Normal Labor and Delivery   Dr Narine Singh MBBS ,MSc
Normal LaborIn order to maximize the patient chance of avaginal delivery ,it is important to understandthe basics of labor...
Normal Labor and Delivery•   Definition of labor•   Factors influencing progress of labor•   Diagnosis of labor•   Stages ...
What is LaborDefinitionLabor is a physiologic process during which theproducts of conception (i.e. fetus ,membranes,umbili...
Definition              Labour isregular ,frequent uterine contraction                     +          cervical change   (d...
Labor can occur at•   Preterm labor --- prior to 37 weeks•   Term --- 37-42 weeks•   Post term --- after 42 weeks•   Postd...
Normal LabourLabour is normal when it is• Spontaneous in onset• At term (37 completed weeks-42 weeks)• Single fetus• Verte...
Normal Labour• Any deviation from this definition is abnormal• In late pregnant ,strong contraction can sometimes be  palp...
Normal laborBraxton –Hick uterine contraction NOTassociated with cervical change• Shorter in duration• Less intense• Over ...
Onset of labour• Based on the naegel’s formula ,labour starts  approximately as follow• In the expected date of delivery (...
Causes of onset of labourThe actual cause for the onset of labor is notexactly known ,but several theories have beenpostul...
Onset of labourHormonal factors            Mechanical factors• Estrogen theory           • Uterine distension theory• Prog...
Hormonal factors•   Estrogen theory•   Progesterone withdrawal theory•   Prostaglandin theory•   Oxytocin theory•   Fetal ...
Stages of labourObstetricians have divided labour into 3 stagesthat delineate milestones in a continuousprocess
Stages and Phases of labor• The first stage begins with the onset of labor  and ends with full cervical dilation .Friedman...
• The Latent phase begins with regular uterine  contractions and ends when there is an increase  in the rate of cervical d...
• The active phase is characterized by an  increase in rate of cervical dilation and  descent of the presenting fetal part...
• Deceleration Phase . During the terminal  portion of the active phase ,the rate of  dilation may slow until full cervica...
First stage of laborDuration• Primigravida – 8 -12 hours• Multigravida -6-8 hoursLatent phase• In primigravida – 8 hours• ...
Stages and Phases of labor• The second stage of labor is the interval  between full cervical dilation and delivery of  the...
Second stage of labour               The second stage has 2 phases• Passive: Cervix is fully dilated ,fetal descent contin...
Third stage of labour• The third stage is the interval between  delivery of the infant and delivery of the  placenta and m...
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Normal labor

  1. 1. Normal Labor and Delivery Dr Narine Singh MBBS ,MSc
  2. 2. Normal LaborIn order to maximize the patient chance of avaginal delivery ,it is important to understandthe basics of labor• Stages of labor• Mechanics of labor• Cardinal movements of labor• delivery
  3. 3. Normal Labor and Delivery• Definition of labor• Factors influencing progress of labor• Diagnosis of labor• Stages of labor• Mechanism of labor• Management of labor
  4. 4. What is LaborDefinitionLabor is a physiologic process during which theproducts of conception (i.e. fetus ,membranes,umbilical cord and placenta) are expelled from theuterusMore specifically, Labor requires the onset ofregular ,effective contractions that lead toprogressive cervical effacement and dilatation ofthe cervix accompanied by descent of thepresenting part
  5. 5. Definition Labour isregular ,frequent uterine contraction + cervical change (dilatation and effacement)
  6. 6. Labor can occur at• Preterm labor --- prior to 37 weeks• Term --- 37-42 weeks• Post term --- after 42 weeks• Postdates --- after 40 weeks
  7. 7. Normal LabourLabour is normal when it is• Spontaneous in onset• At term (37 completed weeks-42 weeks)• Single fetus• Vertex presentation• Within a reasonable time(not less than 3 hrs or more than 18 hrs.)• Without complication to the mother or the fetus
