Operational Medicine Medical Education and Training

Normal Labor and Delivery

Labor

Labor consists of regular, frequent, uterine contractions which lead to progressive dilatation of the cervix.

The diagnosis of labor may not be obvious for several reasons:

  • Braxton-Hicks contractions are uterine contractions occurring prior to the onset of labor. They are normal and can be demonstrated with fetal monitoring techniques early in the middle trimester of pregnancy. These innocent contractions can be painful, regular, and frequent, although they usually are not.
  • While the uterine contractions of labor are usually painful, they are sometimes only mildly painful, particularly in the early stages of labor. Occasionally, they are painless.
  • Cervical dilatation alone does not confirm labor, since many women will demonstrate some dilatation (1-3 cm) for weeks or months prior to the onset of true labor.

Thus, in other than obvious circumstances, labor will usually be determined by observing the patient over time and demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions.

The cause of labor is not known but may include both maternal and fetal factors.

 

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Normal Labor and Delivery

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Latent Phase Labor

The first stage of labor is that portion leading up to complete dilatation. The first stage can be divided functionally into two phases: the latent phase and the active phase.

Latent phase labor (also known as prodromal labor) precedes the active phase of labor. Women in latent phase labor:

  • Are less than 4 cm dilated.
  • Have regular, frequent contractions that may or may not be painful.
  • May find their contractions wax and wane
  • Dilate only very slowly
  • Can usually talk or laugh during during their contractions
  • May find this phase of labor lasting days or longer.

Active Phase Labor

Active phase labor is a time of rapid change in cervical dilatation, effacement, and station.

Active phase labor lasts until the cervix is completely dilated. Women in active phase labor:

  • Are at least 4 cm dilated.
  • Have regular, frequent contractions that are usually moderately painful.
  • Demonstrate progressive cervical dilatation of at least 1.2-1.5 cm per hour.
  • Usually are not comfortable with talking or laughing during their contractions.

Progress of Labor

For a woman experiencing her first baby, labor usually lasts about 12-14 hours. If she has delivered a baby in the past, labor is generally quicker, lasting about 6-8 hours. These averages are only approximate, and there is considerable variation from one woman to the next, and from one labor to the next.

During labor, the cervix dilates (opens) and effaces (thins). This process has been likened to the process of pulling a turtleneck sweater over your head. The collar opens (dilates) to allow your head to pass through, and also thins (effaces) as your head passes through.

The process of dilatation and effacement occurs for both mechanical reasons and biochemical reasons.

The force of the contracting uterus naturally seeks to dilate and thin the cervix. However, for the cervix to be able to respond to these forces requires it to be "ready." The process of readying the cervix on a cellular level usually takes place over days to weeks preceding the onset of labor.

Descent means that the fetal head descends through the birth canal. The "station" of the fetal head describes how far it has descended through the birth canal.

This station is determined relative to the maternal ischial spines, bony prominences on each side of the maternal pelvic sidewalls.

"0 Station" ("Zero Station") means that the top of the fetal head has descended through the birth canal just to the level of the maternal ischial spines.

This usually means that the fetal head is "fully" engaged (or "completely engaged"), because the widest portion of the fetal head has entered the opening of the birth canal (the pelvic inlet).

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From:

Operational Obstetrics & Gynecology
2nd Edition
NAVMEDPUB 6300-2C

Bureau of Medicine and Surgery
Department of the Navy

Leopold Maneuver

Normal Labor and Delivery

MS PowerPoint
30 Slides
6.4 MB ppt file

Free Download Now

 

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