Stages of Normal Labor
Normal Labour is a physiologic process during which the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) are expelled outside the uterus. Labour is said to be normal only when the fetus is mature and the process is spontaneous and uncomplicated.
The normal duration of active labor is 8-10 hours in the first pregnancy and 6-8 hours in later pregnancies.
It is difficult to determine exactly when normal labor starts. This is because, very often, a woman may have uterine contractions which are due to false labor pains. False labor pains are not regular, and can be controlled by painkillers and antispasmodic medicines.
True labor is regular, the intensity and number of contractions increases gradually and it is accompanied by passage of mucus and blood. Rupture of the membranes can also occur at the onset of labor and is marked by a gush of clear liquid.
Onset of Labor:
The start of true labor is characterised by:
- True Labor Pains:
Normal labor is divided into three stages: Regular pains in the abdomen which gradually increase in intensity and which radiates to the back and to the legs are true labor pains. The duration and number of contractions increases over time.
- Show: Show is the passage of blood stained mucus due to the expelled cervical mucus plug. The bleeding occurs from ruptured small vessels as a result of separation of the membranes from the lower uterine segment.
- Dilation of the Cervix: A dilating cervix is a definite sign of the start of labor, especially in primigradias. In a multigravida, the cervix may admit the tip of the finger even before labor starts.
- Formation of the bag of Waters: The bag of waters can be felt through the partially dilated cervix at the start of labor.
Stage I lasts from the onset of labour to full dilation of the cervix. In a woman in her first pregnancy, this stage lasts for about 10 to 12 hours. In a woman who has delivered earlier, it lasts from 6 to 8 hours.
The First Stage is again divided into three phases:
This is the longest and least painful phase of the entire duration of labour. It starts from the time when the cervix first starts to dilate to the time when the cervix is 4 cm dilated. It is also called the 'Latent phase' of labour or the 'Early phase' of labour. It can last for days and can occur with only the mildest discomfort to the pregnant woman.
This is a more active phase of labour. The cervix dilates from 4 cm to 8 cm during this phase.
The contractions are more painful , of longer duration and come more regularly. It is also called the 'middle phase ' of labour.
During this phase, the cervix dilates from 8 cm to 10 cm . At 10 cms, the cervix is fully dilated and the baby's head can come out of the uterus safely and easily.
Stage II lasts from the full dilatation of the cervix to the expulsion of the baby. In a first pregnancy, it lasts for about 1- 2 hour, in subsequent pregnancies, it lasts for about 1/2 hour.
This stage (Second stage) is the stage when the baby's head is travelling down the vaginal canal to be delivered. The contractions are very painful and run into each other, appearing to produce almost continuous pain.
Stage III lasts from the birth of the baby to the expulsion of the placenta and the membranes. It lasts for about 15 - 20 minutes in both first and later pregnancies. The third stage is comparatively less painful and is characterised by a gush of bleeding at the time the placenta separates from the uterus.
- Complications in Labor.
- Testing for Pregnancy.
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- Breast Engorgement