Labour process

NORMAL LABOUR
 Series of events that
takes place in the
genital organs,is an
effort to expel the
viable products of
conception out of the
womb through the
vagina into the outer
world.

STAGES OF LABOUR
Ist STAGE:-
From onset of true
labour pains till the
full dilatation of
cervix.Its 12 hrs in
primigravida and 6
hrs in multiparae.

Contd…
IInd STAGE:-
From full
dilatation of
cervix till fetus is
delivered.Its 2 hrs
in primigravidae
and 30 min. in
multiparae.

Contd…
IIIrd STAGE:-
From delivery of
fetus till delivery
of placenta.Its of
average 15 mins.

PARAMETERS FOR
CONSIDERATION
LIE:-The relationship
between the long axis of
fetus with long axis of
uterus.
E.g.:Longitudnal
Transverse
Oblique

Contd…
ATTITUDE:-
The relationship of
fetal head & its
trunk.
E.g.:- Flexion.

Contd…
PRESENTATION:-
The part of fetus which lies
at pelvis or lower pole of
uterus.
Vertex:- 98.6%
Breech:- 2.5%
Shoulder:- 0.4%
Face:- 0.2%
Brow:- 1%

Contd…
 DENOMINATOR:- It is the leading point
of presentation.
In Vertex:- Occiput
In Breech:- Sacrum
In Face:- Chin

Contd…
 POSITION:- The relationship of
denominator with pelvic brim.
L.O.A:- Left Occipito Anterior
R.O.A:- Right Occipito Ant.
L.O.P:- Lt. Occipito Posterior.
R.O.P:- Rt. Occipito Post.
L.S.A:- Lt. Sacro Ant.
R.S.A:- Rt. Sacro Ant.
L.S.P:- Lt. Sacro Post.
R.S.P:- Rt. Sacro Post.

PHYSIOLOGY OF Ist STAGE OF
LABOUR
  Duration
  Uterine action
  Fundal dominance
  Polarity
  Contraction and Retraction
  Formation of Retraction Ring A ridge on the inner
uterine surface at the boundary between the upper and
lower uterine segments that occurs in the course of
normal labor.
  Dilatation of cervix
  Effacement of cervix
  Show
  Rupture of Membranes/Formation of Bag

Contd…
EFFACEMENT
OR
TAKING UP OF
CERVIX

MANAGEMENT OF Ist STAGE
 Non interference with watchful expectancy.
 To monitor carefully:-
a) General management
b) Bowel And Bladder Care
c) Rest
d) Diet
e) Relief of pain

Contd…
 Note Progress Of Labour:-
a) Abdominal Findings
b) Pelvic Grip
c) Vaginal Examination
d) Fetal And Maternal Condition

First maneuver: Fundal Grip
 While facing the woman, palpate the woman's
upper abdomen with both hands. often determine
the size, consistency, shape, and mobility of the
form. The fetal head is hard, firm, round, and
moves independently of the trunk while the
buttocks feel softer, are symmetric, and the
shoulders and limbs have small bony processes;

Second maneuver: Umbilical
Grip
 Still facing the woman, the health care
provider palpates the abdomen with gentle.
First the right hand remains steady on one
side of the abdomen while the left hand
explores the right side of the woman's
uterus. This is then repeated using the
opposite side and hands.

Third maneuver: Pawlick's
Grip
 In the third maneuver the health care
provider attempts to determine what fetal
part is lying above the inlet, or lower
abdomen.[2] The individual performing the
maneuver first grasps the lower portion of
the abdomen just above the pubic
symphysis with the thumb and fingers of
the right hand.

Fourth maneuver: Pelvic Grip
 The last maneuver requires that the health
care provider face the woman's feet, as he
or she will attempt to locate the fetus'
brow. The fingers of both hands are moved
gently down the sides of the uterus toward
the pubis.

PHYSIOLOGY OF IInd STAGE OF
LABOUR
 Contractions become stronger & longer.
 Continous contraction & retraction of upper
uterine segment & lower uterine segment thins.
 Nature of contraction become more expulsive &
pressure is extended on the rectum & perineal
floor.
 There is soft tissue displacement.
 Bladder is pushed up.
 Rectum becomes flattened into sacral curve &
pressure of advancing head expels any residue

SIGNS OF IInd STAGE OF LABOUR
 Contractions become longer & stronger.
 Full dilatation of cervix.
 Presenting part is seen at vulva.
 There is pouting & gapping of anus.
 Buldging of perineum.

MECHANISM OF
LABOUR
The series of movements that
occur on the head in the
process of adaptation,during
its journey through the
pelvis.

