Labor and Childbirth

• Definition of Labor:
- Labor is the process of delivering a baby and the placenta,
membranes, and umbilical cord from the uterus to the outside
world.
- It usually begins between the 38th and 42nd week of
pregnancy when the fetus is mature.

• Premonitory Signs of Labor (Early Signs):

1. Lightening:
- This is when the fetal head descends into the pelvis, which usually
happens:
A. for first-time mothers (primiparous): 2-3 weeks before the
due date
B. for those who have given birth before (multiparous): later

2. Braxton-Hicks Contractions:
- These are irregular and often painless contractions that can occur
throughout pregnancy, sometimes leading to discomfort but not real
labor.

3. Cervical Changes:
- In the days leading to labor, the cervix softens, effaces (thins out),
and dilates slightly.

4. Bloody Show:
- This is the expulsion of the mucus plug from the cervix, leading to
pink-tinged secretions.

5. Rupture of Membranes:
- This may occur in about 12% of cases before labor begins,
- and labor typically starts within 24 hours afterward.

6. Burst of Energy:
- Some women experience a sudden increase in energy before labor,
often seen in activities like cleaning.
Labor and Childbirth

• Factors Affecting Labor

- Labor is influenced by four interrelated components known as the
"four Ps":

1. Powers:
- This includes uterine contractions and the mother’s pushing
efforts.

2. Passage: This refers to the bony pelvis and soft tissues that the
baby must pass through.

3. Passengers: This includes the fetus, placenta, amniotic

membranes, and amniotic fluid.

4. Psyche: The mother's emotional state can also influence the

labor process, including anxiety and fear.

• True vs. False Labor

A) True Labor:
- Contractions occur at regular intervals,
- Contractions become more intense and longer
- Contractions start in the back and radiate to the abdomen
- Contractions result in cervical dilation.

B) False Labor:
- Contractions are irregular,
- Contractions do not lead to cervical dilation,
- Contractions usually lessen with rest or warm baths.
Labor and Childbirth

• Stages of Labor and Birth

1) First Stage of Labor:
- This stage involves cervical effacement (thinning)
- and cervical dilation (opening).
- It is divided into three phases:

1. Latent Phase: 0-3 cm dilation, contractions are mild.

2. Active Phase: 4-7 cm dilation, contractions become
stronger and more regular.
3. Transition Phase: 8-10 cm dilation, contractions are very
strong and frequent.

• Nursing Care in the First Stage:

1. Welcome the woman and family
2. review antenatal records
3. check vital signs
4. Perform abdominal examinations.
5. Monitor fetal heart rate and contractions.
6. Encourage urination and provide hydration via IV if
needed.
7. Use a partogram to track progress and provide emotional
support.
Labor and Childbirth

2) Second Stage of Labor:

- Begins when the cervix is fully dilated (10 cm) and ends with the
birth of the baby.
- The mother is often positioned on her back (lithotomy position).
- Monitor maternal blood pressure and fetal heart rate closely.
- Encourage the mother during contractions and guide her through
the pushing process.

• nursing care includes the following:

1. Positioning: The mother is typically positioned on her back
(lithotomy position).
2. Monitoring: Continuous monitoring of fetal heart rate every
five minutes, as well as maternal blood pressure.
3. Support: Instruct the support person present in the delivery
room about the labor process.
4. Assessment: After the rupture of membranes, check for
potential cord prolapse. If the baby's head is descending,
instruct the mother not to push but to take deep breaths to
prevent tearing.
5. Sterile Technique: Ensure that the delivery is conducted
under sterile and antiseptic conditions.
6. Episiotomy: If indicated, perform an episiotomy to facilitate
delivery.
7. Delivery Assistance: After the head is delivered, check for a
loop of the cord around the neck and clear the neonate's
mouth and pharynx using a bulb syringe.

3) . Third Stage of Labor:

- This stage involves the separation and expulsion of the placenta
after the baby is born.

- Signs of placental separation include:

1) a change in the shape of the uterus,

2) vaginal bleeding, and lengthening of the umbilical cord.

- Nursing care focuses on monitoring for signs of complications

and ensuring maternal well-being.
Labor and Childbirth

4) Fourth Stage of Labor:

- This stage is the immediate postpartum period (1-2 hours after
delivery).
- Nurses check vital signs, fundal height, and the amount of
lochia (post-birth discharge).
- They also assess for perineal tears or hematomas and provide
comfort measures.

• nursing care
1. Monitoring Vital Signs: Regularly check the mother's vital
signs (blood pressure, pulse, temperature) to detect any signs
of shock or complications.
2. Uterine Assessment: Examine the fundus of the uterus to
ensure it is firm and to rule out uterine atony, which is a leading
cause of postpartum hemorrhage.
3. Lochia Assessment: Determine the amount and color of lochia
(the vaginal discharge following childbirth) to monitor for any
signs of abnormal bleeding.
4. Perineum Inspection: Inspect the perineal area for any signs
of episiotomy, lacerations, or hematomas.
5. Bladder Assessment: Assess the bladder for fullness to prevent
issues such as urinary retention, which can lead to uterine
atony.
6. Pain Management: Provide analgesics as needed for
discomfort related to uterine involution, episiotomy, or
lacerations.
7. Promoting Hygiene: Instruct the mother on general body
hygiene and care for the perineum.
8. Encouraging Rest: Encourage the mother to rest and take care
of her nutritional needs.
9. Breastfeeding Support: Support and assist the mother with
breastfeeding, if applicable, to promote bonding and stimulate
uterine contractions.
10. Patient Education: Educate the mother about what to expect
during recovery, including warning signs for complications that
should prompt medical attention
Labor and Childbirth

Stage Description Key Features

1st Stage of Cervical effacement and • Divided into three phases:

Labor dilation. 1) Active Phase (4-7 cm):
- Mild contractions.
2) Latent Phase (0-3 cm):
- Stronger contractions.
3) Transition Phase (8-10 cm):
- Intense contractions.
2nd Stage Begins when the cervix is - Contractions are strong and push the baby down.
of Labor fully dilated (10 cm) and - Duration varies (up to 2 hours for primigravida,
ends with the birth of the shorter(15 minutes) for multiparas).
infant.
3rd Stage of Placental separation and • Signs of separation include:
Labor expulsion. 1) Change in the shape of the uterus.
2) Lengthening of the umbilical cord.
3) Vaginal bleeding.
4th Stage of Immediate postpartum - Monitoring vital signs for signs of shock.
Labor period where recovery - Checking uterine contraction to prevent atony.
occurs. - Encouraging bonding and breastfeeding.

Feature True Labor False Labor

Contraction Pattern Regular intervals Irregular intervals

Contraction Duration Increases in duration and No change

intensity

Discomfort Location Begins in the back and Usually felt in the

radiates to the abdomen abdomen

Effect of Activity Intensity increases with Walking has no effect

walking or lessens
contractions

Cervical Changes Progressive dilation and No change

effacement

Presence of Show May have show (mucous No show

or blood)

Uterine Tone Firm uterus Soft uterus