STAGES OF LABOR FIRST STAGE OF LABOR a. Latent or Prodromal Phase (Early).

In this phase, the mother feels slow, rhythmic contractions radiating from the lumbar region to the anterior portion of her abdomen. The contractions last from 30 to 45 seconds with the intensity gradually increasing. The frequency of contractions is from 5 to 20 minutes. There is some cervical effacement. Dilation is from 0 to 3 cm. "Bloody show" is usually present. The mother is usually able to walk, talk, or laugh some during this phase. Diversion is usually welcomed during this time. This phase may not be included as part of the first stage of labor since it is before the onset of true labor. True labor is considered to be at 4 cm. Duration of this phase varies, sometimes as long as 24 hours and is referred to as the "prolonged latent" phase. The mother may sometimes make some progress dilating from 1 to 2 cm and will then stop. She is usually not admitted to the hospital at this point unless the membranes are ruptured. b. Active or Accelerated Phase. In this phase, the contractions become stronger and last longer, usually 45 to 60 seconds. The frequency is from 3 to 5 minutes. The cervix dilates from 4 to 7 cm. This phase is considered the onset of true labor. The mother is admitted to the hospital at this point. She, then, becomes involved with bodily sensations and tends to withdraw from the surrounding environment. She is not able to walk, but, desires companionship and encouragement. c. Transient or Transitional Phase. In this phase, the contractions are sharp, more intensified, and last from 60 to 90 seconds. The frequency is from 2 to 3 minutes. The cervix dilates from 8 to 10 cm. Completion of this phase marks the end of the first stage of labor. The mother may express feelings of frustration, loss of control, and/or irritability. Her focus becomes internal. She has difficulty comprehending surroundings, events, and instructions. There is an increase in bloody show as a result of the rupture of capillary vessels in the cervix and the lower uterine segment. The mother feels an urge to push or to have a bowel movement. This is considered the most severe and difficult phase for the mother. SECOND STAGE OF LABOR As previously mentioned, the second stage of labor begins when the cervix is completely effaced and dilated and ends when the infant is born. a. These signs of the second stage of labor are considered imminent or impending signs. (1) Imminent signs. (a) Increased bloody show. (b) Desire to bear down or have bowel movement (result of the descent of the presenting part). (c) Bulging of the perineum. (d) Dilatation of the anal orifice. (2) Impending signs. (a) Nausea and retching. (b) Irritability and uncooperativeness. (c) Complaints of severe discomfort. (d) Pleas for relief. b. Once dilatation and effacement are complete, the patient is instructed to push with each contraction to bring the presenting part down into the pelvis.

THIRD STAGE OF LABOR As previously mentioned, the third stage of labor is the period from birth of the baby through delivery of the placenta. This is considered a dangerous time because of the possibility of hemorrhaging. Signs of the placental separation (see figure 2-9) are as follows: a. The uterus becomes globular in shape and firmer. b. The uterus rises in the abdomen. c. The umbilical cord descends three (3) inches or more further out of the vagina. d. Sudden gush of blood. FOURTH STAGE OF LABOR The fourth stage of labor, as previously mentioned, is the period from the delivery of the placenta until the uterus remains firm on its own. In this stabilization phase, the uterus makes its initial readjustment to the nonpregnant state. The primary goal is to prevent hemorrhage from the uterine atony and the cervical or vaginal lacerations. NOTE: Atony is the lack of normal muscle tone. Uterine atony is failure of the uterus to contract. SIGNS OF TRUE LABOR FACTOR Contractions TRUE LABOR Produce progressive dilation and effacement of the cervix. Occur regularly and increase in frequency, duration, and intensity. Is present. FALSE LABOR Do not produce progressive dilatation and effacement. Are irregular and do not increase in frequency, duration, and intensity. Not present. May have brownish discharge that may be from vaginal exam if within the last 48 hours. Usually uneffaced and closed. May intensify for a short period or it may remain the same.

Show

Cervix Fetal Movement

Becomes effaced and dilates progressively. No significant change, even though fetus continues to move.

BENEFITS of BREASTFEEDING: Breast milk provides complete nutrition, in the right proportions, for the growing baby. Its unique components offer optimal absorption of nutrients and minerals, protection from harmful bacteria, and assistance in the digestion of fats. It also has special growth factors and hormones that contribute to optimal development of the child. Ans since breast milk is a living biological fluid, its composition changes as the baby grows to meet the childs changing nutritional needs.

