2. The Labor
• Labor is the physiological process
in which products of conception
(the fetus, membranes, umbilical
cord, and placenta) is passed from
the uterus to the outside world
between 38 and 42 completed weeks
3. • The period begins with the onset of
regular uterine contractions (UCs)
and lasts until the expulsion of the
placenta; we called the Intrapartum.
• Delivery is the birth of baby itself.
• Delivery can occur in two ways,
vaginally or by a cesarean delivery.
4. A normal labour is the Vaginal delivery with
the following characteristics:
• Spontaneous onset (it begins on its own,
without medical intervention)
• Rhythmic and regular uterine contractions
• Vertex presentation (the ‘crown’ of the
baby’s head is presented to the opening
• No maternal or fetal complications.
5. Normal Labor Signs
1. Pre-labor (1 - 4 weeks before labor):
• The baby drops lower (lightening) and
his head drops down.
• Increased back pain and cramps
• Abdominal pain
• Joints feel looser
• Cervix effacement and dilation (opening
and thins out of cervix) 5
6. 2. Early labor (Hours before labor):
• Bloody show: vaginal discharge
becomes thicker and pink.
• Water breaks: rupture and break of
the amniotic sac.
• Uterine contractions (UCs): painful,
regular, strong contraction.
7. True vs. False Labor
Irregular, less painful
Regular, become closer and
May last 1 – 2 min.Last 30 – 60 sec.Timing
Upper abdomenLower abdomen and backContraction position
Go away with changing
position, walking, hot bath
Get stronger with changing
No changesDilation and effacementCervix
No significant changesDrops into pelvisFetus
8. Factors affecting Labor (5 P’s)
In every labor; there are five essential factors affect the
process. These are easily remembered as the five P’s:
1. Passenger: the fetus
2. Passageway: the pelvis and birth canal
3. Powers: the uterine contractions
4. Position: maternal postures and physical
5. Psyche: the response of the mother
9. 1.Passenger (The Fetus):
The fetus relationship to the passageway is the major
factor in the birthing process. The relationship includes:
• Fetal skull and size
• Number of fetuses
• Position of feus
− Fetal lie: relationship of fetal spine to maternal spine;
longitudinal (vertical) or transverse (horizontal)
− Fetal presentation: part of fetus that enters pelvis first
− Fetal attitude: relationship of fetal body parts to each other;
flexion (normal) or extension (abnormal)
− Fetal position: fetal direction in the pelvis
− Fetal station: position of the baby's head relative to the lower
bone of pelvis called the ischial spines 9
• Brain bleeds, intracranial hemorrhages, and Cerebral palsy
• Spinal cord fractures and injury
• Intellectual disabilities
• Developmental delays, and muscles problems
• Birth injury to the baby
• Injury in the mother reproductive system
• Prolonged labor
• Facial trauma
• Cord prolapse; causing Hypoxia
• Premature separation of the placenta and ruptured uterus.
*Risks happen in Abnormal Presentations
17. 2. Passageway (The pelvis):
• The passage includes the bony pelvis, the soft
tissues of the cervix, and the vagina.
• The maternal pelvis is the greatest determinant in
the vaginal delivery of the fetus.
• During the first stage of labor, the cervix opens
(dilates) and thins out (effaces) to allow the baby
to move into the birth canal.
• The cervix must be 100 percent effaced and 10
centimeters dilated before a vaginal delivery.
20. 3. Powers:
• Powers refer to the involuntary Uterine
Contractions (UCs) and voluntary pushing of
• Contractions are a tightening and relaxing of the
muscles in the abdomen and the back.
• Uterine Contractions have two major goals:
1. To dilate the cervix
2. To push the fetus through the birth canal
• After each contraction there is a uterine
relaxation that allows blood flow to the uterus.
22. 4. Position:
Maternal position during labor and birth.
The psychological state of the mother and her
response. We should give her the support and
health care, and allow the family to give her
24. Mechanism of Labor
In the normal labor; there are series of changes in position
and attitude of the fetus to accommodate himself to the
pelvic to pass easily through the birth canal:
4. Internal rotation
6. External rotation
26. 1. Engagement
The greatest diameter of the fetal head passes
through the pelvic inlet.
