The document discusses the first stage of labor, including its definition, phases, and physiological changes. The first stage begins with regular uterine contractions and ends with full cervical dilation. It is divided into latent, active, and transition phases. During this stage, the cervix effaces and dilates due to uterine contractions and mechanical factors like pressure from the amniotic sac. Midwives should monitor labor using a partograph to assess progress and fetal wellbeing.
2. INTRODUCTION:
• The first stage of labor usually starts with the onset of regular iterine
contractions and culminates the complete dilatationof the cervix.Its
average duration is 12 hours in primigravida and 6 hours in multipara.
• There are number of premonitory signs and symptoms that may alert a
midwife to a womans approaching labor.
3. DEFINITION OF LABOR:
• Labor may be defined as rhythmic contraction and relaxation of the
uterine muscles with progressive effacement (thinning) and dilatation
(opening) of the cervix leadind to expulsion of the products of
conception.
-CLAUSENTAL 1993
• Labor is defined as the process by which the fetus ,placenta and
membranes are expelled through the birth canal.
-CASSIDY 1999
4. NORMAL LABOR:
• Normal labor occurs at term and is spontaneous in onset with the fetus
presenting by the vertex.The process is completed within 18 hours
and no complications arise.
5. THREE P”S OF NORMAL LABOR:
• P-Powers or uterine contractions
• P-The pelvis including size and shape
• P-Passanger which includes the size,position and presentation of the
fetus
6. ABNORMAL LABOR:
• Abnormal or difficult labor ,or delivery .Used to refer weak or
ineffective uterine contractions may also be used to describe the
situation in which the shoulders of a baby in vertex presentation
become trapped after delivery of the head.
7. STAGES OF LABOR:
• First stage:It begins with regular rhythmic uterine contractions and is
complete when the cervix is fully dilated.
• SECOND STAGE:Complete dilatation of the cervix and through
complete birth of the baby.
• THIRD STAGE:Separation and expulsion of the placenta and
membranes.
• FOURTH STAGE:First 4 hours after the delivery of the placenta.
8. FIRST STAGE OF LABOR:
• The first stage is divided in to tree phases
• latent phase
• active phase
• transition phase
9. LATENT PHASE:
• Begins with the onset of true labor contractions
• Contraction may be between 15 -20 minutes apart,lasting 20-30
seconds
• As this progress the contraction will occur every 5-7 minutes and the
duratio lengthen for 30-40 seconds .
• 3-4cm dilatation
• Primigravida 9 hours
• Multigravida 5 hours
10. ACTIVE PHASE:
• Begins when the cervix is 3-4 cm dilated and ends when she is 8 cm
dilated.
• Contraction occurs every 3-5 minutes and last for 60 seconds.
• primigravida -6 hours
• Multigravida-4 hours
• Dilatation rate atleast 1.2 -1.5 cm/hr.
11. TRANSITION PHASE:
• Contraction occur every 2-3 minutes and lasting 60-90 seconds.
• Contractiion is very strong.
• Woman become more restless and agitated.
• primigravida 2 hours
• Multigravida 1 hours
• The nurse need to prepare the patient for second stage of labor.
12. PHYSIOLOGICAL CHANGES OR EVENTS IN THE FIRST
STAGE OF LABOR:
• UTERINE FACTOR
• MECHANICAL FACTOR
13. UTERINE FACTOR:
• Contraction and retraction of uterine muscles
• Formation of upper and lower segment
• Development of retraction ring
• Taking up of the cervix or effacement of the cervix
• Dilatation of the cervix
• Show presentation
15. UTERINE FACTOR :
contraction and retraction of uterine muscles
• Contractions are involuntary movements which are palpable and
painful.
• NATURE OF UTERINE CONTRACTIONS ARE:
• Painful uterine contration
• Fundal dominance
• Raised intra amniotic pressure
• Retraction
• Polarity
16. A.painful uterine contraction
• The contractions are intermittent regular intervals which arre painful.
• following characters of uterine contraction:
• FREQUENCY:Contraction occur immediately throughout the labor.
• 20-30m apart and become closer until
• They as frequent as every 2-3min.
REGULARIT:Contraction occur more and more regularly as labor becomes well
established.
DURATION:Increases from 30s to between 60-90s near full dilatation of the
cervix.then becomes about 60s until delivery of the fetus.
INTENSITY:Contraction also increases as the labor progress.
17. C.raised intra amniotic pressure:
• 3 to 5 mmm/hg
• During contraction it raises up to 40 to 50 mm/hg infirst stage.
• 80 to 100 m/hg in the second stage of labor.
• Good relaxation occurs to bring down intra amniotic pressure less than
8 mm/hg.
18. D.retraction :
During labor the contraction does not passess off entirely,the muscle
fibre retain some of the shortening of contraction instead of becoming
completely relaxed.This is termed retraction.
THE EFFECTS OF RETRACTION WHICH IS ESSENTIAL IN NORMAL
LABOR:
Formation of upper and lower segment
Dilatation and taking up of the cervix
Expulsion of the fetus
Effective hemostasis after separation of placenta
19. E.polarity:
• co ordination between the upper and the lower uterine segment is
called polarity which brings cervical dilatation.
20. FORMATION OF UPPER AND LOWER UTERINE
SEGMENT:
• By the end of the pregnancy the body of the uterus is divided in to the
anatomically distinct ie ,the upper and lower uterine segment.
• The upper uterine segment is mainly concerned with contraction and is
thick and muscular.
