Presented by:

Namita arya
Msc nursing 1st year
DEFINITION:
Series of events that take place in the genital organs in an effort to expel the
viable product of conception out of the womb Spontaneous expulsion,

Criteria for normal labour:

1- Spontaneous in onset at term.
(37-completed weeks-42 weeks)
2 - Presented by vertex,
3 - Through the birth canal (vaginal delivery),
4 - Within a reasonable time (more than 3, less than 18 hours),
5 - Without complications to the mother, Without complications to the fetus
through the vagina into the outer world is called normal labour.
UTERINE CONTRACTIONS IN LABOUR:
-There is good synchronization of the contraction waves from both halves of the
uterus.
There is fundal dominance through midzone down to lower segment with
gradual diminishing contraction wave which takes about 10-20 seconds.
The waves of contraction follow a regular pattern .
Intra amniotic pressure rises beyond 20mm Hg during uterine contraction.
Good relaxation occurs in between contractions to bring down the intra-
amniotic pressure to less than 8 mm Hg.
 Cntractions Of the fundus last longer than that of the midzone.
TONUS:
-It is the intrauterine pressure in between contractions .
-During pregnancy ,as the uterus is quiescent (inactive ),the tonus is of 2-3
mm Hg .
- during the first stage of labour,it varies from 8-10 mm Hg.It is inversely
proportional to relaxation.

INTENSITY:
-The intensity of uterine contraction describes the degree of uterine systole.
-Intrauterine pressure is raised to 40-50 mm Hg during first stage and about
100-120 mm Hg in second stage of labour during contractions .Inspite of
diminished pain in third stage ,the intrauterine pressure is probably the
same as that in the second stage .
DURATION:
-In the first stage ,the contractions last for about 30 seconds initially but
gradually increase in duration with the progress of labour .Thus in the
second stage ,the contractions last longer than in the first stage.

FREQUENCY:
-In the early stage of labour ,the contractions come at intervals of 10-15
minutes The intervals gradually shortens with advancement of labour
until in the second stage ,when it comes every 2 or 3 three minutes.
Duration: 12 hours in primigravida ,6 hours in multigravida .Duration
-

(length)of labour varies and influenced by:

Parity
pelvic shape
pelvic size
psychological state
presentation
position.
Physiology of labour has two aspects /factors as discussed below:
1)Uterine factors /actions.
2)Mechanical factors.
a)Uterine actions:
-Fundal dominance
b)Polarity:
-polarity is neuromascular harmony between upper and lower pole (segment )
of uterus throughout labour.
- When upper segment contracts,retracts and pushes the fetus down the lower
uterine segment and cervix dilates in response.
-Good synchronization of contraction waves from both sides of uterus.
-Regular pattern of contractions .
c) Uterine contractions and retractions:
Bucket handle manner of attachment of longitudinal muscle fibres of upper
uterine segment with circular muscle fibres of lower segment and cervix.Thus
during contraction of upper segment the canal –shortens ,retracts and opens.
d) FORMATION OF UPPER AND LOWER UTERINE SEGMENT:
-By the end of the pregnancy the body of uterus devided into two upper uterine
segment and lower uterine segment . the upper uterine segment is thick and
muscular ,concerned with contraction.
-during labour lower uterine segment is demarcated by physiological retraction
ring above and fibromuscular junction of the cervix and uterus below.
-7.5-10 cm when fully formed and cylindrical during 2nd stage of labour.
-Gradual thinning of the lower uterine segment due to relaxation of its muscle
fibres to allow enlongation and descent of presenting part.
-Lower uterine segment prepared for distension.
) RETRACTION RING (BANDL’S RING):
Retraction ring is a ridge formed between upper and lower uterine segment .

f) CERVICAL EFFACEMENT:
-Muscular fibres of cervix are pulled upwards and merge with lower uterine
segment .
- effacement preceds the dilation in primigravida while it occurs simultaneously
with dilation in multipara.