The downward movement of the fetus through the birth
canal. Full descent occurs when the fetal head pass the
dilated cervix. Descent occurs because of contractions
During descent; the bones of fetal skull overlap (called
Moulding) to pass through the narrow parts of pelvis.
29. 3. Flexion
During Descent; the chin of the fetus moves toward
the fetal chest which reduce the fetal head diameter
12 to 9.5 cm.
30. 4. Internal rotation
The rotation of the fetal head until the longest
diameter of the fetal head match the longest diameter
of the maternal
31. 5. Extension
The fetal head passes successfully through the narrowest
part of the pelvis, and passes out of the birth canal making
The head now is
visible at the
32. 6. External rotation (Restitution)
After the head has delivered, the shoulders rotate
internally to fit the pelvis and comes out.
33. 7. Expulsion
Once the shoulders are born, the rest of the baby is
born easily and smoothly because of its smaller size.
34. The Stages of Labor
1. 1st stage (cervix dilation): begins with onset of
labor and ends with complete cervical dilation.
2. 2nd stage (baby delivery): begins with complete
dilation of cervix and ends with delivery of baby.
3. 3rd stage (placenta delivery): begins after
delivery of baby and ends with delivery of
4. 4th stage (postpartum): begins after delivery of
the placenta and is completed 4 hours later.
35. 1. First stage (6-36 hours):
• This is the onset of labor to complete
dilation of cervix.
• This stage divided into two phases:
1. Latent phase: contractions become
frequent, very strong, and painful. Cervix
dilates about 4 cm. Contractions begins by
lasting about 40 seconds and coming every
36. 2. Active phase: dilatation of the cervix from 6
to 10 centimeters (Full dilation of cervix).
Contractions become regular, longer, more
severe, and more frequent. In most cases,
the active phase is shorter than the latent
37. Effacement of the cervix
(a) Before labour begins, the cervix is not effaced
(b) Cervix is 60% effaced (c) Cervix is fully effaced
39. 2. Second stage (1 hrs. – 2 hrs.):
• It starts when the cervix is completely
opened and ends with the delivery of the
• The second stage is often referred to as the
"pushing" stage when the mom push the
baby outside to the world.
• Contractions will last about 60 to 90
seconds every 2 to 5 minutes.
40. 2. Second stage (1 hrs. – 2 hrs.):
• When the baby's head is visible at the
opening of the vagina, it is called
• The second stage is shorter than the first
stage, and may take between 30 minutes to
3 hours for a woman's first pregnancy.
42. 3. Third stage (30 min.):
• Is the delivery of the placenta; which occurs
after the birth of the baby and the umbilical cord
• Once a baby is born, the womb (uterus)
continues to contract, causing the placenta to
separate from the wall of the uterus.
• This stage usually lasts just a few minutes up to
• There are two ways; Physiological management
(spontaneously with the mother effort) and
44. Active management of the third stage:
• It involves three components:
1. Giving a drug (uterotonic) to contract the
2. Clamp and cut the cord after cord
pulsations have ceased or approximately
2–3 minutes after birth of the baby,
whichever comes first.
45. Active management of the third stage:
3. Traction is applied to the cord with counter-
pressure on the uterus to deliver the
placenta (Controlled Cord Traction CCT).
• After delivery of the placenta; massage the
uterus immediately until it is firm.
• During recovery, assist the woman to
breastfeed the baby.
49. Fourth stage:
• An hour to four hours after delivery, and
sometimes for about six weeks, or with the
stabilization of the mother.
• The baby should be assessed and the mother
should have regular assessments for uterine
contraction, vaginal bleeding (The normal blood
loss is about 500 mL), heart rate and blood
pressure, and temperature, for the first 24 hours
50. Fourth stage:
• Normally, after the delivery of the placenta,
the woman might feel strong contractions
until the uterus return to its normal status.
• Reassure the mother that these
contractions are healthy, and help to stop