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Labor and Delivery

[insert presenter info]


Objective

For parents to become knowledgeable


about each phase of labor and delivery so
that they can be a part of the decision-
making process and confident as they
approach birth
Terminology

Lightening- baby drops down into your pelvis.

Rupture of membranes – the amniotic sac gets a


hole

Presenting part – the part of the baby that is


pressing on the cervix

Engagement- baby’s head has passed through


the upper pelvis into the lower pelvis
Terminology

Contraction- Shortening and tightening of the


cervix

Effacement – Thinning and shortening of the


cervix

Dilatation – Opening of the cervix

Bloody Show – Small blood vessels rupture as


the cervix begins to dilate
Stages of Labor

1st Stage
 Pre-Labor
 Phase 1 - Early Labor
 Phase 2 - Active Labor
 Phase 3 – Transition

2nd Stage- Pushing


3rd Stage- Birth
Pre-Labor

Characteristics What You May Feel Helping Yourself Coach’s Help


Duration: 0 hours to Abdominal or pelvic Relax with Daily practice of
several days; May pressure, cramps, contractions. breathing &
start & stop; Change low backache. relaxation
of activity affects Breathe normally or techniques.
contractions. Burst of energy or its try slow early labor
opposite – laziness. breathing. Stay in close touch.
Contractions:
Increased Braxton- Nesting instinct. Don’t overdo. This Help with meals &
Hicks, some energy is for labor. chores, last minute
uncomfortable, may Finish packing for preparations for
begin a pattern, then hospital. baby.
fade.
Eat small amounts
of easily digested
foods.
First Stage Labor – Phase 1: Early Labor

Characteristics What You May Feel Helping Yourself Coach’s Help

Duration: ranges Bubbly, excited. A Enjoy this! You This phase is usually
from 2 hrs to days. little stage fright. know your cues. spent at home & you will
Normal light need to be in close
Birthing Progress: Wish to tell the activity, plenty of contact in case she
Cervix dilates to 4 world. rest. needs you.
cm.
Gradually less Relax & breathe Extra rest for you too.
Contractions: Last sociable, more thru contraction.
30-60 sec; are 5-15 serious, beginning Use good position. Call sitter for older
min. apart, & are to realize it’s work. children to say
mild but definite; Call the L&D unit. contractions have
progressively started.
longer, stronger, Clear liquids, if
closer together. Check for relaxation.
allowed. Light
small snacks. Start coaching breathing
exercises just for
practice.
Stage 1 – Phase 1
For Early Labor (1st Phase Breathing)
First Stage Labor – Phase 2: Active Labor

Characteristics What You May Feel Helping Yourself Coach’s Help

Duration: 4-8 hrs. Working very hard. Focal point away Time contractions.
Serious, need to from traffic pattern Talk her thru them.
Birthing Progress: concentrate. in room.
Cervix dilates from Check for
relaxation & help
4 to 8 cm. Intense pressure Switch to focused her to relax.
with contractions. breathing.
Contractions: Last Help her change
45-75 sec. & are 3- Vaginal bleeding. Change position. positions often.
5 min. apart; quite Backache may
strong, peak more intensify or vanish. Walk or shower if Tell nurses if she
quickly. possible. has urge to push.
Very self-centered.
Try squatting or Massage.
sitting on exercise
Encourage often!
ball.
Stage 1 – Phase 2
For Active Labor (2nd Phase Breathing)
First Stage Labor – Phase 3: Transition

Characteristics What You May Feel Helping Yourself Coach’s Help


Duration: 15 min Confused, irritable, Switch to transition Be firm in coaching,
to 1½ hours. not wanting to be breathing pattern; never mind her mood.
touched, afraid of take each She’ll thank you later.
losing control. contraction at a
Birthing time. Put your face about
Progress: Cervix 10 inches in front of
Increased rectal her face & do
dilates 7-8 to 10 pressure. DON’T push! Pant breathing exercise if
cm. or blow till urge has she is having difficulty
More vaginal passed. in maintaining control
& breathing.
Contractions: discharge caused by
60-90 sec. long, descent of baby. Concentrate on
relaxing, especially Coach her to pant or
2-3 min. apart. blow if she starts to
Very strong, Increased backache between push & call nurse.
tremendous as baby descends. contractions.
pressure, may Cold cloth for face,
have more than Try to keep lips, & mouth
breathing slow – no
one peak. hyperventilating. PRAISE!
Transition Breathing
Second Stage Labor - Pushing

Characteristics What You May Feel Helping Yourself Coach’s Help


Duration: Varies Urge to push varies, Two cleansing Remind her of
greatly – 2 usually strong. breaths, long cleansing breaths at
pushes to 2 hrs. sustained pushes, beginning & end of
Great relief to push. & rest between each contraction.
Birthing contractions.
Progress: May feel uncertain at Let her rest/sleep
Pushing the baby first but you soon get Listen closely to between contractions.
down the birth into it. coaching from
canal & out into team. Give ice chips
the world. between pushes.

Coach firmly.
Second Stage Labor – Pushing cont.

Characteristics What You May Feel Helping Yourself Coach’s Help


Contraction: Alertness returns, Pushing harder Remind her to “Relax
Last 60-90 sec. new burst of energy. may help you to her bottom”.
& 2-5 min. apart, cope with pain.
peek more slowly Back pain may Support head &
than transition vanish or return. Release perineum
as completely as shoulders to watch
contractions, baby emerge.
Great pressure in you can and think
may have more “Open, baby out!”
rest between. rectum. Stretching,
stinging sensation Look to see WHO’S
around vagina as Lie back & pant or HERE!
crowning blow for birth of
approaches; numb baby’s head. Get the camera out &
for birth of baby.
ready for first shot of
Push as directed new baby.
Actual feel of baby for baby’s
emerging is warm & shoulders.
pleasant relief! Welcome your baby
Get ready to hold into the world!
your new baby.
Stage 2- Pushing
Coached Breathing
Third Stage Labor
(includes time from baby’s birth to expulsion of the afterbirth)

Characteristics What You May Feel Helping Yourself Coach’s Help


Duration: up to 30 May or may not notice Respond to Reinforce
min. contractions. coaching. instructions.
Birthing Progress:
Afterbirth comes Chilled, shivery, Nursing baby Enjoy watching or
out (placenta, impatient. stimulates your holding your baby.
membrane, cord) uterus to contract.
Contractions: Few Overwhelmed & Stay near until she
mild ones. overjoyed! Concentrate on is ready to rest.
your baby.
Stage 3- Birth of the Placenta
Stages of Labor- Summary

Active Labor
Acknowledgements/References

VA/DoD Uncomplicated Pregnancy Clinical


Practice Guidelines (December 2000)

Ms. Brandy Stoffel, Community Health Nursing,


Ft Lewis, Washington

LTC Teresa Hall, Community Health Nurse,


Directorate of Health Promotion and Wellness,
US Army Center for Health Promotion and
Preventive Medicine
Normal Vaginal Delivery

These are real photos!