4 Stages Of Labor And Delivery Pdf

File Name: 4 stages of labor and delivery .zip
Size: 24585Kb
Published: 25.04.2021

If you have any questions or concerns about pregnancy, labour and baby care speak with your health care provider or contact HealthLink BC at to speak with a registered nurse anytime of the day or night, any day of the year, or a pharmacist from p.

There are three stages of labour. The first stage is when your cervix is opening and your baby is moving down the birth canal. The second stage is when your baby is being born and the third stage is when the placenta is delivered.

Management of Normal Labor

Labor consists of a series of rhythmic, involuntary, progressive contractions of the uterus that cause effacement thinning and shortening and dilation of the uterine cervix.

The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. After birth, mother and infant are in good condition 1. The stimulus for labor is unknown, but digitally manipulating or mechanically stretching the cervix during examination enhances uterine contractile activity, most likely by stimulating release of oxytocin by the posterior pituitary gland. Normal labor usually begins within 2 weeks before or after the estimated delivery date.

In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours. Management of complications during labor requires additional measures eg, induction of labor , forceps or a vacuum extractor , cesarean delivery.

See also Abnormalities and Complications of Labor and Delivery. Birth Issues in Perinatal Care 24 2 —, Rupture of the chorioamniotic membranes or bloody show is diagnostic for onset of labor.

Bloody show a small amount of blood with mucous discharge from the cervix may precede onset of labor by as much as 72 hours.

Bloody show can be differentiated from abnormal 3rd-trimester vaginal bleeding because the amount is small, bloody show is typically mixed with mucus, and the pain due to abruptio placentae premature separation is absent. In most pregnant women, previous ultrasonography has been done and ruled out placenta previa. However, if ultrasonography has not ruled out placenta previa and vaginal bleeding occurs, placenta previa is assumed to be present until it is ruled out.

In such cases, digital vaginal examination is contraindicated, and ultrasonography is done as soon as possible. Labor begins with irregular uterine contractions of varying intensity; they apparently soften ripen the cervix, which begins to efface and dilate. As labor progresses, contractions increase in duration, intensity, and frequency. The 1st stage —from onset of labor to full dilation of the cervix about 10 cm —has 2 phases, latent and active.

During the latent phase , irregular contractions become progressively better coordinated, discomfort is minimal, and the cervix effaces and dilates to 4 cm. During the active phase , the cervix becomes fully dilated, and the presenting part descends well into the midpelvis. On average, the active phase lasts 5 to 7 hours in nulliparas and 2 to 4 hours in multiparas. Traditionally, the cervix was expected to dilate about 1. However, recent data suggest that slower progression of cervical dilation from 4 to 6 cm may be normal 1.

Pelvic examinations are done every 2 to 3 hours to evaluate labor progress. Lack of progress in dilation and descent of the presenting part may indicate dystocia fetopelvic disproportion. If the membranes have not spontaneously ruptured, some clinicians use amniotomy artificial rupture of membranes routinely during the active phase.

As a result, labor may progress more rapidly, and meconium-stained amniotic fluid may be detected earlier. Amniotomy during this stage may be necessary for specific indications, such as facilitating internal fetal monitoring to confirm fetal well-being.

Amniotomy should be avoided in women with HIV infection or hepatitis B or C, so that the fetus is not exposed to these organisms. During the 1st stage of labor, maternal heart rate and blood pressure and fetal heart rate should be checked continuously by electronic monitoring or intermittently by auscultation, usually with a portable Doppler ultrasound device see fetal monitoring. Women may begin to feel the urge to bear down as the presenting part descends into the pelvis.

However, they should be discouraged from bearing down until the cervix is fully dilated so that they do not tear the cervix or waste energy. The 2nd stage is the time from full cervical dilation to delivery of the fetus.

On average, it lasts 2 hours in nulliparas median 50 minutes and 1 hour in multiparas median 20 minutes. It may last another hour or more if conduction epidural analgesia or intense opioid sedation is used. For spontaneous delivery, women must supplement uterine contractions by expulsively bearing down.

In the 2nd stage, women should be attended constantly, and fetal heart sounds should be checked continuously or after every contraction. Contractions may be monitored by palpation or electronically. During the 2nd stage of labor, perineal massage with lubricants and warm compresses may soften and stretch the perineum and thus reduce the rate of 3rd- and 4th-degree perineal tears 2.