• The lower segment is prepared for distension and dilatation and is
thinner.
• The lower segment develops from the isthumus and is about 8 to 10
cm in length.
21. DEVELOPMENT OF RETRACTION RING:
• A ridge form between the upper
and lower uterine segment which
isknown as retraction ring.
• The physiological retraction ring
gradually rises as the upper
uterine segment contracts and
retracts and the lower uterine
segment thins out to accomodate
the descending fetus.
• The retraction ring becomes
visible above the symphysis
pubis it is termed as bandl's ring.
22. TAKING UP OF THE CERVIX OR EFFACEMENT:
• Thinning of The cervix.
• Normally ina primigravida the
effacement preceds cervical
dilatation, but in multigravida
both occur simultaneously.
• Uneffaced cervix measures 4cm
and 50% effaced cervix measures
2cm on vaginal examination.
23. dilatation of the cervix:
• Dilatation occurs as a result of
good and progressive uterine
contraction and retraction and
pressure applied by the bag of
membrane.
24. SHOW PRESENTATION:
• It is a blood stained mucoid discharge,which is seen before few hours
of labor or within a few hours after laboe starts.
• Blood is stained due to the detached chorion fro the decidua and
dilating cervix.
29. PARTOGRAPH:
• Is a record of all the observations made on a woman in labor in
labor, the central feature of which is the graphic recording of the
dilatation of the cervix as assed by vaginal examination.
30. PRINCIPLES:
*The active phase of labor commences at 3cm cervical dilatation.
*The latent phase of labor should last no longer than 8 hours.
*During active labor therate of cervical dilation should not be lesser
than 1cm/hr.
• Four hourly vaginal examination is recommended..
31. PURPOSE:
*To record the clinical observation accurately.
* To identify the difference between latent phase and active phase of
labor.
*To interpret the recorded partograph.
* To monitor the well being of the mother as goes through labor.
32. USE AND CRITICAL ANALYSIS OF LABOR BY
PARTOGRAPH :
• Assessment of fetal condition
• FHR greater than or equal to 180 bts/ mim -tachycardia
• Less than or equal to 160 bts/min – bradycardia
• Membranes and liqour:
• Intact membrane
• Ruptured membrane + clear liquor c
• Ruptured membrane + meconium stained m
• Ruptured membrane+ blood stained liquor b
• Ruptured membrane + absent liquor a
33. •Moulding:
It is a state of reduction or loss of space between skull bones,
separated bones, sutures felt easily
34. 2.Progress of labor:
Latent phase
Active phase
Alert line
Action line
Descent of the fetal head
Frequency how often they felt
Duration how long do they last
35. MATERNAL CONDITION:
Oxytocin drip
Drugs and other fluids
Pulse every 30 mts
Blood pressure every 4 hourly
Temperature every 2 hours
36. EVIDENCED BASED STUDIES:
• The findings revealed that partographs were used by midwives at
the st anthony’s hospital with The majority of the material folders
fully completed.
• The use and completion of partograph were significantly associated
with a reduced incidence of birth asphyxia at the hospital.birth
asphyxia could be reduced if partographs are used and completed by
midwives during labor in all cases.
37. ANALGESIA AND ANESTHETIC IN LABOR:
• Analgesics refers to a technique or medication that reduces pain
Dermol- narcotic
Morphine- narcotic
Stadol- non narcotic
38. Anesthetic:
Anesthetics refers to a technique or medication that partially or
completely eliminates sensation.
Types of anesthetics used:
• Local
• Regional
• Paracervical block
• Pudendal block
• Saddle block
• Caudal or lumbar epidural
39. ACTIVE MANAGEMENT OF LABOR:
• PRINCIPLES
• Early diagnosis following strict criteria.
• vaginal examination hourly for three hours,then every two hours atleast.
• Amniotomy one hour after admission.
• woman not in labor should sent home and 50% are readmitted in 24 hours.
• personal and psychological support.
• Antenatal education
40. INDUCTION OF LABOR:
• induction is the process of stimulating the labor by uterine
stimulation.It should be used when it is thought that the baby wiil be
safer delivered than it is in utero.
REASONS:
Polonged pregnancy.
Suspected intra uterine growth retardation.
Hpertension and pre eclampsia.
Planned time of delivery in the best interest of the baby.
41. CHECK PRIOR TO INDUCTION:
• Lie and the position of the fetus.
• Volume of amniotic fluid
• Tone of uterus
• Ripness of cervix
CONTRAINDICATION:
Severe degree of placenta previa
transverse fetal lie
CPD
Bihop score less than 4
45. VAGINAL EXAMINATION
• PREVENTION OF INFECTION
• ARTIFICIAL RUPTURE OF MEMBRANES
• BACK RUB
• ABDOMINAL RUB
• EFFLEURAGE
• EMOTIONAL SUPPORT
46. • PREPARATION OF DELIVERY ROOM
• PREPARATION OF EQUIPMENTS FOR DELIVERY
47. MAINTAIN RECORD OR DOCUMENTATION OF
LABOR:
• General
• Bowel
• Rest and ambulation
• Diet
• Bladder care
• Relif of pain
• Fetal well being
• Vaginal examination
• Watch maternal condition
• Evidence of fetal and maternal distress
48. CONCLUSION:
• Labor is rhythmic contraction and relaxation of uterine muscles
with progressive effacement dilation of the cervix lead to expulsion
of fetus and first stage of labor starts and ended with full cervical
dilatation.
