The document describes the stages of labor and delivery. It discusses: 1) The pains of labor that start at 15-30 minute intervals and increase in frequency and intensity over time. The cervix dilates from 1-10 cm and effaces from 25-100% during this stage. 2) As dilation nears completion, the woman may feel urges to bear down and the membranes may rupture, releasing amniotic fluid. 3) With final pushing, the baby's head crowns at the vaginal opening and is soon followed by the rest of the body. The placenta then delivers, usually within 30 minutes of the birth, completing the delivery process.

2.  Series of events that takes
place in the genital organs,
in an effort to expel the
viable products of
conception out of the womb
through the vagina into the
outer world.

3. PAIN:
Initially the pains come at intervals of 15-30 mins.
With duration of about 30 secs. But gradually the
interval becomes shorts with increasing intensity
and the duration comes at the interval of 3-5 mins
and at last for about 45 secs.
Dilatation and effacement of cervix:
Cervical dilatation is expressed either in term of
fingers 1,2,3, or fully dilated or in term of
centimeter. Effacement of cerrix is expressed in
terms of percentage i.e. 25,50,100%.

4.  Status of membranes: Usually the membrane
remain intact with the full dilatation of cervix or
some times even beyond in second stage and
intact membrane is best felt with the help of
fingers during uterine contraction when it
becomes tense and bulges out through cervical
opening.
 Maternal health: feeling of transient fatigue
appear after strong contraction .
 Pulse rate is increased by 10-15 beats/min.
 Systolic B.P. by about 10 mmHg.
 Temp remains unaffected.
 Fetal wellbeing: During contractions, there may
be slowing of fetal heart rate by 10-20 beats min.

5.  Pains –
Come at interval of 2-3 minutes , last for 1-1
½ min
 Bearing down efforts
 Membrane status
Membranes may rupture with a gush of
liqour per vaginum
 Vaginal signs
Crowning of the head

6.  Maternal signs
Features of exaustion, respiration slowed
down with increased perspiration. During the
bearing down efforts face become congested
with neck veins prominent. Immediately
following the expulsion of the fetus, mother
having a sigh of relief
 Fetal effects
Slowing of FHR during contraction is
observed

7. A)Pains: For a short time the patient experience no pain. However
intermittent discomfort in the lower abdomen appears due to uterine
contractions.
B)Before separation
 Per abdomen: Uterus become discoid in shape, firm in feel and non-
ballotable. The fundal height will reaches slightly below the
umbilicus.
 Per vaginum: There may be slight trickling of blood.
Length of the cord remains static as visible from outside.
After separation
 Per abdomen: Uterus become globular, firm and ballotable.
Fundal height is slightly raised as the separated placenta comes
down in the lower segment and contracted uterus rest on top of it.
 Per vaginum: There may be slight gush of bleeding.
Permanent lengthening of cord is established.

8. C)Expulsion of Placenta and Membranes:
This is achieved either by voluntary bearing
down efforts or more commonly aided by
manipulative procedure. The after birth
delivery is followed by slight to moderate
bleeding i.e. 100- 250ml.
D)Maternal signs: May be:
 Chills
 Occasional shivering
 Slight transient hypotension is not unusual.