By Dr.M.D.Mazumdar, MD
The first stage of labor extends from the first signs of labor to full dilation of the cervix. In a primipara (first full term pregnancy), active first stage of labor can last between 6-12 hours, average being 8 hours. And in a multipara (more than one fullterm pregnancy), it lasts from 5-8 hours.
There is usually wide variation between the duration of the first stage in different women and also in each pregnancy in the same women.
Some women get uterine contractions in late pregnancy which they often mistake for onset of labor. But the contractions are usually not regular, does not increase gradually in intensity and are relieved by medicines or rest. These are 'false labor pains'.
Braxton Hicks contractions occur throughout pregnancy and are not related to labor pains.
There is also some amount of bleeding from blood vessels that rupture when the cervix dilates. These present at the vaginal opening as blood stained mucus. This blood stained mucus is called 'show'or 'mucus plug'.
The mucus plug may consist of thin or thick mucus. It may be just bloodstained in some women, resulting in brownish vaginal discharge. But in others , there may be frank bleeding at the time of expulsion of the mucus plug.
Usually, leakage of water is more in the lying down position. Standing or sitting up causes the head of the fetus to plug the mouth of the uterus and prevents outflow of the amniotic fluids (waters).
The painful contractions increases in frequency,intensity, duration and force as labor advances.
The cervix dilates to 3-4 cm in this stage.. The frequency of the uterine contractions at this stage is from 1-3 per 10 minutes in normal labour and each contraction lasts for less than a minute. The uterus may become firm and more prominent with every contraction.
In some women, the labor pains start at the back rather than in the abdomen. This is more likely if the head of the fetus is more posteriorly placed and presses on the mother's spine or ligaments.
The cervix dilates from 4 cm to 8 cm. Women whose waters have not ruptured at the onset of labour, can experience a gush of water flowing out of the vagina at this stage.
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The principle of management of this stage is to prepare the patient to have a safe vaginal delivery and to carefully monitor the vital signs for early detection of any deviation from the normal.
When the cervix is fully dilated (10 cms) it signifies that the second stage has started and the patient is shifted to the labor room from the observation room. Click here to Read about the Second Stage...
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