Mechanics of Parturition
The uterine contractions during labor begin mainly at the top of the uterine fundus and spread downward over the body of the uterus. Also, the intensity of contraction is great in the top and body of the uterus but weak in the lower segment of the uterus adjacent to the cervix. Therefore, each uterine contraction tends to force the baby downward toward the cervix.
In the early part of labor, the contractions might occur only once every 30 minutes. As labor progresses, the contractions finally appear as often as once every 1 to 3 minutes, and the intensity of contraction increases greatly, with only a short period of relaxation between contractions. The combined contractions of the uterine and abdominal musculature during delivery of the baby cause a downward force on the fetus of about 25 pounds during each strong contraction.
It is fortunate that the contractions of labor occur intermittently, because strong contractions impede or sometimes even stop blood flow through the placenta and would cause death of the fetus if the contractions were continuous. Indeed, overuse of various uterine stimulants, such as oxytocin, can cause uterine spasm rather than rhythmical contractions and can lead to death of the fetus.
In about 95 per cent of births, the head is the first part of the baby to be expelled, and in most of the remain-ing instances, the buttocks are presented first. The head acts as a wedge to open the structures of the birth canal as the fetus is forced downward.
The first major obstruction to expulsion of the fetus is the uterine cervix. Toward the end of pregnancy, the cervix becomes soft, which allows it to stretch when labor contractions begin in the uterus. The so-called firststage of labor is a period of progressive cervical dilation,lasting until the cervical opening is as large as the head of the fetus. This stage usually lasts for 8 to 24 hours in the first pregnancy but often only a few minutes after many pregnancies.
Once the cervix has dilated fully, the fetal membranes usually rupture and the amniotic fluid is lost suddenly through the vagina. Then the fetus’s head moves rapidly into the birth canal, and with additional force from above, it continues to wedge its way through the canal until delivery is effected. This is called the second stageof labor, and it may last from as little as 1 minute aftermany pregnancies to 30 minutes or more in the first pregnancy.
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