Stages of Labor
First stage
Stage of cervical
effacement and dilatation
characteristic:
“Bloody show”
Upon uterine contractions
pregnant women will feel
pain
Ruptured bag of water
Formation of distinct lower &
upper uterine segments.
2 Fundamental cervical
changes during 1st stage of
labor
Cervical effacement:
Obliteration or taking up of
cervix
Second stage
Stage of fetal expulsion
Fetal descent and delivery
Happens after full cervical
dilatation and ends with
expulsion of fetus
Ancillary forces in Labor:
Maternal Intraabdominal
pressure- most important
force in fetal expulsion after
full cervical dilatation
Pushing
Contraction of abdominal
muscles simultaneous with
respiratory efforts w/ closed
glottis.
Nature of force is similar with
defacation but with much
higher intensity.
Accomplishes little in 1st
stage labor and is useful
nd
Third stage
Stage of placental separation &
expulsion
- Delivery of placenta &
membranes directly after
birth.
- Placental separation is due
to a disproportion between
uterine cavity & placental
size.
After fetal delivery. The
fundus is normally lies below
the level of umbilicus.
Separation of amniochorion:
Occurs until separation of
placenta is complete
Peeled off by :
Further uterine contractions
Traction from separating
placenta.
Cervical dilatation:
Stage ends with cervix fully
dilated:10 cm
Due to centrifugal pull
during uterine contraction
As uterine contraction cause
pressure to membranes,
hydrostatic action of
amniotic sac dilates cervical
canal
Fetal descent follows a
hyperbolic curve when
plotted.
Onset occurs in maximum
slope.
-In nulliparas increase rate
of descent are observed
ordinarily during cervical
dilatation phase of
maximum slope.
Placental extrusion:
Separated after uterine
contraction
Occupies lower uterine
segment or upper vagina
Expelled by increase
intraabdominal pressure
Completion of 3rd stage
of labor is accompanied
by compressing and
elevating fundus with
minimal traction on
umbilical cord.
-Duncan mechanism
-schultze mechanism
From undilated, uneffaced cervix
it becomes partly dilated, partly
effaced until fully dilated, fully
effaced.

Process of cervical dilation and

effacement causes the formation
of the forebag of amniotic fluid.

Characteristics of uterine
contractions:
Painful b/c:
(1-4)

Formation of the lower & upper

uterine segment
Actively contracting part: (UPPER
segment)
- firm & hard on palpation
- It contracts & retracts to expel
the fetus
- does not relax to its original
length; becomes thicker.
Inactive: lower segment
-Softer, distended, & more
passive
Results of the thickening and
thinning of uterine segments:
Physiologic retraction ring:
Marked ridge or boundary
formed as a result of the lower
segment thinning &
concomitant upper segment
thickening.
Pathologic retraction ring:
BANDL ring
When the thinning of lower
segment is extreme
Occurs in obstructed labor.
Elongation in uterus: fetal axis
pressure
2 Phases of stage 1
stage of Labor
Latent phase
Active phase

3 divisions of stage 1
labor:
Preparatory division
Phase of maximum slope
Pelvic division