  8. 8. Normal Labour• Any deviation from this definition is abnormal• In late pregnant ,strong contraction can sometimes be palpated that do not produce cervical dilatation ,even when the cervix is normal and these do not constitute true labour (Braxton – Hick)• Cervical dilatation in the absence of uterine contraction suggest cervical insuffiiciency,whereas uterine contraction without cervical change does not meet the definition of labour• Delivery refers to the complete expulsion of the products of conception
  9. 9. Normal laborBraxton –Hick uterine contraction NOTassociated with cervical change• Shorter in duration• Less intense• Over lower abdomen and groin• Resolves with ambulation
  10. 10. Onset of labour• Based on the naegel’s formula ,labour starts approximately as follow• In the expected date of delivery (EDD) in 40%of cases• One week on either side in 50% of cases• Two weeks earlier and one week later in 80%of cases• At 42 weeks in 10%of cases• At 43 weeks plus in 4% of cases
  11. 11. Causes of onset of labourThe actual cause for the onset of labor is notexactly known ,but several theories have beenpostulated but none of them is completelyproven• Hormonal factors• Mechanical factors
  12. 12. Onset of labourHormonal factors Mechanical factors• Estrogen theory • Uterine distension theory• Progesterone withdrawal theory• Prostaglandin theory• Oxytocin theory• Fetal cort
  13. 13. Hormonal factors• Estrogen theory• Progesterone withdrawal theory• Prostaglandin theory• Oxytocin theory• Fetal cortisol theory
  14. 14. Stages of labourObstetricians have divided labour into 3 stagesthat delineate milestones in a continuousprocess
  15. 15. Stages and Phases of labor• The first stage begins with the onset of labor and ends with full cervical dilation .Friedman subdivided the first stage into latent and active phases
  16. 16. • The Latent phase begins with regular uterine contractions and ends when there is an increase in the rate of cervical dilation• . It is complete when a nulliparous woman reaches 3– 4 cm dilatation and a parous woman reaches 4– 5 cm . Cervical length should usually be <1 cm . The onset of the latent phase is often difficult to define. According to Friedman the onset of the latent phase is define as the point at which the mother perceives regular contraction
  17. 17. • The active phase is characterized by an increase in rate of cervical dilation and descent of the presenting fetal part .It ends with complete cervical dilation ,and is further subdivided into :• Acceleration Phase A gradual increase in the rate of dilation initiates the active phase and marks a change in rapid dilation• Phase of maximum slope, The period of active labor with the greatest rate of cervical dilation
  18. 18. • Deceleration Phase . During the terminal portion of the active phase ,the rate of dilation may slow until full cervical dilation• .Cervical dilatation rate of 1.2 cm /hr. for nulliparous and 1.5 cm/hr for parous women
  19. 19. First stage of laborDuration• Primigravida – 8 -12 hours• Multigravida -6-8 hoursLatent phase• In primigravida – 8 hours• In multigravida – 4 hoursActive phase• In primigravida – 4 hours• In multigravida – 2 hours
  20. 20. Stages and Phases of labor• The second stage of labor is the interval between full cervical dilation and delivery of the neonate
  21. 21. Second stage of labour The second stage has 2 phases• Passive: Cervix is fully dilated ,fetal descent continued during the time from full dilatation until an urge to push is felt at about station+ 2 station• Active :Time from the onset of the urge to push until delivery Presenting part of fetus reaches the pelvic floor. The fetal head will become visible at the introitus ,initially appearing and disappearing between contractions. Once the head is crown ,it does not recede in between contraction .The fetus moves through the birth canal and is completely delivered
  22. 22. Third stage of labour• The third stage is the interval between delivery of the infant and delivery of the placenta and membranes• Its duration is 10-20 minutes in both primi and multipara• The third stage is considered prolonged after 30 minutes, and active intervention ,such as manual extraction of the placenta is commonly considered
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