The Principle Movements Are:-
 Engagement
 Descent
 Flexion
 Internal Rotation Of Head
 Extension Of Head
 Restitution
 External Rotation Of Head & Internal
Rotation Of Shoulders
 Expulsion Of Head & Trunk

ENGAGEMENT
 Mechanism by which
fetal nestles into the
pelvis.also termed as
LIGHTENING or
DROPPING.In
primigravida it occurs
before the onset of
labour while in
multigravida occurs in
late Ist stage with
rupture of
membranes.

DESCENT
 It is a continous
process.It is slow in
Ist stage & becomes
pronounced in Iind
stage.Descent is
completed with
expulsion of
fetus.Head is expected
to reach pelvic floor
by the time cervix is
fully dilated.

FACTORS FACILITATING
DESCENT
 Uterine Contractions & Retractions.
 Bearing Down Effort.
 Straightening Of Fetus Especially After
Rupture Of Membranes.

FLEXION
 Process of fetal head
nodding forward
towards the fetal
chest.As the head
meets the resistance
of birth canal during
descent,full flexion is
achieved either due to
resistance offered by
unfolding of cervix
walls of pelvic or by
pelvic floor

INTERNAL ROTATION OF
HEAD
 In a well flexed vertex
presentation, the
occiput leads & meets
the pelvic floor Ist &
rotates ant. Through
1/8th of the circle.this
causes slight twist in
neck of fetus as head
is no longer in
alignment to
shoulder.The head
slips benesth sub-
pubic arch &crowning
occurs.

CROWNING
 After internal rotation
of head, further
descent occurs,untill
the sub- occiput lies
underneath the pubic
arch.At this stage the
max. diameter of head
stretches the vulval
outlet without any
recession of head
even after contraction
is over-It is called
CROWNING.
 Biparietal diameter:-
9.5cm.

EXTENSION OF HEAD
 Once crowning has
occurred the fetal
head can extend.The
driving force pushes
the head in downward
direction.The
successive parts of
fetal head to be born
through stretched
vulval outlet are
VERTEX,BROW
&FACE

RESTITUTION
Visible passive movement of head
due to untwisting of neck sustained
during internal rotation.Movements
of restitution occurs rotating the
head through 1/8th of circle in
direction opposite to internal
rotation & comes in lateral flexion
& faces towards thighs.

EXT. ROTATION OF
HEAD &INT. ROTATION
OF SHOULDER
Movement of rotation of head
visible externally due to internal
rotation of shoulders.As the
ant.shoulder rotates towards the
symphysis pubis,it carries the head
in a movement of ext. rotation
through 1/8th of circle in same
direction of restitution.

EXPULSION OF
SHOULDER & TRUNK
After the shoulders are positioned in
ant.-post. Diameter of outlet,further
descent takes place until the ant.
Shoulder is born.By a movement of
lat.flexion of spine,the post. shoulder
sweeps over the perineum.Rest of the
trunk is expelled out by lateral
flexion.

PRINCIPLES OF
MANAGEMENT OF IInd STAGE
OF LABOUR
 To assist in natural expulsion of fetus
slowly & steadily.
 To prevent perineal injuries.

MANAGEMENT OF IInd STAGE
OF LABOUR
 General Measures:-
a)Patient should lie down in bed.
b)Constant supervision for F.H.S.
c)To note maternal vital signs every ½ hrly
d)To administer analgesics.
e) To advice & instruct the patient to keep
up morale.

Vaginal examination
It is done at early or beginning of
2nd stage of labour to rule out any
accidental cord prolapse.Position &
station of head should be once
more noted to progressive descent
of head.
Nothing should be given to mother
except sips of water.

PREPARATION OF DELIVERY
 Shifting of patient to delivery table.
 Positioning of patient.
 Aseptic techniques.
 Toileting of genitalia.
 Emptying of bladder.
 Supporting perineum while delivery.
 Providing EPISIOTOMY to prevent tears.
 Inj. METHERGIN 0.2 mg I/M after
delivery of anterior shoulder of baby.

CONDUCTION OF DELIVERY
 Delivery should be spontaneous & is
divided into 3 phases:-
a) Delivery of head.
b) Delivery of shoulders.
c) Delivery of trunk.

SIGNS OF IIIrd STAGE OF
LABOUR
 Lengthening of cord.
 Gush of bleeding.
 Uterus becomes full
OR boggy uterus.

MANAGEMENT OF IIIrd
STAGE OF LABOUR
Control
Cord
Traction

Contd…
Mannual
Removal Of
Placenta

IV th STAGE OF LABOUR
 Stage of
observation for
at least 1 hr after
expulsion of the
after births.

Contd…
 Check vital signs of
mother & baby.
 Bleeding per vagina.
 Breast Feeding.
 Comfortable position.
 Observation for urine
output.
 Comfort of mother
and newborn.

Labour process

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Labour process