UNIT 4 OBG

2. NORMAL
LABOUR

3. NORMAL LABOUR
 Series of events that
takes place in the
genital organs, in an
effort to expel the
viable products of
conception out of the
womb through the
vagina into the outer
world.

4. STAGES OF LABOUR
Ist STAGE:-
From onset of true
labour pains till the
full dilatation of
cervix. Its 12 hrs in
primigravida and
6 hrs in
multiparae.

5. Contd…
IInd STAGE:-
From full
dilatation of
cervix till fetus is
delivered. Its 2 hrs
in primigravidae
and 30 min. in
multiparae.

6. Contd…
IIIrd STAGE:-
From delivery of
fetus till delivery
of placenta. Its of
average 15 mins
in PGR.

7. 4TH STAGE
 It is the stage of observation for at
least 1 hour after expulsion of the
after birth. During this period,
general condition of the patient and
the behavior of uterus are to be care
fully watched

8. First stage of labour
The first stage of labour starts with
the onset of labour pains to the full
dilatation of the cervix. This stage
takes about 12 hours in primi-
gravida and half that time for
subsequent deliveries.

9. EVENTS IN 1ST STAGE OF
LABOUR
FACTORS
Predisposing Actual
factors factors

10. Pre-disposing factors
 Softening of the cervix
 Fibro-musculo-glandular hypertrophy
 Increase vascularity
 Accumulation of fluid in between collagen fibres
 Breaking down of collagen fibrils by enzymes
collagenase and elastase.

11. ACTUAL/MAIN EVENTS
 Dilatation and effacement of cervix.
 Full formation of lower uterine segment.

12. Actual factors
1)Uterine contractions and retractions
The longitudnal muscle fibres of upper segment are attached
with circular muscle fibres of lower segment and upper part
of cervix in a bucket holding fashion .

13. 2)Bag of memberanes
The memberanes are
attached loosely to the
decidua lining the uterine
cavity expect over the
internal os . In vertex
presentation girdle of head
fit in to lower uterine
segment and divides amnotic
cavity in to two parts that
are forewater and
hindwater. This generates
hydrostatic pressure and
dilates the cervical canal

14. Fetal axis pressure:
in longitudnal lie there is tendency of
straightening out of the fetal vertebral column
due to contractions of circular muscles of the
body of uterus, this exerts pressure on cervix
and dilates cervical canal.

15.  Vis-a-tergo: it is the downward thrust of
the presenting part of fetus and upward
pull of cervix over lower uterine
segment.

16. Effacement
 It is the process by which the muscular
fibres of the cervix are upward and
merges with fibres of the lower uterine
segment.

17. Lower uterine segment
 As the labour
progresses wall of upper
segment becomes
thickened and there is
thining of lower
segment. A distinct ring
is produced at the
junction of two, called
physiological retraction
ring.

18. NURSING CARE DURING
THE FIRST STAGE OF
LABOR:

19. NURSING CARE DURING THE FIRST
STAGE OF LABOR:
A. Hospital Admission. After a physician or
nurse has evaluated the patient, an admission
order is written. At this point duties of nurse
are:
(1) Establish a rapport with the patient and
significant others.
(2) Remove nail paint from hands, feet, jewelry
and handover all belongings to significant
relatives
(3) Change the clothes of the women according to
policy

20. (4)Taking history
- Present labour – name
- Case number
- When labour started
- Membranes ruptured or intact
- Frequency or strength of contractions

21. - Past history
- Parity
- Character of previous labour
- Weight and condition of previous babies
- Evidence of cephalopelvic disproportion
- Maternal disease
- Rh- isoimmunization

22. (5) Perineal Preparation
Shaving of pubic hair to prevent
infection of perineal
episiotomy/lacerations.
(6) Enema
The purposes of enema are:
To stimulate uterine contractions
To assure a clean field without fecal
contamination at the time of delivery

