BIRTH
Recognition of Labor
Contractions are:
 regular in frequency
 intermittent in character
 at intervals of 10 minutes or less
 each lasts 30 seconds or longer
“Bloody Show”

Small amount of bloody discharge from
the vagina
 This
is the operculum releasing due to
dilation of the cervix
What is “False Labor”?
signs of what appears to be uterine
contractions getting stronger
 may be painful
 and may be at or near the EDD

How can you tell?
FALSE LABOR
TRUE LABOR
Irregular contractions
Regular contractions
No “show”
“show”
No progressive dilation or Progressive dilation and
effacement of the cervix
effacement of the cervix
Palpation of the Cervix
Assessing
effacement
and dilation…
Palpation of the Cervix

Ascertain the specific amount of dilation
ripeness of the cervix
 full dilation (10 cm) and effacement


If done too frequently
can cause infection
 introduces bacteria into an otherwise clean
environment

Uterine Contractions
Uterine muscle fibers are unique, unlike any
other muscle in the body

Regular muscle fibers

get shorter during contraction and return to their
normal length after the contraction
The purpose of the uterine contraction
however necessitates a different action

the baby has to be pushed out…
Uterine Contractions
So instead…
 After the uterus contracts, the muscle
fibers stay shortened during the
relaxation phase
Pressure is maintained on the cervix
 Dilation takes place slowly but progressively

Uterine Contractions

This process is
called “retraction”

Progressively
reduces the capacity
of the uterus

eventually pushes
the baby out
Uterine Contractions

The cervix (the lowest part of the lower pole)
does not contract


primarily a fibrous connective tissue (not muscle)
The contractions of the upper pole causes
retraction of the tissues of the lower pole

stretch and thin out = effacement & dilation
Effacement & Dilation

As the cervix thins, the internal os is retracted up the
sides of the uterus
 The external os is loosened and begins to dilate
allowing the operculum to dislodge ~> “Bloody Show”
Dilation and the Forewaters

Thinning of the cervix and dilation of the
external os allows the amniotic fluid in
front of the baby’s head to protrude

This is known as the “forewaters” or the
“Hydrostatic Dilator”
Dilation and the Forewaters
“Hydrostatic Dilator” = fluid trapped
between the head and the sides of the
birth canal
Hydrostatic Dilator
Function
 protects the baby’s head during the
dilation process

does not let the head push directly on the
cervix
Stages of Labor
Labor is a process…
Stage 1

Begins with the onset of regular contractions
 Ends with the full dilation of the cervix
Stage 1

Takes about 8-10 hours (multiparous) or 12-24
hours (primigravida)
“Transition”
Second Phase of Stage 1

This is the most physically and
emotionally taxing phase of labor
Cervix is opening from 8-10 centimeters
 Uterus is contracting strongly


May enter an emotionally vulnerable
state of exhaustion and exhilaration
Stage 2
Begins with full dilation of the cervix
 Ends with the birth of the baby


Generally takes from 10-60 minutes
(1 hour)
Contractions become more
powerful…
 Urge
to bear down or push
 She
may want to hold her breath
through the contractions
 She may become nauseated and vomit
 She may feel like she has to have a
bowel movement
May inhibit her pushing…
Stage 2
Mechanisms of Birth
AKA Cardinal Movements
Mechanisms of Birth

The baby has to make its way down and
out of the birth canal by fitting its head
and body through narrow passages

The baby must twist and turn along the
path of escape

known as the “Cardinal Movements”
Obstetrics Illustrated (1998)
I
 II
 III
 IV
V
 VI

Flexion
Descent
Internal Rotation
Delivery of the Head
Restitution
External Rotation
Stage 3
Stage 3
 Begins with the birth of the baby
 Ends with the birth of the placenta

Generally takes about 5-50 mins.
(1 hour)
Placental Birth
Placental Birth
After delivery of the baby
 the uterus and vagina become loose and
slackened


soft to external palpation
The site of the placental attachment is
harder and firmer and may be palpable
NOTE

The placenta is usually attached to the anterior
superior portion of the fundus of the uterus

This will depend on


the shape of the uterus and
the position of the uterus at the time of implantation
**Normally the uterus is slightly anti-flexed and the
blastocyst falls onto the anterior superior wall
Placental Birth
Normally
 the placenta will dislodge from the
uterine wall with
uterine contractions or
 massage of the uterus

Signs of Placental Detachment

The fundus becomes narrow, hard and
ballotable

Slight bleeding occurs again (bleeding
has stopped from the birth)

The cord becomes longer
Credes’ Method

Apply gentle pressure on the fundus while
pulling on the cord gently


the cord will usually lengthen out of the vagina with
this process
Releasing pressure on the fundus will then
show one of two things


either the cord retracts back into the vagina
indicating it has not detached or
it will remain lengthened out of the vagina indicating
it has detached
Note…

It is not a good idea to pull or tug on the cord
to remove the placenta

tearing of the placenta from the fundus (prior to
cessation of uterine arterial flow to the placenta)
could cause severe bleeding and possibly death
Blood Loss

Blood loss should be noted


normally 250 ml (cup) will be lost during the
placental delivery
Any excessive bleeding should be taken
as a sign of retention of placental parts
until otherwise determined
After Care… Stage 4
Stage 4
Begins with the birth of the placenta
 Ends with the recovery of the new
mother

Lasts for about 4 –6 hours
 Consists of close observation


monitoring vital signs; excessive uterine
bleeding
After the placenta is delivered…

The vagina and labia are inspected for
tears or other general injuries
provide the appropriate care
 may include suturing tears and episiotomies


The placenta must also be inspected for
appearance and completeness

suspicion of any missing pieces
necessitates inspection of the uterus
Placental Types
Disperse
Battledore
Circumvallate*
Succenturiate*
Bipartite/Tripartite*
Magistral
Fenestrate
Duplex*
Vellamentosa

some are at higher risks for retention of
placental parts*

fenestrate may look like a retained placenta
even if it is not (false finding)
Retention of Placental Parts

Retention of part or all of the placenta


usually causes bleeding
may be severe enough to cause death
There are cases when it does not immediately
cause a problem

If parts are retained for a period of time,
eventually… infection or immune reaction
Retention of Placental Parts
Management

D&C (dilatation and curettage) needs to
be performed

remove the offending parts