Stages of labour

Stages of labour :-
There are 3 stages in labour -

1st stage - 
It starts from onset of true labour pain and ends with full dilatation of the cervix.
In other words, it is ''cervical stage'' of labour. Average duration of this stage is
about 12 hour in primigravidae and 6 hour in multiparae.

2nd stage - 
It starts from the full dilatation of the cervix and ends with expulsion of fetus
from the birth canal. It has got two phages -
a) The propulsive phase - starts from full dilatation upto the descent of the
presenting part to the pelvic floor.
b) The expulsive phase - is distinguished by maternal bearing down efforts and
ends with delivery of the baby.
Average duration of this stage is 2 hour in primigravidae and 30 min in multigravidae.

3rd stage - 
It begins after expulsion of fetus and ends with the expulsion of the placenta and membranes.
It's average duration is 15 min in both gravidae. The duration is, however, reduced to
5 min in active management.

4th stage - 
It is not include in labour. It is only a observational stage. Duration of this stage is
at least one hour after the expulsion of placenta. During this period, general condition
of the patient and the behaviour of the uterus are to be carefully watched.

Note:-
Primigravidae : Woman who is pregnent first time. 
Multigravidae : Woman who is pregnent multi times.

Duration of labour

Time of normal labour -

In primigravidae :  12 - 14 hours

In multigravidae :   6 - 8 hours

Duration of stages (labour has 3 stages) -

1st stage -  Average duration 12 hours in primigravidae &
                                              6 hours in multigravidae.

2nd stage - Average duration 2 hours in primigravidae &
                                             30 min in multigravidae.

3rd stage -  Average duration 15 min in both primigravidae and multigravidae.

For more about stages of labour go to following page -
http://pregnancyandlabour.blogspot.in/2014/01/stages-of-labour.html

False pain and True labour pain

False pain -
It usually appears prior to the onset of true labour pain, by one or two weeks
in primigravidae and by a few days in multiparae. The woman feels pain and
discomfort in the abdomen and these are mistaken for labour pain.
False pain has got the following features -
  - Dull in nature and usually confined to the lower abdomen and groin.
  - Continuous and unrelated with hardening of the uterus.
  - Without any effect on dilatation of the cervix.
  - Usually relieved by enema and administration of a sedative.

True labour pain -
The features of true labour pain are -
  - Painful uterine contractions (labour pain) at regular intervals.
  - Contraction with increasing intensity and duration.
  - ''Show''.
  - Progressive effacement and dilatation of the cervix.
  - Formation of ''bag of waters''.

Que.-  What is ''Show'' in labour ?
Ans. -  Expulsion of cervical mucus plug, mixed with blood is called ''show''.

Que.-  What is ''Bag of water'' in labour ?
Ans. -  Due to stretching of lower uterine segment , the membranes are detached
           easily because of its loose attachment to the poorly formed decidua. With
           the dilatation of the cervical canal, the lower pole of the fetal membranes
           becomes unsupported and tends to bulge into the cervical canal. As it contains
           liquor which has passed below the presenting part, it is called ''bag of water''.
           Above the presenting part liquor is called ''hind waters'' and below the presenting
           part liquor is called ''forewaters''. After the contractions pass off, the bulging
           may disappear completely. This is almost a certain sign of onset of labour.

Sign and symptoms of labour

The sign and symptoms of labour are following -

1. False pain -
It is found more in primigravidae then in parous woman. It usually appears
prior to the onset of true labour pain, one or two weeks in primigravidae
and by a few days in multiparae.

2. Lightening -
Few weeks to prior to the onset of labour specially in primigravidae.
The presenting part sinks into the true pelvis. It is due to active pulling up
of lower pole of the uterus around the presenting part. It is a welcome 
sign of pregnancy.

3. Cervical changes -
Variable days prior to the onset of labour the cervix becomes ripe.
A ripe cervix is soft, less than 1.5 cm in length, admits a finger easily
and is dilatable.

4. Labour pain -
Throughout pregnancy, painless Braxton Hicks contractions with simultaneous
hardening of the uterus occur. These contractions chenge there character,
become more powerful, intermittent and are associated with pain. The pains are 
more often felt in front of the abdomen or radiating towards the thighs.

For details about false pain and true labour pain, go to following page -
http://pregnancyandlabour.blogspot.in/2014/01/false-pain-and-true-labour-pain.html

Causes for onset of labour

Theories regarding initiating of labour include the following -

1. Oxytocin -
There is oxytocin receptor in the uterus. Oxytocin receptors are increased
in the uterus with the onset of labour. And then oxytocin promotes the
release of prostaglandins from the decidua. Oxytocin synthesis is increased
in the decidua and in the placenta. Oxytocin level reaches the maximum at 
the moment of birth.

2. Progesterone -
A decrease in progesterone production may stimulate prostaglandins (PG)
synthesis and enhance the effect of estrogen which has a stimulating effect on
uterine muscle.

3. Estrogen -
The probable mechanisms are-
 - Increases the release of oxytocin from maternal pituitary.
 - Promotes the synthesis of receptors for oxytocin in the myometrium and decidua.

