stages of labor antenatal workshop
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1Copyright © 2014 Paras Hospitals. All rights reserved.
STAGES OF LABOR
Dr Nupur Gupta, Unit HeadDepartment of Obstetrics & Gynecology
Paras Hospital, Gurgaon
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Pain and the brain…
What will labour feel like and can I
cope with it?
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WHAT IS LABOR?
Series of events to deliver viable fetus from uterus
into outside world
Term labor- 32-40wks
Preterm labor- < 37 wks
Post term labor- > or = 42wks
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ONSET OF LABOR
Initiation of labor
- hormones of mother & fetus
- placental hormones
Hormones
- estrogen, progesterone, oxytocin & prostaglandin
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True Vs False Labor
TRUE LABOR
Regular contractions
Increase in frequency and intensity
Cervix dilates
No relief with sedation
Abdomen and back pain
FALSE LABOR
Irregular
Remain the same
Unchanged
Relieved
Lower abdomen pain
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WOW! I AM IN LABOR?
Waiting for this precious arrival!
Mild pain radiating from back to abdomen
Feeling frequency of urination
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STAGES OF LABOUR
Conventionally labour divided into 3 stages
(some 4th stage)
First stage
Second stage
Third stage
Fourth stage
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FIRST STAGE (Dilatation stage)
From onset of true labour pains - full
dilatation of cervix
CERVICAL stage
Duration - 12 hrs in primi & 6-7 hrs in
multiparae
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SECOND STAGE (Expulsive stage)
From full dilatation of cervix- expulsion of
fetus
Average duration 2hrs in primi
& 30 mins in multipara
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THIRD STAGE (Placental stage)
From expulsion of fetus to expulsion of placenta
with membranes
Average duration 10-15 mins
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FOURTH STAGE (Observation stage)
Stage of observation
At least 1 hr ( Golden Hour)
observation after expulsion of
afterbirths
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First stage
Beginning of contractions -progressing
changes in cervix & ends -cervix fully
dilated
3 phases of labor
- Early Labor Phase
- Active Labor Phase
- Transition phase
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Phases of First Stage
Latent (EARLY) : Dilation 0-3 cms. Contractions mild/irregular.
Active: 4-7 cms. Contractions 5-8 min. apart. Lasts 45-60 sec;
moderate - strong intensity.
Transition: Dilatation 8-10 cms. Contractions 1-2 min. apart; 60 –
90 sec.; strong intensity.
Baby’s heart beats monitored
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First Stage of labour: Early Labour - How do you know?
Mild, regular contractions, 30-45 sec / 5-30 min
Cervical dilatation starts
Contractions - lower back, menstrual cramps, & pressure on pelvis area
Pink or brownish-red blood tinged vaginal discharge- “bloody show”
Possibility of breaking of water bag
Early labor ends -cervix about 4cm dilated
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First stage of labour: Active Labor (4 to 8 hrs)
Contractions frequent, longer, and stronger 1-2 mins duration/
2-3 mins
Cervix dilates from 4 to 10 cm
Baby begins to descend or drop
The last part of active labor, cervix dilates upto 10 cm
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WHAT TO DO: Natural Pain Coping techniques?
Take a walk
Be relaxed
Can take a warm bath
Listen to favorite music or watch videos
Take help from husband or close relatives
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Best to take rest
Tired, try to doze off between contractions
Be sure to drink plenty of fluids to stay well
hydrated & energetic
Pass urine frequently
WHAT TO DO: Natural Pain Coping techniques?
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Try some breathing exercises
Can watch a movie or read a book
Opt for which relaxes you
Different comfortable positions
Pain medication
WHAT TO DO: Natural Pain Coping techniques?
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Take a massage
A cool cloth on forehead or a cold pack on back or warm compression
for comfort
Transition stage most painful- try to distract – music or conversation
or loving touch from partner
WHAT TO DO: Natural Pain Coping techniques?
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Fathers do make a difference to birth……………
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Second stage
Cervix fully dilated, and it is time to push
Contractions will last 45-90sec with a 3-5 minute rest period
Baby is very low in pelvis - feel pressure on rectum
Each contraction forces baby down
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Second Stage
Delivery of infant
up to 1 hr. or approx 20 contractions – primigravida
20 min. or approx 10 contractions in multipara
Most difficult & uncomfortable part of labor
Strong urge to push & bear down
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Pushing stage
Try to follow doctor’s instructions
Use deep breathing techniques to stay controlled
Concentrate on self power
Positions: Sitting, Side Lying, Standing, Squatting, All Fours, Kneeling
WHAT TO DO: Natural Pain Coping techniques?
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Third stage
After birth of baby, uterus contracts
First contractions separate the placenta from
uterine wall
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Afterwards!
Be patient
Feeling of achievement
All that pain subsides with touch of baby
Try to put baby on breast
Helps to create immediate bonding
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