Normal Labor

Definitions

-Lie מנח This refers to the longitudinal axis of the fetus in relation to the mother's longitudinal axis. This refers to the longitudinal axis of the fetus in relation to the mother's longitudinal axis. - Longitudinal - Transverse - oblique

-Presentation מצג This describes the part on the fetus lying over the inlet of the pelvic or at the cervical os. This describes the part on the fetus lying over the inlet of the pelvic or at the cervical os. - Vertex - Breech - Shoulder - Face

- Position מצב - Position מצב This describes the relation of the point of reference (pubis) to one of the 8 octamers of the pelvic inlet This describes the relation of the point of reference (pubis) to one of the 8 octamers of the pelvic inlet And OP,OA

Point of Reference of Direction This is an arbitrary point on the presenting part used to orient it to the maternal pubis This is an arbitrary point on the presenting part used to orient it to the maternal pubis - Occiput - in vertex presentation - Mentum (chin) – in face presentation - Sacrum – in breech presentation

Engagement Engagement This occurs when the biparietal diameter is at or below the inlet of the true pelvis This occurs when the biparietal diameter is at or below the inlet of the true pelvis

Station This references the presenting part to the level of the ischial spines measured in plus or minus centimeters. (-5 to +5) This references the presenting part to the level of the ischial spines measured in plus or minus centimeters. (-5 to +5)

The mechanical steps the baby undergoes can be arbitrarily divided, and clinically they are usually broken down into six or eight steps for ease of discussion. It must be understood, however, that these are arbitrary distinctions in a natural continuum. The following 6 – 8 divisions of labor are easy to use: The mechanical steps the baby undergoes can be arbitrarily divided, and clinically they are usually broken down into six or eight steps for ease of discussion. It must be understood, however, that these are arbitrary distinctions in a natural continuum. The following 6 – 8 divisions of labor are easy to use:

Flexion and Engagement Occurs at various times before the forces of labor begin Occurs at various times before the forces of labor begin

Descent Occurs as a result of active forces of labor Occurs as a result of active forces of labor

Internal Rotation This occurs as a result of impingement of the presenting part on the bony and soft tissues of the pelvis. This occurs as a result of impingement of the presenting part on the bony and soft tissues of the pelvis.

Extension This is the mechanism by which the head normally negotiates the pelvic curve This is the mechanism by which the head normally negotiates the pelvic curve

External Rotation (Restitution) This is the spontaneous realignment of the head with the shoulders This is the spontaneous realignment of the head with the shoulders

Expulsion This is the delivery of the anterior and the posterior shoulders, followed by trunk and lower extremities in rapid succession This is the delivery of the anterior and the posterior shoulders, followed by trunk and lower extremities in rapid succession

Emanuel Friedman " The clinical features of uterine contractions namely frequency, intensity, and duration cannot be relied upon as measures of progression in labor nor as indices of normality. Except for cervical dilatation and fetal decent, none of the clinical features of the parturient patient appears to be useful in assessing labor progression ”

Lower segment between contracting muscle and cervix

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Crowning