4. Prostaglandins -
Prostaglandins are the important factors which initiate and maintain labour. 
Prostaglandins stimulates smooth muscle to contract. The major sites of synthesis
of prostaglandins are amnion, chorion, decidual cells and myometrium.

Labour process

Labour -
''Series of events that take place in the genital organ in an effort to expel the viable products of
conception out of the womb through the vagina.''
                                  It may occur prior to completed 37 weeks, when it called preterm labour.
Expulsion of previable fetus occurs through the same process but in a miniature form, is called
mini labour. Delivery is the expulsion or extraction of a viable fetus out of the womb. It is not
synonymous with of labour. delivery can take place without labour as in elective caesarean 
section. Delivery may be vaginal or it may be abdominal.

Normal labour - 
Labour is called normal if it fulfils the following criteria -
1. Spontaneous in onset at term
2. With vertex presentation
3. Without undue prolongation
4. Natural termination with minimal aids
5. Without having any complications affecting the health of the mother and/or the baby.

Abnormal labour -
Any deviation from the definition of normal labour is called abnormal labour.

Common health related problems in pregnancy

• Backache
• Bleeding
• Bleeding gums
• Constipation
• Cramp
• Deep vein thrombosis (DVT)
• Faintness
• Feeling hot
• Headaches
• High blood pressure
• Pre-eclampsia
• Urinary Incontinence
• Indigestion
• Heartburn
• Itching
• Leaking nipples
• Morning sickness
• Nausea
• Nosebleeds
• Urinating a lot
• Pelvic pain
• Piles (haemorrhoids)
• Skin and hair
• Sleeplessnes 
• Stretch marks
• Swollen ankles, feet, fingers Teeth and gums
• Tiredness
• Vaginal discharge
• Vaginal bleeding
• Varicose veins

Constipation in pregnancy - 
Woman may become constipated very early in pregnancy because of the hormonal
changes in her body.

Measures for avoid constipation -
There are a few things that can do to help prevent constipation. These include:
       - Eat foods that are high in fibre, such as wholemeal breads, wholegrain cereals,
          fruit and vegetables, and pulses such as beans and lentils.
       - Exercise regularly to keep muscles toned.
       - Drink plenty of water avoid iron supplements as they can make constipated.


Cramp in pregnancy - 
Cramp is a sudden, sharp pain, usually in calf muscles or feet. It is most common
at night. Nobody really knows what causes it, but there are some ideas about causes
of cramp and why it can happen in pregnancy.

Measures for avoid cramp - 
       - Regular, gentle exercise in pregnancy, particularly ankle and leg movements,
          will improve circulation and may help to prevent cramp occurring.
       - Try these foot exercises
       - Consult to midwife, GP or pharmacist before taking painkillers in pregnancy.


Feeling faint (sudden lose of consciousness) in pregnancy - 
Pregnant women often feel faint. This is because of the hormonal changes occurring
in body. Fainting happens if brain is not getting enough blood and therefore not
enough oxygen. 

Measures for avoid feeling faint -
       - Try to get up slowly after sitting or lying down if feel faint when standing still,
          find a seat quickly and the faintness should pass. It’s better not to lie flat on
          her back in later pregnancy or during labour. Woman can find out about
          treating faintness, including what to do to help someone who is about to faint.


Incontinence in pregnancy -
Incontinence is a common problem both during and after pregnancy. Sometimes
pregnant women are unable to prevent a sudden spurt of urine or a small leak
when they cough, laugh or sneeze, or when they move suddenly, or just get up
from a sitting position. This may be temporary, because the pelvic floor muscles 
(the muscles around the bladder) relax slightly to prepare for the baby's delivery.
Woman can help to prevent incontinence by doing pelvic floor exercises.
When to get help In many cases incontinence is curable.


Urinating a lot in pregnancy - 
Needing to urinate (pass water, or pee) often may start in early pregnancy.
Sometimes it continues throughout pregnancy. In later pregnancy it is the result
of the baby’s head pressing on your bladder. How to reduce the need to pass
urine If woman find that she need to get up in the night to pass urine, try cutting out
drinks in the late evening. But make sure woman drink plenty of non-alcoholic,
caffeine-free drinks during the day. If woman have any pain while passing water 
or pass any blood in urine, she may have a urine infection, which will need treatment.
Drink plenty of water to dilute urine and reduce pain. Don't take any medicines
without asking midwife, doctor or pharmacist whether they are safe in pregnancy.


Skin and hair changes in pregnancy - 
Hormonal changes taking place in pregnancy will make nipples and the area around
them go darker. Skin colour may also darken a little, either in patches or all over.
Some women develop a dark line down the middle of their stomach. These changes
will gradually disappear after the baby is born, although nipples may remain a little
darker. If woman sunbathe while she is pregnant, woman may find that she burn more
easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for 
a long time. Hair growth can also increase in pregnancy. After the baby is born,
it may seem as if woman is losing a lot of hair but she is simply losing the extra hair.