1. The First Stage of Labor
Chapter 25
The First Stage of Labor

3. Changes during the last week of pregnancy
Mood swing
Fetal changes : fetal in the lower site 2-3 wk
Expansion of lungs
Easy breathing
Woman feel more comfort
Soften and lightning
Increase effacement
Difficult walking
Back pain
Increase the pressure within the pelvises and vag. secr.

4. The onset of spontaneous labour
First Stage
Latent phase: cervix dilated about 3-4cm this phase stay 6-8 hr
this phase started before the active phase
Active phase: cervix is more dilated. Started when cervix about 4cm with regular uterine cont.
Transitional Phase: cervix dilated around 8cm -10cm.
The onset of spontaneous labour
Women have to be informed and feel comfort good labor preparation, explain and provide privacy, good management.

5. Spurious ( false) Labour Contraction before onset of labour
Contraction may be regular
No cervical dilation
No effacement
No true labour
Medical and Midwifery Management:
Support
Increase a awareness
Reassurance
Discussion for future management
Effacement mean that the cervix merge into the uterine segment

7. Complete effacement include internal and external cervical os
Complete effacement include internal and external cervical os. This happen by the action of combination of hormonal and mechanical factors.
Action of estrogen
Increase oxytocin receptors release
Stimulate placenta for H. production (progest.)
Increase softening of cervix

8. What is the onset of labour
Is the process of establishing true labour
It is difficult to determine
Diagnosis of onset of labour is important in order to make correct management
Physiology of first stage of labor
Duration vary and affected by: parity, birth interval, psychological status and position of fetus
Uterine Contraction
Fundal dominance
Cont. started in the conrea and spread cross and down

9. Uterine Contraction Fundal dominance Polarity
Contraction and retraction
Formation of upper and lower uterine segment
The retraction ring
Cervical effacement
Cervical dilation
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12. Cervical dilation process

13. Mechanism Factors of Labor
Formation of forewater
2. General fluid pressure

14. Mechanism Factors of Labor
3. Rupture of membrane
4. Fetal axis pressure
Recognition of First Stage of Labour
By woman
By midwife [How]
History
Physical exam
Vaginal exam

15. Indication for Vaginal Exam
Assessment of true labor
Determine presentation
Check for membrane
Discover abnormality
Assess cervix dilation
[how to do vaginal exam clinical section]
Communication and physiacal assesment [history taking , physical exam , vaginal exam

16. Vaginal exam
Communication and physiacal assesment [history taking , physical exam , vaginal exam

19. Record
Complete record
Use of partogram
Accurate
Comprehensive
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