There are many signs of pregnancy , ranging from those that make you wonder if you might just

be pregnant to those that even your caregiver will consider proof positive. Here's a look and the signs and symptoms you may experience, and how likely each one is to be correct. Presumptive signs "Presumptive signs" are the symptoms and sensations that, while possibly indicating pregnancy, could also each be caused by any number of other reasons. These are also some of the earliest pregnancy symptoms. 1. 2. 3. 4. 5. 6. 7. 8. Absent menstrual periods (amennorhea) Nausea and/or vomiting ("morning sickness") Unexplained fatigue The frequent need to urinate Breast tenderness and changes Excessive salivation (ptyalism) Skin changes A sensation of movement in abdomen (quickening)

Probable signs There are several "probable signs" of pregnancy. These are symptoms that, most of the time, do indicate pregnancy -- but, in certain cases, might be false or caused by another condition. 1. 2. 3. 4. 5. 6. Positive pregnancy test (presence of hCG detected, by blood or urine test) Softening of cervix at 6-8 weeks (Goodell's Sign) Bluish coloration of cervix, vagina and vulva at 6-8 weeks (Chadwick's Sign) Enlarged abdomen Braxton-Hicks contractions Passive movement of the fetus during an exam (ballottement)

Positive signs "Positive signs" are those which cannot be mistaken for any other condition -- they are considered absolute evidence that you are, in fact, pregnant. They rely on the senses: sound, sight and touch, as interpreted by your caregiver. 1. 2. 3. 4. Fetal heart sounds heard by doptone or Doppler Fetus visible on ultrasound Fetal movements felt by caregiver Fetus visible on x-ray, MRI or other diagnostic imaging device (Note: use of these devices is not recommended during pregnancy)

The value of these signs Even the presumptive signs are important to know because of the value of prenatal care. As soon as you suspect you might be pregnant, start taking extra good care of yourself: avoid alcohol and cigarettes, eat well, and start taking prenatal vitamins . Make an appointment with a qualified caregiver to find out what else you need to do to grow a happy and healthy baby . Components of Labor and Delivery When the events that occur during labor and vaginal delivery are considered, it is helpful to think about the following three components of the process: (1) the powers (uterine contractions and, in the second stage, the addition of voluntary maternal expulsive efforts); (2) the passageway (the bony pelvis and the soft tissues contained therein); and (3) the passenger (the fetus). The interaction of these three components determines the success or failure of the process.
Labor Labor consists of regular, frequent, uterine contractions which lead to progressive dilatation of the cervix. The diagnosis of labor may not be obvious for several reasons: Braxton-Hicks contractions are uterine contractions occurring prior to the onset of labor. They are normal and can be demonstrated with fetal monitoring techniques early in the middle trimester of pregnancy. These innocent contractions can be painful, regular, and frequent, although they usually are not. While the uterine contractions of labor are usually painful, they are sometimes only mildly painful, particularly in the early stages of labor. Occasionally, they are painless. Cervical dilatation alone does not confirm labor, since many women will demonstrate some dilatation (1-3 cm) for weeks or months prior to the onset of true labor.

Thus, in other than obvious circumstances, labor will usually be determined by observing the patient over time and demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions. The cause of labor is not known but may include both maternal and fetal factors.

Normal Labor and Delivery

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Vaginal Delivery Video

This 5-Minute video shows a normal vaginal delivery of a baby, illustrating the 7 cardinal movements of labor. Included is pushing, crowning, delivery of the head, removing the umbilical cord from around the neck, delivery of the placenta and suturing of the vulva.

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Latent Phase Labor The first stage of labor is that portion leading up to complete dilatation. The first stage can be divided functionally into two phases: the latent phase and the active phase. Latent phase labor (also known as prodromal labor) precedes the active phase of labor. Women in latent phase labor: Are less than 4 cm dilated. Have regular, frequent contractions that may or may not be painful. May find their contractions wax and wane Dilate only very slowly

Can usually talk or laugh during during their contractions May find this phase of labor lasting days or longer.

