Stages of labor antenatal workshop

1Copyright © 2014 Paras Hospitals. All rights reserved.
STAGES OF LABOR
Dr Nupur Gupta, Unit Head
Department of Obstetrics & Gynecology
Paras Hospital, Gurgaon

Pain and the brain…
What will labour feel like and can I
cope with it?

WHAT IS LABOR?
 Series of events to deliver viable fetus from uterus
into outside world
 Term labor- 32-40wks
 Preterm labor- < 37 wks
 Post term labor- > or = 42wks

ONSET OF LABOR
 Initiation of labor
- hormones of mother & fetus
- placental hormones
 Hormones
- estrogen, progesterone, oxytocin & prostaglandin

True Vs False Labor
TRUE LABOR
 Regular contractions
 Increase in frequency and intensity
 Cervix dilates
 No relief with sedation
 Abdomen and back pain
FALSE LABOR
 Irregular
 Remain the same
 Unchanged
 Relieved
 Lower abdomen pain

6Copyright © 2014 Paras Hospitals. All rights reserved. 6
WOW! I AM IN LABOR?
 Waiting for this precious arrival!
 Mild pain radiating from back to abdomen
 Feeling frequency of urination

STAGES OF LABOUR
Conventionally labour divided into 3 stages
(some 4th stage)
 First stage
 Second stage
 Third stage
 Fourth stage

FIRST STAGE (Dilatation stage)
 From onset of true labour pains - full
dilatation of cervix
 CERVICAL stage
 Duration - 12 hrs in primi & 6-7 hrs in
multiparae

SECOND STAGE (Expulsive stage)
 From full dilatation of cervix- expulsion of
fetus
 Average duration 2hrs in primi
& 30 mins in multipara

THIRD STAGE (Placental stage)
 From expulsion of fetus to expulsion of placenta
with membranes
 Average duration 10-15 mins

FOURTH STAGE (Observation stage)
 Stage of observation
 At least 1 hr ( Golden Hour)
observation after expulsion of
afterbirths

First stage
 Beginning of contractions -progressing
changes in cervix & ends -cervix fully
dilated
 3 phases of labor
- Early Labor Phase
- Active Labor Phase
- Transition phase

Phases of First Stage
 Latent (EARLY) : Dilation 0-3 cms. Contractions mild/irregular.
 Active: 4-7 cms. Contractions 5-8 min. apart. Lasts 45-60 sec;
moderate - strong intensity.
 Transition: Dilatation 8-10 cms. Contractions 1-2 min. apart; 60 –
90 sec.; strong intensity.
 Baby’s heart beats monitored

First Stage of labour: Early Labour - How
do you know?
 Mild, regular contractions, 30-45 sec / 5-30 min
 Cervical dilatation starts
 Contractions - lower back, menstrual cramps, & pressure on pelvis area
 Pink or brownish-red blood tinged vaginal discharge- “bloody show”
 Possibility of breaking of water bag
 Early labor ends -cervix about 4cm dilated

First stage of labour: Active Labor (4 to 8 hrs)
 Contractions frequent, longer, and stronger 1-2 mins duration/
2-3 mins
 Cervix dilates from 4 to 10 cm
 Baby begins to descend or drop
 The last part of active labor, cervix dilates upto 10 cm

WHAT TO DO: Natural Pain Coping techniques?
 Take a walk
 Be relaxed
 Can take a warm bath
 Listen to favorite music or watch videos
 Take help from husband or close relatives

 Best to take rest
 Tired, try to doze off between contractions
 Be sure to drink plenty of fluids to stay well
hydrated & energetic
 Pass urine frequently

 Try some breathing exercises
 Can watch a movie or read a book
 Opt for which relaxes you
 Different comfortable positions
 Pain medication

 Take a massage
 A cool cloth on forehead or a cold pack on back or warm compression
for comfort
 Transition stage most painful- try to distract – music or conversation
or loving touch from partner

Fathers do make a difference to birth……………

Second stage
 Cervix fully dilated, and it is time to push
 Contractions will last 45-90sec with a 3-5 minute rest period
 Baby is very low in pelvis - feel pressure on rectum
 Each contraction forces baby down

Second Stage
 Delivery of infant
 up to 1 hr. or approx 20 contractions – primigravida
 20 min. or approx 10 contractions in multipara
 Most difficult & uncomfortable part of labor
 Strong urge to push & bear down

 Pushing stage
 Try to follow doctor’s instructions
 Use deep breathing techniques to stay controlled
 Concentrate on self power
 Positions: Sitting, Side Lying, Standing, Squatting, All Fours, Kneeling

Third stage
 After birth of baby, uterus contracts
 First contractions separate the placenta from
uterine wall

Afterwards!
 Be patient
 Feeling of achievement
 All that pain subsides with touch of baby
 Try to put baby on breast
 Helps to create immediate bonding

Stages of labor antenatal workshop

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