Chapter 25The First Stage of Labor

Changes during the last week of pregnancyChanges during the last week of pregnancy

Mood swingFetal changes : fetal in the lower site 2-3 wkExpansion of lungsEasy breathingWoman feel more comfortSoften and lightningIncrease effacementDifficult walkingBack painIncrease the pressure within the pelvises and vag. secr.

First StageLatent phase: cervix dilated about 3-4cm this phase stay 6-8 hr this phase started before the active phase

Active phase: cervix is more dilated. Started when cervix about 4cm with regular uterine cont.

Transitional Phase: cervix dilated around 8cm -10cm.

The onset of spontaneous labour

Women have to be informed and feel comfort good labor preparation, explain and provide privacy, good management.

Spurious ( false) Labour

Contraction before onset of labour

Contraction may be regular

No cervical dilation

No effacement

No true labour

Medical and Midwifery Management:

Support

Increase a awareness

Reassurance

Discussion for future management

Complete effacement include internal and external cervical os. This happen by the action of combination of hormonal and mechanical factors.

Action of estrogenIncrease oxytocin receptors releaseStimulate placenta for H. production (progest.)Increase softening of cervix

What is the onset of labourIs the process of establishing true labour It is difficult to determineDiagnosis of onset of labour is important in order to make correct management

Physiology of first stage of laborDuration vary and affected by: parity, birth interval, psychological status and position of fetus

Uterine Contraction1.Fundal dominance

Uterine Contraction1.Fundal dominance2.Polarity3.Contraction and retraction4.Formation of upper and lower uterine segment5.The retraction ring 6.Cervical effacement 7.Cervical dilation 8.Show

Cervical dilation process

Mechanism Factors of Labor1.Formation of forewater

1.2. General fluid pressure

Mechanism Factors of Labor

3. Rupture of membrane4. Fetal axis pressure

Recognition of First Stage of LabouroBy womanoBy midwife [How]History Physical examVaginal exam

Indication for Vaginal Exam

Assessment of true laborDetermine presentationCheck for membraneDiscover abnormality Assess cervix dilation

[how to do vaginal exam clinical section]

Vaginal exam

Record Complete record Use of partogramAccurate ComprehensiveShared