These techniques are widely used by midwives and birth attendants. Precautions should be taken to reduce risk of infection with perineal massage. During the 2nd stage in contrast to the 1st stage , the mother's position does not affect duration or mode of delivery or maternal or neonatal outcome in deliveries without epidural anesthesia 3.

Also, the pushing technique spontaneous versus directed and delayed versus immediate does not affect the mode of delivery or maternal or neonatal outcome. Use of epidural anesthesia delays pushing and may lengthen the 2nd stage by an hour 4.

The 3rd stage of labor begins after delivery of the infant and ends with delivery of the placenta. This stage usually lasts only a few minutes but may last up to 30 minutes. Aasheim V, et al : Perineal techniques during the second stage of labour for reducing perineal trauma.

Cochrane Database Syst Rev. Occasionally, the membranes amniotic and chorionic sac rupture before labor begins, and amniotic fluid leaks through the cervix and vagina. Rupture of membranes at any stage before the onset of labor is called premature rupture of membranes PROM.

Some women with PROM feel a gush of fluid from the vagina, followed by steady leaking. Further confirmation is not needed if during examination, fluid is seen leaking from the cervix. Confirmation of more subtle cases may require testing. A sample of the secretions from the posterior vaginal fornix or cervix may be obtained, placed on a slide, air dried, and viewed microscopically for ferning.

Ferning crystallization of sodium chloride in a palm leaf pattern in amniotic fluid usually confirms rupture of membranes. If rupture is still unconfirmed, ultrasonography showing oligohydramnios deficient amniotic fluid provides further evidence suggesting rupture. Rarely, amniocentesis with instillation of dye is done to confirm rupture; dye detected in the vagina or on a tampon confirms rupture. The earlier the membranes rupture before 37 weeks, the longer the delay between rupture and labor onset.

If membranes rupture at term but labor does not start within several hours, labor is typically induced to lower risk of maternal and fetal infection. Most women prefer hospital delivery, and most health care practitioners recommend it because unexpected maternal and fetal complications may occur during labor and delivery or postpartum, even in women without risk factors.

Other complications include abruptio placentae , abnormal fetal heart rate pattern, shoulder dystocia , need for emergency cesarean delivery , and neonatal depression or abnormality. Nonetheless, many women want a more homelike environment for delivery; in response, some hospitals provide birthing facilities with fewer formalities and rigid regulations but with emergency equipment and personnel available.

Birthing centers may be freestanding or located in hospitals; care at either site is similar or identical. In some hospitals, certified nurse-midwives provide much of the care for low-risk pregnancies.

Midwives work with a physician, who is continuously available for consultation and operative deliveries eg, by forceps, vacuum extractor, or cesarean.

All birthing options should be discussed. For many women, presence of the their partner or another support person during labor is helpful and should be encouraged. Moral support, encouragement, and expressions of affection decrease anxiety and make labor less frightening and unpleasant. Childbirth education classes can prepare parents for a normal or complicated labor and delivery. Sharing the stresses of labor and the sight and sound of their own child tends to create strong bonds between the parents and between parents and child.

Typically, pregnant women are advised to go to the hospital if they believe their membranes have ruptured or if they are experiencing contractions lasting at least 30 seconds and occurring regularly at intervals of about 6 minutes or less. Within an hour after presentation at a hospital, whether a woman is in labor can usually be determined based on the following:.

If these criteria are not met, false labor may be tentatively diagnosed, and the pregnant woman is typically observed for a time and, if labor does not begin within several hours, is sent home.

When pregnant women are admitted, their blood pressure, heart and respiratory rates, temperature, and weight are recorded, and presence or absence of edema is noted. A urine specimen is collected for protein and glucose analysis, and blood is drawn for a CBC and blood typing and antibody screening. If routine laboratory tests were not done during prenatal visits, they should be done; these tests include screening for HIV, hepatitis B, syphilis, and group B streptococcal infection.

A physical examination is done. While examining the abdomen, the clinician estimates size, position, and presentation of the fetus, using the Leopold maneuver see figure Leopold maneuver. The clinician notes the presence and rate of fetal heart sounds, as well as location for auscultation. Preliminary estimates of the strength, frequency, and duration of contractions are also recorded.

