What is Labour?
Labour is the process of delivering a baby and the placenta, membranes, and
umbilical cord from the uterus to the vagina to the outside world.
umbilical cord from the uterus to the vagina to the outside world.
Stages of Labour
The First Stage:
During the
first stage of labor (which is called dilation), the cervix dilates fully to a
diameter of about 10 cm (2 inches). The first stage of labor is divided into
two phases: the latent phase and the active phase. In the latent phase,
contractions become progressively more coordinated and the cervix dilates to 4
cm (approximately 1.5 inches).
The
latent phase averages about 8 hours for a nullipara (a woman having her first
baby) and 5 hours for a multipara (a woman having a subsequent baby). In the
active phase, the cervix becomes fully dilated and the presenting part of the
baby descends into the midpelvis. The active phase averages about 5 hours for a
nullipara and 2 hours for a multipara.
latent phase averages about 8 hours for a nullipara (a woman having her first
baby) and 5 hours for a multipara (a woman having a subsequent baby). In the
active phase, the cervix becomes fully dilated and the presenting part of the
baby descends into the midpelvis. The active phase averages about 5 hours for a
nullipara and 2 hours for a multipara.
The Second Stage
In the
second stage (which is called expulsion), the baby moves out through the cervix
and vagina to be born. Expulsion generally lasts 2 hours for a nullipara and 1
hour for a multipara.
second stage (which is called expulsion), the baby moves out through the cervix
and vagina to be born. Expulsion generally lasts 2 hours for a nullipara and 1
hour for a multipara.
The Third Stage
The third
stage of labor begins with the delivery of the baby and ends when the placenta
and membranes are expelled. Also known as parturition and childbirth.
stage of labor begins with the delivery of the baby and ends when the placenta
and membranes are expelled. Also known as parturition and childbirth.
How Mothers Are Cared For In the Wards
Routine Procedures
The preparation for birth on admission to a
hospital or health centre often includes several “routine” procedures such as
the measuring of temperature, pulse and blood pressure, and an enema, followed
by shaving of all or some of the pubic hair. The first three procedures, taking and recording temperature, pulse and
blood pressure, can have implications for the final outcome of birth, and could
therefore influence the management of labour. Measuring the temperature every 4
hours, because a rise in temperature may be a first sign of infection, and thus
may lead to early treatment, especially in case of prolonged labour and
ruptured membranes. Sometimes it may be a sign of dehydration. Taking the blood
pressure at the same intervals, is an important check on maternal well-being. A
sudden rise in blood pressure can indicate the need to expedite delivery or
transfer the woman to a higher level of care.
hospital or health centre often includes several “routine” procedures such as
the measuring of temperature, pulse and blood pressure, and an enema, followed
by shaving of all or some of the pubic hair. The first three procedures, taking and recording temperature, pulse and
blood pressure, can have implications for the final outcome of birth, and could
therefore influence the management of labour. Measuring the temperature every 4
hours, because a rise in temperature may be a first sign of infection, and thus
may lead to early treatment, especially in case of prolonged labour and
ruptured membranes. Sometimes it may be a sign of dehydration. Taking the blood
pressure at the same intervals, is an important check on maternal well-being. A
sudden rise in blood pressure can indicate the need to expedite delivery or
transfer the woman to a higher level of care.
Enemas
are still widely used because they supposedly stimulate uterine contractions
and because an empty bowel allows the head to descend. They are also believed
to reduce contamination and thereby infection of mother and child.
are still widely used because they supposedly stimulate uterine contractions
and because an empty bowel allows the head to descend. They are also believed
to reduce contamination and thereby infection of mother and child.
Pubic
shaving is presumed to reduce infection and facilitate suturing but there is no
evidence to support this.
shaving is presumed to reduce infection and facilitate suturing but there is no
evidence to support this.
Care during the First Stage of
Labour
1.
