Labor Assessment & Vaginal Delivery

Stages of Labor: First

• Uterine Contractions

• Cervical dilation

• Cervical effacement

• Fetal station

• ROM (rupture of membranes - when water breaks)

Early Latent Phase (1st)

• Onset of uterine contractions

• 0-3cm dilation

Active Phase (2nd)

• Contractions become more frequent, longer, and stronger

• 4-7cm

Transition Phase (3rd)

• Most intense phase

• 8-10cm

Stages of Labor: Second

• Pushing & delivering the baby

  • Urge to push - occurs during contractions

  • Can take a few minutes or hours

  • Position for delivering the baby is whenever is most comfortable for the pregnant person

  • Supine (flat on back) is least beneficial

Stages of Labor: Third

• Delivering the placenta

  • Within 30 minutes after the baby is born

    • Spontaneous

    • Initiating breastfeeding is helpful

  • Average about 5-6 minutes

  • 90% within 15

  • 97% within 30

  • Longer time = higher risk of hemorrhage

Stages of Labor: Fourth

• Postpartum recovery

  • At least 2-24 hours (or more)

  • Fundal massage until firm at the umbilicus (frequently at first, spacing out as time goes on)

  • Assess lochia (bleeding)

  • Initiate breastfeeding and bonding

Dilation

Vagina opens 0-10 centimeters

Vaginal Exam: Early Phase

Gradual change (can take hours or days)

Vaginal Exam: Active Phase

Expected 1cm per hour

• wide variation of “normal progress”

Effacement

• Thinning 0-100 percent

• Measured by vaginal exam

Station & Engagement

• 0 station = engaged

• +/- = below/above the ischial spines of the pelvis

• +5 closer to the vagina, -5 or negative numbers meaning lower

Crowning

• Baby’s head is approaching the vaginal opening

• Head becomes visible, forming a ring around the head

Mucus Plug

• Thick, jelly-like substance

• Forms in the cervix during pregnancy

• Acts as a barrier to protect the developing fetus from bacteria and infections

Bloody Show

• A small amount of pink/brown discharge that occurs due to the mucus plug releasing

• Usually occurs in the days or weeks leading up to labor

ROM

Rupture of membrane (water breaks)

SROM

Spontaneous: occurs as expected

AROM

Amniotic: amniotomy with hook

PROM

Premature: occurs before labor starts

Freidman’s Curve

• Based on the first 500 births

• Included pitocin, sedation, forceps, etc.

• Active phase was 2.5 hrs at 4-9cm

• Used for decades as the standard guide to “managing” labor 

Is the Friedman’s Curve effective?

Not effective: should not be used to decide interventions of augmentation forceps, vacuum, or c/s

T/F: First labors are typically longer, as the body is experiencing labor for the first time

True

T/F: It is harder to have a baby the second time around

False

T/F: With subsequent labors, the cervix can open quickly, as it has already effaced and dilated before

True

Best position for pushing

Whatever is comfortable for the mother

T/F: Supine (flat on back) is recommended and most beneficial

False

What encourages contractions to be stronger and more regular

Walking/standing during the early stages of labor

What widens pelvic outlet, maximizing space for baby

Squatting

What encourages hip mobility

Sitting upright/leaning during early stages of labor

What allows mother to rock pelvis

Kneeling during active labor/pushing

Descent

Fetus moves down through pelvis

Flexion

Chin to chest due to pelvis pressure (largest diameter changes from 11.5 to 9cm)

Internal Rotation

To bring the head in line with the opening

Extension

Pressure form public bone makes head extend up and out - head born

Restitution & Internal Rotation

Head twists 45 degress

Expulsion

Anterior shoulder rotates under pubic bone then posterior shoulder and rest of baby