A The uterine fundus is palpated to determine which fetal part occupies the fundus. B Each side of the maternal abdomen is palpated to determine which side is fetal spine and which is the extremities. C The area above the symphysis pubis is palpated to locate the fetal presenting part and thus determine how far the fetus has descended and whether the fetus is engaged.

D One hand applies pressure on the fundus while the index finger and thumb of the other hand palpate the presenting part to confirm presentation and engagement.

If labor is active and the pregnancy is at term, a clinician examines the vagina with 2 fingers of a gloved hand to evaluate progress of labor. If bleeding particularly if heavy is present, the examination is delayed until placental location is confirmed by ultrasonography. If bleeding results from placenta previa, vaginal examination can initiate severe hemorrhage.

If labor is not active but membranes are ruptured, a speculum examination is done initially to document cervical dilation and effacement and to estimate station location of the presenting part ; however, digital examinations are delayed until the active phase of labor or problems eg, decreased fetal heart sounds occur. If the membranes have ruptured, any fetal meconium producing greenish-brown discoloration should be noted because it may be a sign of fetal stress.

Cervical dilation is recorded in centimeters as the diameter of a circle; 10 cm is considered complete. Because effacement involves cervical shortening as well as thinning, it may be recorded in centimeters using the normal, uneffaced average cervical length of 3.

Station is expressed in centimeters above or below the level of the maternal ischial spines. Fetal lie, position, and presentation are noted. Lie describes the relationship of the long axis of the fetus to that of the mother longitudinal, oblique, transverse.

Position describes the relationship of the presenting part to the maternal pelvis eg, occiput left anterior [OLA] for cephalic, sacrum right posterior [SRP] for breech. Presentation describes the part of the fetus at the cervical opening eg, breech, vertex, shoulder. Women are admitted to the labor suite for frequent observation until delivery. If labor is active, they should receive little or nothing by mouth to prevent possible vomiting and aspiration during delivery or in case emergency delivery with general anesthesia is necessary.

Shaving or clipping of vulvar and pubic hair is not indicated; it increases the risk of wound infections.

Management of Normal Labor

Labor consists of a series of rhythmic, involuntary, progressive contractions of the uterus that cause effacement thinning and shortening and dilation of the uterine cervix. The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. After birth, mother and infant are in good condition 1. The stimulus for labor is unknown, but digitally manipulating or mechanically stretching the cervix during examination enhances uterine contractile activity, most likely by stimulating release of oxytocin by the posterior pituitary gland. Normal labor usually begins within 2 weeks before or after the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours. Management of complications during labor requires additional measures eg, induction of labor , forceps or a vacuum extractor , cesarean delivery.

3. Identify descriptive phrases that concern the four stages of labor. 4. Identify the nursing care given the patient while in the delivery room.

Stages of labour and delivery

Before labour starts, your cervix is long and firm. During the first hours of labour, the muscles of the uterus womb contract and help shorten and soften the cervix, so that it can dilate open. Every labour is different.

During the first stage of labor, contractions help your cervix to thin and begin to open. This is called effacement and dilation. As your cervix dilates, your health care provider will measure the opening in centimeters.

Stages of labour (birth)

Labour is the process of passage of the foetus and placenta from the uterus , through the vagina , to be external to the mother. It is part of the process of parturition , which refers to labour, delivery and birth. Parturition requires the dilation of the cervical canal to accommodate for the passage of the foetus, as well as contractions of the uterine muscle wall that are strong enough to expel the foetus. The entire process of labour and vaginal birth takes an average of 13 hours in women giving birth for the first time, and 8 hours in women who have given birth before. However, the exact duration varies a great deal from one woman to another. Stage one lasts from the initiation of labour until there is full dilation of the cervix. This process of contractions, thinning and stretching is usually painful for the mother.

Read about the three stages of labour. Tips, such as breathing exercises, are provided for dealing with the pain and exhaustion of labour. Roughly speaking, vaginal birth, also called labour and delivery, is divided into three stages. The first stage of labour lasts from the time when you start having contractions until the time that your cervix is fully dilated, or open. The second stage is the "pushing" stage where the baby is actually delivered. The third stage of labour is the delivery of the placenta.

NCBI Bookshelf. Labor is a process that subdivides into three stages. The first stage starts when labor begins and ends with full cervical dilation and effacement. The second stage commences with complete cervical dilation and ends with the delivery of the fetus. The third stage initiates after the fetus is delivered and ends when the placenta is delivered. This activity outlines the stages of labor and its relevance to the interprofessional team in managing women in labor.

