contractions
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BIRTH
Recognition of Labor
Contractions are:
regular in frequency
intermittent in character
at intervals of 10 minutes or less
each lasts 30 seconds or longer
“Bloody Show”
Small amount of bloody discharge from
the vagina
This
is the operculum releasing due to
dilation of the cervix
What is “False Labor”?
signs of what appears to be uterine
contractions getting stronger
may be painful
and may be at or near the EDD
How can you tell?
FALSE LABOR
TRUE LABOR
Irregular contractions
Regular contractions
No “show”
“show”
No progressive dilation or Progressive dilation and
effacement of the cervix
effacement of the cervix
Palpation of the Cervix
Assessing
effacement
and dilation…
Palpation of the Cervix
Ascertain the specific amount of dilation
ripeness of the cervix
full dilation (10 cm) and effacement
If done too frequently
can cause infection
introduces bacteria into an otherwise clean
environment
Uterine Contractions
Uterine muscle fibers are unique, unlike any
other muscle in the body
Regular muscle fibers
get shorter during contraction and return to their
normal length after the contraction
The purpose of the uterine contraction
however necessitates a different action
the baby has to be pushed out…
Uterine Contractions
So instead…
After the uterus contracts, the muscle
fibers stay shortened during the
relaxation phase
Pressure is maintained on the cervix
Dilation takes place slowly but progressively
Uterine Contractions
This process is
called “retraction”
Progressively
reduces the capacity
of the uterus
eventually pushes
the baby out
Uterine Contractions
The cervix (the lowest part of the lower pole)
does not contract
primarily a fibrous connective tissue (not muscle)
The contractions of the upper pole causes
retraction of the tissues of the lower pole
stretch and thin out = effacement & dilation
Effacement & Dilation
As the cervix thins, the internal os is retracted up the
sides of the uterus
The external os is loosened and begins to dilate
allowing the operculum to dislodge ~> “Bloody Show”
Dilation and the Forewaters
Thinning of the cervix and dilation of the
external os allows the amniotic fluid in
front of the baby’s head to protrude
This is known as the “forewaters” or the
“Hydrostatic Dilator”
Dilation and the Forewaters
“Hydrostatic Dilator” = fluid trapped
between the head and the sides of the
birth canal
Hydrostatic Dilator
Function
protects the baby’s head during the
dilation process
does not let the head push directly on the
cervix
Stages of Labor
Labor is a process…
Stage 1
Begins with the onset of regular contractions
Ends with the full dilation of the cervix
Stage 1
Takes about 8-10 hours (multiparous) or 12-24
hours (primigravida)
“Transition”
Second Phase of Stage 1
This is the most physically and
emotionally taxing phase of labor
Cervix is opening from 8-10 centimeters
Uterus is contracting strongly
May enter an emotionally vulnerable
state of exhaustion and exhilaration
Stage 2
Begins with full dilation of the cervix
Ends with the birth of the baby
Generally takes from 10-60 minutes
(1 hour)
Contractions become more
powerful…
Urge
to bear down or push
She
may want to hold her breath
through the contractions
She may become nauseated and vomit
She may feel like she has to have a
bowel movement
May inhibit her pushing…
Stage 2
Mechanisms of Birth
AKA Cardinal Movements
Mechanisms of Birth
The baby has to make its way down and
out of the birth canal by fitting its head
and body through narrow passages
The baby must twist and turn along the
path of escape
known as the “Cardinal Movements”
Obstetrics Illustrated (1998)
I
II
III
IV
V
VI
Flexion
Descent
Internal Rotation
Delivery of the Head
Restitution
External Rotation
Stage 3
Stage 3
Begins with the birth of the baby
Ends with the birth of the placenta
Generally takes about 5-50 mins.
(1 hour)
Placental Birth
Placental Birth
After delivery of the baby
the uterus and vagina become loose and
slackened
soft to external palpation
The site of the placental attachment is
harder and firmer and may be palpable
NOTE
The placenta is usually attached to the anterior
superior portion of the fundus of the uterus
This will depend on
the shape of the uterus and
the position of the uterus at the time of implantation
**Normally the uterus is slightly anti-flexed and the
blastocyst falls onto the anterior superior wall
Placental Birth
Normally
the placenta will dislodge from the
uterine wall with
uterine contractions or
massage of the uterus
Signs of Placental Detachment
The fundus becomes narrow, hard and
ballotable
Slight bleeding occurs again (bleeding
has stopped from the birth)
The cord becomes longer
Credes’ Method
Apply gentle pressure on the fundus while
pulling on the cord gently
the cord will usually lengthen out of the vagina with
this process
Releasing pressure on the fundus will then
show one of two things
either the cord retracts back into the vagina
indicating it has not detached or
it will remain lengthened out of the vagina indicating
it has detached
Note…
It is not a good idea to pull or tug on the cord
to remove the placenta
tearing of the placenta from the fundus (prior to
cessation of uterine arterial flow to the placenta)
could cause severe bleeding and possibly death
Blood Loss
Blood loss should be noted
normally 250 ml (cup) will be lost during the
placental delivery
Any excessive bleeding should be taken
as a sign of retention of placental parts
until otherwise determined
After Care… Stage 4
Stage 4
Begins with the birth of the placenta
Ends with the recovery of the new
mother
Lasts for about 4 –6 hours
Consists of close observation
monitoring vital signs; excessive uterine
bleeding
After the placenta is delivered…
The vagina and labia are inspected for
tears or other general injuries
provide the appropriate care
may include suturing tears and episiotomies
The placenta must also be inspected for
appearance and completeness
suspicion of any missing pieces
necessitates inspection of the uterus
Placental Types
Disperse
Battledore
Circumvallate*
Succenturiate*
Bipartite/Tripartite*
Magistral
Fenestrate
Duplex*
Vellamentosa
some are at higher risks for retention of
placental parts*
fenestrate may look like a retained placenta
even if it is not (false finding)
Retention of Placental Parts
Retention of part or all of the placenta
usually causes bleeding
may be severe enough to cause death
There are cases when it does not immediately
cause a problem
If parts are retained for a period of time,
eventually… infection or immune reaction
Retention of Placental Parts
Management
D&C (dilatation and curettage) needs to
be performed
remove the offending parts