23. (7) Rest and ambulation
Intact membranes- allowed to walk
Ruptured membranes- bed rest in left
lateral position.
(8) Diet-
 Food is withheld during active labour
 Fluids in the form of plain water, fruit
juice may be given in early labour
In DMC & H
 Semi solid diet and liquids are allowed
during first stage

24. (9) Bladder care –
Patient is encouraged to pass urine by herself
as full bladder often inhibits uterine
contractions.
(10) Explain all procedures or routines, which
will be carried out prior to performing them.
These include:
(a)Explain activities allowed and disallowed
according to ward policies (i.e. bathroom
privileges).
(b) Use of fetal monitors to
know the fetal well being

25. 11) Initiate the patient's labor chart.
12) Orient the patient to the
surroundings.
13) Explain visiting hours or policies to
patient and relatives:
IN DMC&H
One female attendant is allowed for 24
hours
No male attendant is allowed.

26. 14) Use of partograph to assess progress of
labor as well as fetal status and well being.
NOTE: In Partograph nurse has to assess:
i) Fetal heart rate
ii) Status of liquor
C- clear
MS -meconium stained
Amniotic fluid should be carefully
examined for meconium if the fetus is in
the vertex presentation, (that is, head
first).

28. VAGINAL EXAMINATION.
Only the physician or a trained
nurse performs this exam.
It is done to evaluate cervical
effacement, cervical dilatation,
status of membranes, &
station of presenting part.
Care must be taken to
perform good perineal
cleansing before and after the
procedure (vaginal
examination).
Once membranes rupture, the
exam should be limited even
further to prevent the risk of
infection.

29. CONTRACTIONS
When palpating for
contractions, place
hand over the fundal
area of the patient's
uterus.
Contractions can be
felt by fingers before
the patient actually
becomes aware of
them.

30. Contractions
The purpose of this evaluation is to assess the
ability of the uterus to dilate the cervix, help in
determining the progress of labor
1.FREQUENCY(how often in minutes
contraction occurs
2. INTENSITY: (Strength of Contractions as:-)
 MILD- <20 seconds
 MODERATE- 20-40 seconds
 SEVERE- 40-60 seconds
3. DURATION:(How long the contraction lasts
in Seconds)

31. Vital Signs
Monitor the patient's vital signs.
(1) On admission.
(2) Every hour during early labor.
(3)Blood pressure (BP), pulse (P), and
respiratory rate (R) every 30 minutes
during active, to include the
temperature every hour.
(4) More frequently if complications arise.

32. General measures
Rest and ambulation
Vaseline may be applied to her lips to
prevent chapping.
 Assist the patient in turning side to side
 Elevate the bed at 30 to enhance
breathing
 Avoid supine position
 Prefer left lateral position

33. Criteria for shifting the patient
to delivery table
 After full dilatation ( 10 cm dilatation )
shift the patient to delivery table.

34. EVIDENCE BASED STUDIES

35. Use of birthing ball for comfort in
pregnancy & labour
This will help to keep the deep
muscles of the spine in good
working conditions. The ball has
many uses in late pregnancy
when sitting can become so
uncomfortable. The ball support
perineal muscles without a lot of
pressure and keep the fetus
aligned in the pelvis.

36. Ambulation during labour
Ambulation in women
during labour is very
necessary during the
labour. It should be free to
adopt any position unless
there is any medical or
obstetrical contraindication.
It helps to reduce the time
period means shorter the
labour with less labour
pain.

37. Vaginal examination
It should be performed by
trained personnel only. It
should be done every
4 hourly not more
frequently and should
be carried out under
strict asepsis during labour.

38. Support during labour
According to evidenced
based practices the
presence of second
person of the women
own choice during the
labour. The second
Should be an
experienced women who
has some understanding
of the birthing process.

39. Use of enemas
There is no evidence that enemas will
shorter the length of labour and also
reduce in infection rate in post delivery.
It should be given when there is clear
indication and women has to wish to
take it.