Active Phase Labor Active phase labor is a time of rapid change in cervical dilatation, effacement, and station. Active phase labor lasts until the cervix is completely dilated. Women in active phase labor: Are at least 4 cm dilated. Have regular, frequent contractions that are usually moderately painful. Demonstrate progressive cervical dilatation of at least 1.2-1.5 cm per hour. Usually are not comfortable with talking or laughing during their contractions.

Progress of Labor For a woman experiencing her first baby, labor usually lasts about 12-14 hours. If she has delivered a baby in the past, labor is generally quicker, lasting about 6-8 hours. These averages are only approximate, and there is considerable variation from one woman to the next, and from one labor to the next. During labor, the cervix dilates (opens) and effaces (thins). This process has been likened to the process of pulling a turtleneck sweater over your head. The collar opens (dilates) to allow your head to pass through, and also thins (effaces) as your head passes through. The process of dilatation and effacement occurs for both mechanical reasons and biochemical reasons. The force of the contracting uterus naturally seeks to dilate and thin the cervix. However, for the cervix to be able to respond to these forces requires it to be "ready." The process of readying the cervix on a cellular level usually takes place over days to weeks preceding the onset of labor. Descent means that the fetal head descends through the birth canal. The "station" of the fetal head describes how far it has descended through the birth canal. This station is determined relative to the maternal ischial spines, bony prominences on each side of the maternal pelvic sidewalls. "0 Station" ("Zero Station") means that the top of the fetal head has descended through the birth canal just to the level of the maternal ischial spines. This usually means that the fetal head is "fully" engaged (or "completely engaged"), because the widest portion of the fetal head has entered the opening of the birth canal (the pelvic inlet).

Cardinal Movements

Labor is a physical and emotional event for the laboring woman. For the infant, however, there are many positional changes that assist the baby in the passage through the birth canal. Because of the resistance met by the baby, positional changes are specific, deliberate and precise as they allow the smallest diameter of the baby to pass through a corresponding diameter of the woman's pelvic structure. Neither care providers nor the laboring woman is directly responsible for these position changes. The baby is the one responsible for these position changes ~ the cardinal movements. Descent The baby's head moves deep into the pelvic cavity. This movement, commonly called lightening, is preceded by Engagement or the entering of the biparietal diameter (measuring ear tip to ear tip across the top of the baby's head) into the pelvic inlet. The baby's head becomes markedly molded when these distances are closely the same. When the occiput is at the level of the ischial spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet. Flexion This movement occurs during descent and is brought about by the resistance felt by the baby's head against the soft tissues of the pelvis. The resistance brings about a flexion in the baby's head so that the chin meets the chest. The smallest diameter of the baby's head (or suboccipitobregmatic plane) presents into the pelvis. Internal rotation As the head reaches the pelvic floor, it typically rotates to accommodate for the change in diameters of the pelvis. At the pelvic inlet, the diameter of the pelvis is widest from right to left. At the pelvic outlet, the diameter is widest from front to back. So the baby must move from a sideways position to one where the sagittal suture is in the anteroposterior diameter of the outlet (where the face of the baby is against the back of the laboring woman and the back of the baby's head is against the front of the pelvis). If anterior rotation does not occur, the occiput (or head) rotates to the occipitoposterior position. The ocipitoposterior position is also called persistent occipitoposterior and is the common cause for true back labor. Extension After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head,

face and chin are born. External rotation After the head of the baby is born, there is a slight pause in the action of labor. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman's inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch. It is at this point that shoulder dystocia may be identified. Shoulder dystocia occurs when the baby's shoulders are halted at the pelvic outlet due to inadequate space through which to pass. Mother's birthing babies who are identified as macrosomatic (in excess of 9.9 lbs.) are more likely to experience shoulder dystocia. Additionally, 15-30% of macrosomatic babies experiencing shoulder dystocia sustain some injury to the brachial plexus. Most of these injuries (80%) resolve by the baby's first birthday. Commonly, the McRobert's technique is used to resolve shoulder dystocia. This technique involves a sharp flexing of the maternal thighs against the maternal abdomen to reduce the angle between the sacrum and the spine. Expulsion Almost immediately after external rotation, the anterior shoulder moves out from under the pubic bone (or symphisis pubis). The perineum becomes distended by the posterior shoulder which is then also born. The rest of the baby's body is then born, with an upward motion of the baby's body by the care provider.