Labour is the onset of painful regular uterine contraction after the 28th week of pregnancy leading to the dilatation of the cervix and expulsion of the products of conception.
It is said to be normal if it occurs after the 37th week of pregnancy and it is spontaneous vaginal delivery of the fetus within 24 hours.
What starts labor is yet unknown; however, the symptoms of labor include:
- Painful regular uterine contraction
- Passage of mucus plug mixed with blood. This is called ‘show’
- Rupture of membrane
- Shortening and dilating of the cervix
It should be remembered that during pregnancy there are often painless irregular contractions of the uterus. It will not lead to the dilation of the cervix. This contraction is called Braxton-Hick’s contraction.
What are the stages of labor?
Labor is divided into three stages known to us, and as follows:
- From the onset of efficient contraction till full dilatation of the cervix.
- From full dilation of the cervix till the baby is delivered.
- From delivery of the baby to delivery of the placenta.
What are the components of labor?
The components of labor are different from the stages of labor in the sense that the former is the stages whereas the latter is the processes that take place during each stage. They include:
- Power: This refers to the muscles involved in pushing the baby out of the uterus. During labor, there is increased Intra uterine pressure. The primary forces come from the uterine muscle while the abdominal muscle and diaphragm are the secondary forces.
- Passage: The passage consists of the bony pelvis, the cervix, and the vagina. The body’s pelvis must be adequate to allow for the passage of the fetus. X-ray pelvimetry can be used to assess the pelvis at about the 36th week of pregnancy. The cervix and the vagina offer no resistance to the passage of the fetus except in cases of stenosis.
- Passenger: These consist of the fetus, the placenta, and the membrane.
When a pregnant woman is admitted into the labor ward, it is:
- Ensure that your baby’s load as required by the hospital is complete.
- You have to take a bath if you have not already done so.
- Shave
- Take enema if required
- Ensure that you are never left alone at any given time.
- Vital signs are monitored by the nurse.
- The frequency and duration of contraction are also to be monitored.
- The midwife will determine whether the contraction is strong or weak and checks the fetal heart rate.
- To do a vaginal examination by the nurse every two hours. This will determine the enhancement of the cervix.
- You will be asked to walk if the fetus is engaged. This will enable the weight of the liquor and the fetus to help dilate the cervix and the pressure on the lower segment to stimulate the uterus to contract.
The first stage of labor is divided into a latent and an active phase. The latent phase is from the onset of labor until the cervical as it is 3xm dilated, while the active phase is from there till full dilatation. The latter is more rapid. Monitoring labor in the first stage is very important to avoid fetal distress. This is done by an instrument called Cardiotocogram. However, some hospitals still make use of the traditional way of monitoring.
When you are fully dilated, it enables the presenting part to rest on the pelvic floor leading to the irresistible urge on you to bear down. At this junction, you are to take a deep breath, hold it down, and then strain it down. While the midwife avails herself/himself with words of encouragement.
As the head stretches the perineum, the anus begins to open and you may defecate. The head will be seen in the vulva with each construction and it retracts when interaction stops. When the head passes the pelvic floor it is no longer retracted if contraction stops. At this point the has is said to have crowned.
The perineum is carefully guarded to prevent tears. The head too must be delivered slowly otherwise tear will occur. An episiotomy may be given in some cases. As soon as the head is delivered, the midwife passes her finger to feel the cord around the neck. If any, it is slipped over the head or it can be clamped with artery forceps and divided.
Next is the delivery of the anterior shoulder, then the posterior shoulder, and lastly the rest of the body.
The knowledge here is that as the anterior shoulder is delivered, intramuscular ergometrine 0.5 is given by the midwife but in most clinics, the drug is given when the baby is born. If there is no cord around the neck of the baby as soon as the baby is born, the midwife clamps the cords at a point.
Express blood from this point back toward the baby and put the second clamp proximally and then divide. The midwife assesses the Apgar score of the baby in the first minute of birth which she shows the baby to you afterward. The baby is then dressed up by the midwife. Some babies do not cry well at birth due to the fact they have swallowed a lot of liquor.
Such babies are sucked through the nose and mouth in some cases. Sucking out the swallowed liquor is a traditional practice and will make them cry well. Whereas some are yet depressed due to drugs taken by you or due to your prolonged labor.
Your baby’s extremities turn blue at birth. These groups of babies are actively resuscitated by the pediatrician or experienced midwife.
- Sucks the baby
- Holds the baby’s head down and smack both feet.
- Gives drugs such as hydrocortisone, carmine, and nikethamide.
- Gives oxygen
After the birth of the baby, the uterus remains quiet and does not contract. While the assistant midwife is dressing up the normal baby, the midwife watches for the separation of the placenta. If the placing a is not separated, it should not be delivered to avoid inversion of the uterus.
The signs of placenta separation are:
- Contraction of the uterus.
- The rise in the fundus uterus.
- Slight bleeding from the vagina.
- Lengthening of the cord.
The placenta is now delivered by continuous cord traction known as the Bandt-Andrews method. The placenta is examined after delivery. The placenta is divided into cotyledons. The midwife checks if they are complete or if any are missing, and further examines the membrane made up of the amnion and the chorion. However, both can be separated. The cut end of the umbilical cord is examined for umbilical arteries. It should be realized that if the placenta is not complete the uterus must be explored otherwise there will be postpartum bleeding.
After the examination of the placenta, the perineum is examined for tears. Except for the very small ones, all tears must be sutured.
Partogram
As soon as labor becomes established, the midwife attending to the patient records all events. Such recordings include the maternal pulse rate and blood pressure, fetal heart rate, frequency, duration, and strength of contraction. The time each vaginal examination is made and the cervical dilatation is recorded. The records showing cervical dilatation in centimeters are plotted against the time in hours.
Moulding
This refers to the changes in the shape of the head of the fetus during labor. There is a decrease in the diameter of the skull. The parietal bone slide under each other and can override the frontal and occupy bone. This is due to the pressure in the birth canal, especially when the fetus is moderately large. Molding reduces the bi-parietal diameter but excessive molding causes intracranial damage.
Caput Succedeneum
This is oedematous swelling on the scalp superficial to the periosteum of the cranial bone. During labor except for that part of j, the most advanced half of the other parts are pressed upon by the c and lower part of the uterus. This results in venous Congestion.