Breast milk serves as the babys first immunization. It provides antibodies, which protects the child from diseases and significantly lowers risks of common infant sicknesses like infection, diarrhea and bacterial meningitis. Babies from families with a tendency to allergic diseases particularly benefit from breastfeeding as it provides protection against allergies, asthma and eczema. Research also shows how breastfeeding increases a childs IQ, reduces risk of obesity, improves the effectiveness of immunization, and enhances emotional security. In all these cases, benefits begin immediately, and increase with longer duration of breastfeeding. For babies who do not receive breast milk, studies show that they have higher rates of pneumonia, childhood diabetes and cancers, AIDS, and gastroentiritis. The benefits of breastfeeding to mothers health are not often emphasized. But just as breastfeeding is best for babies, it is also best for moms. Immediately after birth, increased levels of oxytocin that are released in the mothers body due to the babys sucking cause contraction and toning of the uterus. Exclusive breastfeeding also offers protection against the early return to fertility as it delays the return of ovulation and menstruation. In fact, the child spacing method, LAM or lactational amenorrhea method, is 99 percent effective in preventing pregnancy in the first six months as long as exclusive breast feeding is practiced, the mothers menstrual period has not resumed, and the baby is less than six month old. The prolonged suppression of ovulatory cycles appears to be associated with significant long-term health advantages as well. Mothers who breastfeed for at least six months throughout their lifetime have a decreased risk of breast, ovarian and uterine cancers. A well-documented benefit of breastfeeding is a more rapid and sustained weight loss as milk production uses up 200 500 calories a day. Thats equivalent to swimming 30 laps or riding a bicycle for over an hour. Breastfeeding also provide psychological benefits to mothers. Clearly, healthier breastfed babies are less stressful to care for. They are also shown to have increased self-confidence and a stronger sense of connection with their babies. Automatic skin-to-skin contact and closeness afforded by breastfeeding result in improved bonding between mother and child. The benefits of breastfeeding do not end there. There is also something for fathers. For one, they are able to enjoy a healthy baby and wife. They can also appreciate the impact on the family budget with lower health care costs, fewer sick days, and lack of need to buy formula milk. Breastfeeding rates in the country, according to the National Demographic and Health Survey, has ranked the lowest with only 16 percent of newborns being nursed exclusively at 4-5 months. The study also showed that 13 percent were never breastfed. These numbers have created significant economic impact to the country. It is estimated that inappropriate infant feeding practices causes P340 million on funeral expenses alone. Add to it the projected cost of P1 billion in lost wages to care for sick infants, P100 million out-of-pocket expenditures for health facility visits, and P50 million for hospitalization.

Giving children a healthy start on life is already a compelling reason to start and continue breastfeeding. With added benefits to the family and even the country, breastfeeding is, as it should have always been, more than just a lifestyle choice. Published in the Manila Bulletin, September 3, 2006 issue. SIGNS OF PLACENTAL SEPARATION a. The uterus becomes globular in shape and firmer. b. The uterus rises in the abdomen. c. The umbilical cord descends three (3) inches or more further out of the vagina. d. Sudden gush of blood.

Figure 2-9. Placental separation and delivery. NURSING CARE DURING THE THIRD STAGE a. Continue observation. Following delivery of the placenta, continue in your observation of the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted. b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.

Leopolds Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: 1. Instruct woman to empty her bladder first. 2. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. 3. Drape properly to maintain privacy. 4. Explain procedure to the patient. 5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). 6. Use the palm for palpation not the fingers. Purpose First Maneuver: Fundal Grip To determine fetal part lying in the fundus. To determine presentation. Second Maneuver: Umbilical Grip To identify location of fetal back. To determine position. Procedure Findings

Using both hands, feel Head is more firm, hard and round for the fetal part lying in that moves independently of the the fundus. body. Breech is less well defined that moves only in conjunction with the body. One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands. Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

Third To determine Maneuver: engagement of Pawliks Grip presenting part.

The presenting part is engaged if it is not movable. It is not yet engaged if it is still movable.

Fourth Maneuver: Pelvic Grip

To determine the degree of flexion of fetal head. To determine attitude or habitus.

Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees. Poor atitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)