

Stages of Labor and Delivery

Delivery Stages

You made it! If you are reading this undoubtedly you are approaching or soon will be approaching the
final stages of pregnancy. You may be wondering what exactly to expect during labor and delivery. There
are two distinct phases of labor - early or latent labor and active labor. Active Labor is subdivided into
three stages, which will be described in more detail below. There is no criteria for exactly predicting the
moment when labor will start. Some women can have all the signs of impending delivery but hold out for
several weeks, whereas others will have no signs and go into active labor in a matter of hours.
Early or Latent Labor
During early labor, you will probably be relatively comfortable. It is generally the longest part of the
birthing process and may last anywhere from one to three days. During this time you may experience
contractions that are mild or moderate, generally lasting anywhere from 30 to 45 seconds. These
contractions may also be irregular in nature, and may stop and re-start again.

During the early phase of labor most women will dilate to 3 cm. During this phase of labor taking a warm
shower may help you relax. Try to sleep if possible to prepare for the active stage of labor.

If you are interested in speeding up the labor process, consider going for long walks which might help
move the baby further into your pelvis.

Most women will be able to talk and function

relatively normal during this phase. You can
typically enjoy this part of labor in the comfort of
your home. Traditionally early labor is longer for
first time mothers than it is for moms who have
given birth previously.

Active Labor
Active labor is characterized by three distinct phases:
• Stage One - The cervix dilates and effaces
• Stage Two - The baby is born
• Stage Three - The placenta is delivered

First Stage
During the first stage the cervix will dilate and efface or thin out, preparing for birth. This stage typically
commences when a woman is 3 to 4 cm dilated. Women will dilate until 10 cm.

Uterine contractions during this phase of labor are generally more intense than they are during early
 labor. They are also more frequent, occurring 2-3 minutes apart and may last from 50-70 seconds.

During active labor the bag of water often breaks.

Most women will report significantly more discomfort or pain during the active stage of labor. Your
physician might offer you some form of pain relief, including use of an epidural to help ease the pain you
are feeling from uterine contractions.

The first stage of active labor ends with the transition phase, where contractions become increasingly
intense as the baby moves into the birthing canal. During this time you will be absorbed by contractions.
You may feel anxious and exhausted.

This is the time where you might start feeling the urge to push. You will be dilated a full 10 cm at this point
in time.

Second Stage
The second stage of active labor is the actual birth of your baby, or the process of pushing the baby out.
This is usually preceded by a powerful urge to push the baby out of the vagina. You may feel a great deal
of pressure in the pelvic region, in your vagina or in the back.

The pushing phase may be short or long. Most first time moms push for 2 to 3 hours, however some
women may push for minutes before the baby passes through the vagina.

Third Stage
The third stage of labor is the time during which the placenta detaches and passes out of the body.
Generally this occurs within 30 minutes after the second stage of labor. Though not as exciting as the
actual birth of your baby, the passage of the placenta is a vital part of labor and delivery.

This process may require that you push a small amount to deliver the placenta. However, many women
are so involved with their baby and the process of birth that they hardly even notice the delivery of the
placenta.

The more prepared for labor you are the more comfortable you will be with the birthing process. Childbirth
education classes can help you prepare for the actual process of labor.

DILATATION AND CURETTAGE

Instruments Used in Dilatation & Curettage

1.
Curettes are the primary instruments of D&Cs.
 A dilation and curettage, also known as a D&C, is a surgical procedure done on the uterus. It
is a relatively common procedure, according to Healthcentral's website. Women sometimes
require this procedure to remove uterine problems such as polyps and cysts, but it also is
used to clean the uterus of potentially harmful matter after miscarriages or abortions.
Regardless of why a doctor performs a D&C, medical professionals use the same
instruments in the procedure. These instruments either control the cervix/uterus or remove
tissue.

