Labour“in labour”…..when uterine contractions reach sufficient strength, duration and frequency to cause effacement and dilatation of

the cervix.

Normal labour takes place at term. -a single fetus -presents by the vertex and -the delivery, followed by that of the

placenta and membranes, -is accomplished with in 4-24 hours, -with out artificial aid and without complication.

Possible causes for the onset of labour include:

-fetal pressure on the uterine wall-increasing tension on the uterine wall-changes in hormonal balance (fetal

adrenal cortex)

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Signs of labour for a pregnant woman

-regular contractions increasing in strength, duration and frequency.

-show (bloody mucus plug around cervix)

-rupture of the membranes (amniotic fluid escapes)

Terms used during labour:-contractions: shortening of the uterine muscle fibres. -during labour increase in strength duration and frequency

-strength: increase in intensity -duration: from the beginning of a contraction to the end of that contraction. -frequency: from the beginning of one contraction to the beginning of the next.

The cervix during labour

The cervix during labour:-effacement: or taking up of the cervix.-the cervix becomes part of the lower

uterine segment and flat

-dilatation of the cervix-the external os of the cervix increases in

diameter to full dilatation =10 cms.

The mechanisms of labour

The mechanisms of labour

Briefly outline the “mechanisms” of labour

( note only a general understanding is needed)

-a series of passive movements of the fetus in its passage through the birth canal.

-

pelvis: -inlet / outlet differing in size and shape -curve at the lower end.(Curve Of Carus) -cylindrical

Powers-uterine contractions

-abdominal muscles

Resistance-offered by the pelvis, cervix and the pelvic

muscles

Passengers:-fetus (flexible neck acts like a fulcrum) -fetal skull (shape and size)

http://www.youtube.com/watch?v=duPxBXN4qMg&feature=related

http://www.youtube.com/watch?v=YooksLV1tFc

http://www.youtube.com/watch?v=CgsDBqBgymY&feature=related

Stages of Labour

Stage one: from the onset of regular contractions to full dilatation of the cervix

Stage two: from full dilatation of the cervix to the birth of the baby

Stage three: from the birth of the baby to the delivery of the placenta.

Stage four: from the delivery of the placenta and membranes to 1-4 hours after the baby’s birth

-average durationFirst stage -primigravida = 10-12 hours -multigravida = 1-2 hoursSecond stage -primgravida =1-2 hours -multi gravida =½ hour Third stage: -average duration ½ hour (with ecbolic drugs = 5

minutes)

Factors which may influence a woman’s experience of labour include:

-previous experiences-tiredness-dehydration-position of the baby-environment-support people-

Nursing actions during labour to observe and record the maternal and fetal physical condition

-blood pressure -pulse -temperature

- urine output amount and urinalysis-vaginal loss (blood, mucus, amniotic fluid-contractions-pain-general wellbeing

1) www.google imagesnuclearfamily.wordpress.com/page/2/&usg=_

Emotional assessment (Maternal)-anxiety-mood-response to pain and labour

Nursing actions for fetal assessment

-fetal heart rate-amniotic fluid (colour)-

Nursing actions to assist a woman’s pain management during labour.

-distraction techniques-breathing techniques-music -counting-conversation-massage---

Nursing actions:-assist with hygiene needs, bath , back

rubs, change the bed linen, cold flannels to forehead, heat packs……….

-remind re elimination needs-support her support person-stay with her-give feedback re the progress of her

labour and her fetus-encourage……………..

http://www.youtube.com/watch?v=wRkyT9HQSEQ

http://www.youtube.com/watch?v=6QXb0vzuwWs&feature=related

Discuss:

What factors might influence a woman’s choice about where she would like to have her baby?

For example home versus hospital