D. CHARACTERISTICS OF TRUE LABOR
1. Contractions occur at regular intervals (Client and Family Teaching 9-1)
2. Contractions start in the black and sweep around to the abdomen, increase in intensity and durations and gradually have shortened intervals.
3. Walking intensifies contractions.
4. “Bloody show” (pink-tinged mucus released from the cervical canal as labor starts) is usually present.
5. Cervix becomes effaced and dilated.
6. Sedation does not stop contractions.
E. CHARACTERISTICS OF FALSE LABOR
1. Contractions occur at regular intervals (Client and Family Teaching 9-1)
2. Contractions starts in the back and sweep around to the abdomen, intensify remains the same or is variable, and the intervals remain long.
3. Walking does not intensify contractions and often relief.
4. Blood show usually is not present, if present, it is usually brownish rather than right red and may be due to a recent pelvic examination or intercourse.
5. There are no cervical changes.
6. Sedation tends to decrease the number of contractions.
F. STAGES OF LABOR
1. The FIRST STAGE of labor begins with the onset of regular contractions which cause progressive cervical dilation and effacement. It ends when the cervix is completely effaced and dilated. It is composed of a latent, an active, and a transition phase.
a. Latent phase. This phase begins with the onset of regular contractions and effacement and dilation of the cervix 3 to 4 cm. It lasts an average of 6.4 hours for multiparas. Contractions become increasingly stronger and more frequent.
b. Active phase. Dilation continues from 3 to 4 cm to 7 cm. Contractions become stronger, more frequent, longer, and more painful.
c. Transition phase. The culmination of the first stage is the transition phase during which the cervix dilates from 8 to 10 cm. The intensity, frequency, and durations of contractions peak and there is an irresistible urge to push.
2. SECOND STAGE (expulsive stage)
a. The second stage begins with complete dilation of the cervix and ends with delivery of the newborn. Durations may differ among primiparas (longer) and multiparas (shorter), but this stage should be completed within 1 hour after complete dilation.
b. Contractions are severe at 2 to 3 minute intervals, with a duration of 50 to 90 seconds.
c. The newborns exists the birth canal with help from the following cardinal movements or mechanisms of labor (figure 9-2)
i. Descent
ii. Flexion
iii. Internal Rotation
iv. Extension
v. External Rotation (restitution)
vi. Expulsion
d. “Crowning” occurs when the newborns head or presenting part appears at the vagina; opening
e. Episiotomy (surgical incision in perineum) may be done to facilitate delivery and avoid laceration of the perineum.
3. THIRD STAGE (placental stage)
a. This stage begins with delivery of the newborn and ends with delivery of the placenta. It occurs in two phases – placental separation and placental expulsion.
b. Signs of placental separation include the uterus becoming globular, the fundus rising in the abdomen, lengthening of the cord, and increased bleeding (trickle or gush)
c. Contraction of the uterus controls uterine bleeding and aids placental separation and explanation.
d. Generally, oxytocic drugs are administered to help the uterus contract.
4. FOURTH STAGE (recovery and bonding)
a. This stage lasts form 1 to 4 hours after birth.
b. The mother and newborn recover from the physical process of birth.
c. The maternal organs undergo initial readjustment to the nonpregnant state.
d. The newborn body systems begin in the midline of the abdomen with the fundus midway between the umbilicus and symphysis pubis.