Labor || Stages of Labor || Mechanisms of Labor (Cardinal Movements of the Fetus) || Signs of True vs False Labor || Pain Management in Labor || Complications of Labor || Role of Nurses and Paramedics During Labor

Labor

Labor is the process by which the fetus, placenta, and membranes are expelled from the uterus after the 28th week of pregnancy. It is a complex physiological process that involves coordinated uterine contractions, cervical dilation, and fetal descent.

Stages of Labor

Labor is divided into four stages:

1. First Stage (Cervical Dilatation Stage)

• Starts: Onset of regular uterine contractions.
• Ends: Complete dilatation of the cervix (10 cm).
• Duration:
  • Primigravida (first-time mother) → 12-14 hours
  • Multigravida (previous childbirth experience) → 6-8 hours

Phases of the First Stage

1. Latent Phase (Early Labour)

   • Cervix dilates 0-3 cm
   • Mild, irregular contractions (every 5–30 minutes, lasting 30–45 seconds).
   • Patient feels mild discomfort and excitement.

2. Active Phase

   • Cervix dilates 4-7 cm
   • Contractions become more frequent (every 3–5 minutes) and intense.
   • Pain increases, and patient may feel discomfort.

3. Transition Phase

   • Cervix dilates 8-10 cm (full dilatation).
   • Strong, painful contractions every 2-3 minutes, lasting 60-90 seconds.
   • Increased urge to push, nausea, restlessness.

2. Second Stage (Expulsion Stage)

• Starts: Complete cervical dilatation (10 cm).
• Ends: Birth of the baby.
• Duration:
  • Primigravida → 1-2 hours
  • Multigravida → 30-60 minutes
• Contractions: Strong, every 2-3 minutes.
• Mother has urge to push (involuntary bearing-down reflex).

Mechanisms of Labor (Cardinal Movements of the Fetus)

1. Engagement – Fetal head enters the pelvis.
2. Descent – Fetal head moves downward.
3. Flexion – Fetal head tucks into chest.
4. Internal Rotation – Head rotates to align with the birth canal.
5. Extension – Head extends to emerge.
6. External Rotation (Restitution) – Head rotates to realign with the shoulders.
7. Expulsion – Baby’s body is delivered.

3. Third Stage (Placental Stage)

• Starts: Birth of the baby.
• Ends: Expulsion of the placenta and membranes.
• Duration: 5-30 minutes.

Signs of Placental Separation

1. Gush of blood.
2. Lengthening of the umbilical cord.
3. Fundus rises and becomes firm.

Methods of Placental Delivery

• Schultze Method (Fetal side first, "shiny" appearance).
• Duncan Method (Maternal side first, "rough" appearance).

4. Fourth Stage (Recovery Stage)

• Starts: Expulsion of placenta.
• Ends: First 1-2 hours postpartum.
• Uterus contracts to prevent bleeding (involution).
• Close monitoring for postpartum hemorrhage (PPH), uterine atony, vital signs, and bonding.

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Signs of True vs False Labor

Feature	True Labor	False Labor (Braxton Hicks Contractions)
Contractions	Regular, increase in intensity and duration	Irregular, weak, do not increase
Pain Location	Starts in back, moves to abdomen	Felt mainly in the abdomen
Cervical Changes	Progressive dilatation and effacement	No cervical changes
Effect of Activity	Contractions persist/worsen	Contractions stop/decrease

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Pain Management in Labor

Non-Pharmacological Methods

• Breathing techniques (Lamaze method).
• Positioning (upright, squatting, hands and knees).
• Massage and counterpressure.
• Hydrotherapy (warm water immersion).

Pharmacological Methods

• Analgesia (Opioids like Pethidine, Morphine).
• Regional Anesthesia (Epidural, Spinal Block).
• Local Anesthesia (For episiotomy or repair).

Complications of Labor

1. Prolonged Labor

• Labor lasts >18 hours.
• Causes: Cephalopelvic disproportion (CPD), weak contractions, malpresentation.
• Management: Oxytocin infusion, operative delivery (C-section, forceps, vacuum extraction).

2. Preterm Labor

• Labor before 37 weeks gestation.
• Causes: Infections, multiple pregnancy, uterine abnormalities.
• Management: Tocolytics (Nifedipine, Magnesium Sulfate), steroids (Betamethasone for lung maturity).

3. Post-Term Labor

• Labor beyond 42 weeks gestation.
• Risks: Fetal distress, meconium aspiration, macrosomia.
• Management: Induction of labour (Oxytocin, Membrane Sweep, Artificial Rupture of Membranes).

4. Fetal Distress

• Signs: Abnormal fetal heart rate (bradycardia <110 bpm, tachycardia >160 bpm), meconium-stained liquor.
• Management: Oxygen, left lateral position, IV fluids, emergency C-section if necessary.

5. Shoulder Dystocia

• Difficulty delivering the fetal shoulders after the head.
• Management (HELPERR Mnemonic):
  • H – Call for help.
  • E – Evaluate for episiotomy.
  • L – Legs (McRoberts maneuver).
  • P – Suprapubic pressure.
  • E – Enter rotational maneuvers.
  • R – Remove posterior arm.
  • R – Roll the patient (Gaskin maneuver)

Role of Nurses and Paramedics During Labor

1. Monitor maternal vital signs (BP, pulse, respiration, temperature).
2. Assess fetal heart rate (via Doppler or CTG).
3. Provide emotional and psychological support.
4. Ensure adequate hydration and nutrition.
5. Encourage movement and positioning for comfort.
6. Assist with delivery procedures if needed.
7. Prepare for neonatal resuscitation if necessary.

Conclusion

Labor is a natural but complex process requiring careful monitoring and timely interventions. Nurses and paramedics play a critical role in ensuring safe delivery for both the mother and baby by recognizing the stages, managing pain, and identifying complications early. Understanding labour mechanisms, pain management, and emergency protocols is essential for effective maternal and neonatal care.

                               Thank You!