g) CERVICAL DILATION:
it is the process of enlargement of external os from a closed external os to permit
passage of fetal head.Full dilation of cervix is 10 cm.
 Three physiological changes result from a continuation of the same
forces,which have been at work during the first stage of labor.
 (1) DECEND
 Decend of the fetal presenting part,which began during the first stage
of labor and reached its maximum speed toward the end of first stage
of labor,continues its rapid pace through the second stage of labour
until reaching the pelvic floor.
 The average maximum rate of decend is 1.6cm per hour in nulliparas
and 5.4cm per hour in multiparas.
 (2)UTERINE ACTION
 Contraction during the second stage are frequent,strong and slightly
longer that is approximately every two minutes,lasting 60-90 seconds.
 They are of strong intensity and become expulsive in nature.After the
painful contractions she experienced during the transition ,the woman
usually feels relief to be in second stage and be able to push if she so
desires.
 The hard contractions of transition are now past and the cervix is fully
dilated .The woman’s body seems to” take a breath” before starting
expulsive efforts.The contractions space out and are not so intense.
The woman rests and may even nap.
 This quiet period may last as long as an hour and is longer in
primigravidae than in multigravidae.Gradually momentum builds as
the fetal head decends through the pelvis,the contraction become
more forceful and the woman begins to voluntarily bear down with
expiratory ,grunty, short pushes.
 REPTURE OF MEMBRANES
 The membranes often rupture spontaneously at the onset of the second
stage .The consequent drainage of liquor allows the hard,round fetal
head to be directly applied to the vaginal tissues and aid distension.
 Fetal axis pressure increases flexion of the head ,which results in smaller
presenting diameters,more rapid progress and less trauma to both
mother and fetus. As the fetus further decends into the vagina,pressure
from the presenting part stimulates nerve receptors in the pelvic floor
and the woman experiences the needs to push.
 SOFT TISSUE DISPLACEMENT
 As the hard fetal head decends,the soft tissues of the pelvis become
displaced.Anteriorly,the bladder is pushed upwards into the abdomen
where it is at less risk of injury during fetal decend.
 Posteriorly ,the rectum becomes flattened into the sacral curve and
the pressure of the advancing head expels any residual fecal matter.
 The levator ani muscles dilate ,thin out and become displaced
laterally,and the perineal body is flattened,stretched and thinned.The
fetal head becomes visible at the vulva ,advancing with each
contraction,and receding during the resting phase until crowing takes
place and the head is born.
 The third stage of labour comprises the phase of placental sepration ;
its decent to the lower segment and finally its expulsion with the
membrane.
 PLACENTAL SEPARATION:At the beginning of labour, the placental
attachment roughly corresponds to an area of 20cm in diameter.
 There is no appreciable diminution of the surface area of the placental
attachment during first stage .During the second stage ,there is slight
but progressive diminution of the area following successive retraction
,which attains its peak immediately following the birth of the baby.
 After the birth of the baby ,the uterus measures about 20cm vertically
and 10cm antero-posteriorly,the shape becomes discoid.The wall of
the upper segment is much thickened while the thin and flabby lower
segment is thrown into folds.The cavity is much reduced to
accommodate only the afterbirths.
 There are two ways of separation of placenta:
 Central separation (schultz)
 Marginal separation(mathews-duncan)
 SEPARATION OF THE MEMBRANES:
 The membranes which are attached loosely in the active part are
thrown into multiple folds.
 Those attached to the lower segment are already separated during its
stretching
 The separation is facilitated partly by uterine contraction and mostely
by weight of the placenta as it descends down from the active part.
 The membranes so separated carry with them remnants of decidua
vera giving the outer surface of the chorion its characteristic
roughness.
 After complete separation of the placenta,it is forced down into the
flabby lower uterine segment or upper part of the vagina by effective
contraction and retraction of the uterus.
 Thereafter,it is expelled out by either voluntary contraction of
abdominal muscles(bearing down efforts)or by manual procedure.
 Living ligature -After placental separation, innumerable torn sinuses which
have free circulation of blood from uterine and ovarian vessels have to be
obliterated.
 The occlusion is effected by complete retraction where by the arterioles,as
they pass tortuously through the interlacing intermediate layer of the
myometrium,are literally clamped during uterine contractions.
 Thrombosis -occurs to occlude the torn sinuses,a phenomenon which is
facilitated by hyper-coagulable state of pregnancy .
 Myotemponade-Apposition of the walls of the uterus following expulsion of
the placenta() also contributes to minimise blood loss.
 BOOK:
 Dutta D.C Textbook of obstetrics , seventh edition,new central book
agency(p)Ltd , page no.117-123.
 Essentials of obstetrics,first edition,2015,page no.191-208
 A text book of MIDWIFERY AND GYNAECOLOGICAL
NURSING,edition-2016 ,page no.186-222.
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 https:www.ncbi.nlm.nih.gov>articles
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