 Да. Это очень важная часть! - заявил лейтенант.  - Это не ребро или палец, как в церквях Галиции. Вам и в самом деле стоило бы задержаться и посмотреть. - Может быть, я так и сделаю.

Он не знал ни где он находится, ни кто его преследует и мчался, подгоняемый инстинктом самосохранения. Он не чувствовал никакой боли - один лишь страх. Пуля ударила в кафельную плитку азульехо чуть сзади. Осколки посыпались вниз и попали ему в шею. Беккер рванулся влево, в другую улочку.

Она попробовала закричать, но голос ей не повиновался. Ей хотелось убежать, но сильные руки тянули ее. - Я люблю тебя, - шептал коммандер.

Labour and Delivery

Нам нужно поговорить. Если Грег Хейл ворвется… - Он не закончил фразу. Сьюзан потеряла дар речи. Он пристально посмотрел на нее и постучал ладонью по сиденью соседнего стула. - Садись, Сьюзан.

ТРАНСТЕКСТ тогда еще не был создан, и принятие стандарта лишь облегчило бы процесс шифрования и значительно затруднило АНБ выполнение его и без того нелегкой задачи. Фонд электронных границ сразу увидел в этом конфликт интересов и всячески пытался доказать, что АНБ намеренно создаст несовершенный алгоритм - такой, какой ему будет нетрудно взломать. Чтобы развеять эти опасения, конгресс объявил, что, когда алгоритм будет создан, его передадут для ознакомления лучшим математикам мира, которые должны будут оценить его качество. Команда криптографов АНБ под руководством Стратмора без особого энтузиазма создала алгоритм, который окрестила Попрыгунчиком, и представила его в конгресс для одобрения.

Интересно, о чем он. У Бринкерхоффа подогнулись колени. Он не мог понять, почему Мидж всегда права. Он не заметил отражения, мелькнувшего за оконным стеклом рядом с .

The four stages of labor

Он посмотрел на дверь с номером 301. Там, за ней, его обратный билет. Остается только заполнить .

Клушар вдруг разбушевался. - Я знал, что он меня не слушает. Вот так и рождаются слухи. Я сказал ему, что японец отдал свое кольцо - но не .

Мысль Сьюзан показалась ему достойной внимания. - Неплохо, но есть одно. Он не пользовался своими обычными почтовыми ящиками - ни домашним, ни служебными. Он бывал в Университете Досися и использовал их главный компьютер. Очевидно, там у него был адрес, который он сумел утаить.

Человек в очках в железной оправе положил в карман ее халата связку ключей. Он не услышал ее крика, когда ударил ее, он даже не знал, кричала ли она вообще: он оглох, когда ему было всего двенадцать лет от роду. Человек благоговейно потянулся к закрепленной на брючном ремне батарее: эта машинка, подарок одного из клиентов, подарила ему новую жизнь. Теперь он мог принимать заказы в любой точке мира.

 Я должен был вам рассказать… но думал, что тот тип просто псих. - Какой тип? - Беккер хмуро взглянул на полицейского.

В дальнем конце палаты появилась медсестра и быстро направилась к. - Хоть что-нибудь, - настаивал Беккер. - Немец называл эту женщину… Беккер слегка потряс Клушара за плечи, стараясь не дать ему провалиться в забытье. Глаза канадца на мгновение блеснули. - Ее зовут… Не отключайся, дружище… - Роса… - Глаза Клушара снова закрылись.

Убийца целился, высунувшись из окна. Беккер вильнул в сторону, и тут же боковое зеркало превратилось в осколки. Он почувствовал, как этот удар передался на руль, и плотнее прижался к мотоциклу. Боже всевышний.

Даже в полуметре от шефа она не видела очертаний его фигуры. Всякий раз, ступая на очередную ступеньку, она носком туфли первым делом старалась нащупать ее край. К ней снова вернулись страхи, связанные с новой попыткой найти ключ Хейла в Третьем узле. Коммандер был абсолютно убежден в том, что у Хейла не хватит духу на них напасть, но Сьюзан не была так уж уверена в .

Он знал, что Фонтейн прав: у них нет иного выбора.

1 Response
  1. Jamie H.

    There are four stages of labor. First stage of labor. Thinning (effacement) and opening (dilation) of the cervix. During the first stage of labor, contractions help.

Leave a Reply