Speculums, Retractors, Dilators and Tenaculums

2. Doctors use at least four related instruments to begin a D&C. Speculums and vaginal
retractors move the walls of the vagina and cervix out of the way so that the doctor
performing the D&C has a better view during the procedure. Usually these instruments are
dual sided, and the doctor expands the two sides once the instruments are in the vagina.
Although the stretching of the cervix and vagina may be a bit uncomfortable, these
instruments usually don't cause pain, as the cervix and vagina naturally have some
elasticity. If the speculum and retractors don't open the cervix and vagina enough, then the
doctor also uses dilators to stretch the opening further. Lastly, a doctor may use a
tenaculum to physically grasp the cervix and pull it out of the way.
Forceps (Vulsellas)
3. Ovum and vaginal forceps are instruments that look somewhat like scissors or tongs. The
doctor uses these instruments for grasping problematic or suspicious matter from the
uterus. This is especially useful if the doctor needs to remove specific tissues for lab tests.
Forceps use usually precedes the use of the curet and eliminates the need for excessive
scraping.
Hystetometer
4. The hystetometer, also known as a uterometer or uterine sound, is a probe. The doctor uses
this instrument to get an idea of how the uterus is placed directionally. Doctors also use the
sound in conjunction with physical exams and palpitations to determine where the
abnormalities in the uterus are, according to the University of Bonn and The Global Library
of Women's Medicine.
Curet
5. The curet is the main instrument of a D&C. A curet is a scraping instrument that gently
removes layers of the uterine lining. The removal of tissue through this scraping and minor
cutting is what qualifies a D&C as a surgical procedure. Curettes may be "dull" or "sharp,"
just as any other knife--controlling the sharpness of the curet makes it less likely that the
doctor will perforate the uterine lining in a way that causes excessive bleeding, according to
The Global Library of Women's Medicine. Doctors thus usually use multiple curettes during a
D&C

Read more: Instruments Used in Dilatation & Curettage |

eHow.com http://www.ehow.com/list_6589008_instruments-used-dilatation-
curettage.html#ixzz0re9qUyTY

General Information

DEFINITION--Opening the cervix and scraping the inner wall of the uterus to
remove tissue.
BODY PARTS INVOLVED--Uterus; cervix; vagina (as route for surgery).
REASONS FOR SURGERY
• Diagnosis of abnormal bleeding or possible cancer inside the uterus.
• Incomplete spontaneous miscarriage.
 • Treatment of minor diseases of the uterus.
• Elective abortion during early pregnancy.
SURGICAL RISK INCREASES WITH
• Obesity.
• Smoking.
• Excess alcohol consumption.
• Recent or chronic illness, including anemia, diabetes mellitus, and heart or lung disease.
• Use of drugs, such as: antihypertensives; cortisone; diuretics; or insulin.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or
cocaine.

What To Expect
WHO OPERATES--Obstetrician-gynecologist, general surgeon or family doctor.
WHERE PERFORMED--Outpatient surgical facility or hospital.
DIAGNOSTIC TESTS
• Before surgery: Pap smear (See Glossary); pregnancy test; blood and hormonal studies.
• After surgery: Blood studies; Pap smear in 2 months.
ANESTHESIA--Local anesthesia by injection, or general anesthesia by injection and inhalation with an airway tube placed in
the windpipe.
DESCRIPTION OF OPERATION
• The vagina is cleansed with an antiseptic solution.
• The cervix is carefully opened with a dilator, and a curette is inserted into the uterus.
• The curette is used to scrape away a small part of the uterine lining for laboratory analysis.
• The instruments are removed.
• Some surgeons now collect tissue by suction curettage (see Abortion in Surgery section) rather than by the
procedure described here.
POSSIBLE COMPLICATIONS
• Surgical-wound infection.
• Excessive bleeding.
• Inadvertent injury to the uterus.
AVERAGE HOSPITAL STAY--0 to 1 day.
PROBABLE OUTCOME--Tissue obtained successfully without complications in virtually all cases. Allow about 4 to 6 weeks
for recovery from surgery.

Postoperative Care
† Wear cotton panties or pantyhose with a cotton crotch. Avoid panties made from nylon, polyester, silk or other
non--
ventilating materials.
• Expect slight vaginal bleeding during recovery from surgery. Use a sanitary pad to protect clothing. Avoid tampons
temporarily; they may lead to infection.
† You may use non--prescription drugs, such as acetaminophen, for minor pain.
† To help recovery and aid your well--
being, resume daily activities, including work, as soon as you are able.
• Resume sexual relations when spotting ceases.
DIET---No special diet.
 Call Your Doctor If
† Vaginal discharge increases or smells unpleasant.
• You experience pain that simple pain medication does not relieve quickly.
• Unusual vaginal swelling or bleeding develops.
• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.

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