Labour “in labour” …..when uterine contractions reach sufficient strength, duration and frequency to cause effacement and dilatation of the cervix.

 Normal labour takes place at term. -a single fetus -presents by the vertex and -the delivery, followed by that of the placenta and membranes, -is accomplished with in 4-24 hours, -with out artificial aid and without complication.

Possible causes for the onset of labour include: -fetal pressure on the uterine wall -increasing tension on the uterine wall -changes in hormonal balance (fetal adrenal cortex)

Signs of labour for a pregnant woman -regular contractions increasing in strength, duration and frequency. -show (bloody mucus plug around cervix) -rupture of the membranes (amniotic fluid escapes)

Terms used during labour: -contractions: shortening of the uterine muscle fibres. -during labour increase in strength duration and frequency -strength: increase in intensity -duration: from the beginning of a contraction to the end of that contraction. -frequency: from the beginning of one contraction to the beginning of the next.

 The cervix during labour

 The cervix during labour: -effacement: or taking up of the cervix. -the cervix becomes part of the lower uterine segment and flat -dilatation of the cervix -the external os of the cervix increases in diameter to full dilatation =10 cms.

 The mechanisms of labour

The mechanisms of labour Briefly outline the “mechanisms” of labour ( note only a general understanding is needed) -a series of passive movements of the fetus in its passage through the birth canal. -

pelvis: -inlet / outlet differing in size and shape -curve at the lower end.(Curve Of Carus) -cylindrical

Powers -uterine contractions -abdominal muscles

Resistance -offered by the pelvis, cervix and the pelvic muscles

Passengers: -fetus (flexible neck acts like a fulcrum) -fetal skull (shape and size)

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Stages of Labour Stage one: from the onset of regular contractions to full dilatation of the cervix Stage two: from full dilatation of the cervix to the birth of the baby

Stage three: from the birth of the baby to the delivery of the placenta. Stage four: from the delivery of the placenta and membranes to 1-4 hours after the baby’s birth

-average duration First stage -primigravida = hours -multigravida = 1-2 hours Second stage -primgravida =1-2 hours -multi gravida =½ hour Third stage: -average duration ½ hour (with ecbolic drugs = 5 minutes)

 Factors which may influence a woman’s experience of labour include: -previous experiences -tiredness -dehydration -position of the baby -environment -support people -

Nursing actions during labour to observe and record the maternal and fetal physical condition -blood pressure -pulse -temperature - urine output amount and urinalysis -vaginal loss (blood, mucus, amniotic fluid -contractions -pain -general wellbeing

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Emotional assessment (Maternal) -anxiety -mood -response to pain and labour

Nursing actions for fetal assessment -fetal heart rate -amniotic fluid (colour) -

Nursing actions to assist a woman’s pain management during labour. -distraction techniques -breathing techniques -music -counting -conversation -massage - - -

Nursing actions: -assist with hygiene needs, bath, back rubs, change the bed linen, cold flannels to forehead, heat packs………. -remind re elimination needs -support her support person -stay with her -give feedback re the progress of her labour and her fetus -encourage……………..

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Discuss: What factors might influence a woman’s choice about where she would like to have her baby? For example home versus hospital