Changes taking place during the stages of the labour :
Labour is the expulsion or extraction of viable fetus out of the uterus. Delivery may be vaginal [either spontaneous or aided] or it may be abdominal.
Labour is a series of events that takes in the genital organs in an effort to expel the viable products of conception out of the uterus through the vagina. Usually it occurs between 38-42 weeks of pregnancy. If labour occurs before 37 weeks, it is termed as preterm labour.
Expulsion of conceptual products before 28 weeks is called abortion.
Normal labour (Eutocia) occurs at term and is spontaneous in onset with the fetus presenting by the head. The process is completed within 18 hours and no complications arise. by which the fetus, placenta and membrane are expelled through the birth canal.
Stages of labour:
A First stage:
This is the stage of dilatation of the cervical OS. It begins with the onset of true labour contractions to full dilatation of the cervix. Duration of first stage is an average of 13 hours for nullipara and 7.5 hours for multipara.
The first stage is clinically manifested by progressive uterine contraction, progressive taking up of the cervix and ultimate rupture of membranes.
B Second stage:
It is the stage of fetal expulsion. It begins with full dilation of cervical OS and ends with the birth of the baby. Second stage lasts for one to one and half hours for nullipara and 20 to 45 minutes in multipara.
D Third stage:
It is the stage of separation and expulsion of the placenta and membranes. It begins with birth of the baby until the expulsion of placenta and membranes. The third stage may last from few minutes to thirty minutes.
E Fourth stage:
The fourth stage lasts from the delivery of placenta and membranes until the postpartum condition of the women has become stabilized. This stage is usually one hour after delivery. In this stage the mother must start breast-feeding her infant.
Changes taking place during the first stage of the labour:
1. Presence of show-profuse cervical secretions, mixed with blood is called show.
2. Dilation and taking up of cervix: The cervical canal begins to dilate and takes up.
Formation of 'bag of waters': With the dilation of the cervical canal, the lower pole of the fetal membranes becomes unsupported and tends to bulge into the cervical canal.
Role of nurse in caring of the woman in the first stage of labour:
1. Take a brief history and assessment
2. Encourage the woman to have a warm bath or vulval toileting.
3. Give a soap and water enema.
4. When membranes are intact, allow the woman to walk, sit or lie down in lateral position according to her convenience. If membranes are ruptured bed rest must be advised. Analgesics may be given as per doctor' s prescription
5. Encourage the woman to take fluid diet soup, fruit juice, salt lemon juice or plain water. Food and oral fluids to be withheld, when the woman is in active labour.
6. Encourage the woman to empty her bladder herself frequently.
7. Monitor the progress of the labour by recording a partograph.
The following are recorded in partograph.
Maternal vital signs
Station of fetal head
Presence or absence of membranes
Fetal heart rate, (Normal FHR is 110 - 150 per minute).
Watch for maternal and fetal well-being
Monitor pulse, blood pressure and temperature every second hourly and FHR every hour
Monitor urine output
Observe the tongue to assess the hydration status.
Psychological preparation of the mother and her family is equally important as her ambitions play a great role in managing labour pain and discomfort.
Changes taking place during the second stage of the labour:
The second stage is clinically manifested by increased frequency and intensity of uterine contractions
Appearance of 'bearing down' efforts which result in expulsion of the fetus
The mother may show features of exhaustion.
The role of nurse in caring the woman in the second stage of labour is
1.To assist in the natural expulsion of the fetus slowly and steadily.
2.To prevent perineal injures.
3.To assist labour under aseptic precautions
4.Vigilant monitoring of maternal vital sign and fetal heart rate.
Changes taking place during the third stage of the labour:
1. The placental separation is achieved by marked reduction in the uterine surface area of the placental site following delivery of baby due to retraction.
2. After separation of placenta it is expelled by controlled cord traction. The bleeding is controlled by effective contraction and retraction of uterus.
The role of nurse in caring the woman in the third stage of labour is
1. Watch for signs of placental separation before taking efforts to remove the placenta. (lengthening of cord, suprapubic bulge and fresh gush of blood from vaginum)
2. The placenta is removed by controlled cord traction.
3. Injection Methergin may be given for effective uterine contraction to control bleeding.
4. Watch for maternal vital signs, consistency of uterus, height of the uterus and amount of vaginal bleeding.
5. The placenta and membranes should be examined for any abnormality following their expulsion.