Assessing the Start of Labour: Assessing
the start of labour is one of the most important aspects of the management of
labour. Signs of the start of labour are:
Assessing the Start of Labour: Assessing
the start of labour is one of the most important aspects of the management of
labour. Signs of the start of labour are:
·
painful contractions with a certain regularity
painful contractions with a certain regularity
·
effacement and/or dilatation of the cervix
effacement and/or dilatation of the cervix
·
leakage of amniotic fluid
leakage of amniotic fluid
·
bloody discharge
bloody discharge
2. Vaginal Examination: This is one of the
essential diagnostic actions in the assessment of the start and the progress of
labour. It is conducted by trained birth attendants, with clean hands, covered
by sterile gloves. The number of vaginal examinations is limited to the
strictly necessary; during the first stage of labour usually once every 4 hours
is enough.
3. Monitoring the Progress of Labour: The
assessment of the progress of labour is made by observation of the woman; her
appearance, behaviour, contractions, and the descent of the presenting part.
The most accurate measure is dilatation of the cervix.
4. Prevention of Prolonged Labour: Several
measures have been proposed to prevent delay in the progress of labour. The
most active interventions are early amniotomy and early oxytocin infusion, or a
combination of the two.
Care during the Second Stage of
Labour
1. The
woman is transferred from the labour room to a specific “delivery room” at the
onset of the second stage.
2. Caregivers
often decide on the onset of the second stage by encouraging the woman to push,
either when full dilatation has been diagnosed, or sometimes even earlier.
Care during the Third Stage of
Labour
1. Use of
Oxytocics: Oxytocics may be given at various moments during the third stage.
Most often they are administered immediately with the delivery of the anterior
shoulder, or after delivery of the infant.
2. Cord Traction: Cord traction involves
traction on the cord, combined with counterpressure upwards on the uterine body
by a hand.
3. Cord Clamping: The umbilical cord can be
clamped immediately after birth or at a later moment.
4. Immediate Care of the Newborn: Directly
after birth immediate attention is given to the condition of the newborn. These
includes
·
Baby has to be dried with warm towels or cloths,
while being placed on the mother’s abdomen or in her arms. The baby’s condition
is assessed and the existence of a clear airway is ensured (if necessary)
simultaneously. Maintaining the body temperature of the baby is important;
newborn babies exposed to cold delivery rooms may experience marked drops in
body temperature, and concurrent metabolic problems. A fall in infant
temperature can be reduced by skin-to-skin contact between baby and mother.
Baby has to be dried with warm towels or cloths,
while being placed on the mother’s abdomen or in her arms. The baby’s condition
is assessed and the existence of a clear airway is ensured (if necessary)
simultaneously. Maintaining the body temperature of the baby is important;
newborn babies exposed to cold delivery rooms may experience marked drops in
body temperature, and concurrent metabolic problems. A fall in infant
temperature can be reduced by skin-to-skin contact between baby and mother.
·
Early skin-to skin contact between mother and baby
is important for several other reasons. Psychologically it stimulates mother and
baby to get acquainted with each other. After birth babies are colonized by
bacteria; it is advantageous that they come into contact with their mothers’
skin bacteria, and that they are not colonized by bacteria from caregivers or
from a hospital.
Early skin-to skin contact between mother and baby
is important for several other reasons. Psychologically it stimulates mother and
baby to get acquainted with each other. After birth babies are colonized by
bacteria; it is advantageous that they come into contact with their mothers’
skin bacteria, and that they are not colonized by bacteria from caregivers or
from a hospital.
·
Cutting the cord should take place with sterile
instruments, either disposable, for instance from the clean delivery kit, or
thoroughly decontaminated by sterilization. This is of utmost importance for
the prevention of infections.
Cutting the cord should take place with sterile
instruments, either disposable, for instance from the clean delivery kit, or
thoroughly decontaminated by sterilization. This is of utmost importance for
the prevention of infections.
