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Stages of Labor

1. a) Define labor and describe the physiology of first stage of labor.
b) Discuss in detail on management of a mother in first stage of labor.

Labor is the physiological process in a pregnant woman, by which the fetus and the placenta are expelled out of the uterus and vagina and the baby is delivered
Stages of labour

3 stages - I stage upto full dilatation, II stage upto delivery of the baby, III stage delivery of the placenta

First Stage of Labor
First stage until the cervix has opened to around 10 cm
Duration :  usually 8-12 houre; May last for 48 hours
Cervix starts to soften and to open

Three phases
Early labor phase - From the time of the onset of labour until the cervix is dilated to 3 cm - 8-12 hours, cervix will efface and dilate to 3 cm, contractions will last about 30-45 seconds with 5-30 minutes intervals - a blood-stained mucus discharge called  a ‘show’ - contractions are mild and somewhat irregular - progressively stronger and more frequent - contractions are felt like lower back (like during menstrual cramps) and pressure or tightening in the pelvic area - membranes may rupture and the amnitotic fluid may suddenly gush out or leak intermittently - color of the  fluid is clear and colorless or slightly pink ( a greenish or bloody color signifies some abnormality)

Active labor phase - Cervix dilatation from 3 cm to 7 cm - will last for 3-5 hours - contractions last for 45-60 seconds with 3-5 minutes intervals - contractions are stronger and longer - this is the time to go to hospital

Transition phase - Cervix dilatation from 7 cm to 10 cm - lasts for 30 minutes to 2 hours - contractions last for 60-90 seconds with a 30 seconds to 2 minutes intervals - contractions are long, strong, intense and may overlap - hot flashes, chills, nausea, vomiting or gas may appear

The Second Stage of Labor
From the time when the cervix is fully dilated to when the baby is born.
longer and stronger contractions, with a one to two minute intervals
increased pressure in the perineum
the desire or urge to push
shaky cramps, nausea and vomiting
stretching and burning feelings in the vagina.

When the urge to push arrives it can be overwhelming. The pushing phase may last for up to two hours, usually less in multipara.
Perineal pressure, and a strong urge to go to the toilet
Baby’s head moves down.

The third stage
Begins after the baby is born and finishes when the placenta and membranes have been delivered.
In the third stage there will be more contractions to expel the placenta
A feeling of fullness in the vagina.
The midwife may pull on the cord to deliver the placenta and ask the mother to help by gently pushing.

Management of the mother in First Stage
Early labor phase
Make the mother relax
No need to rush to hospital
Home surrounding in this phase builds up courage and stamina
Allow the mother to do simple routines around the  house
Conserve energy
Plenty of water and small snacks given
Keep monitoring the contractions : the duration of the contractions, the strength and the intervals between the contractions
If possible let the mother sleep
If unable to sleep focus on doing light activities
Watch the color, odor and the time of show
Calm down the patient by making her comfortable

Active labor phase
Take the mother to hospital
Start breathing techniques and relaxation exercises between contractions
Switch positions often
Take a warm bath
Continue dringking plenty of water and urinate periodically
The mother should get undivided attention
Offer verbal  reassurance and encouragement
Massage her abdomen and lower back
Monitor contractions, monitor the machines used
Make mother comfortable : offer prop pillows, get her water, apply touch
Remind her change positions frequently, go with her on a walk, offer bath
Provide distractions from labor : music, reading a book, or playing simple card game

Transition phase
Give heavy support
Ask mother think of the contraction "one conraction at a time"
Remind her how far she has successfully come already
Ask her to tell you when she feels like pushing
Reassure the mother when she feels hot flashes, chills, nausea, vomiting or gas
offer lots of encouragement and praise
Avoid small talk
Continue breathing with her
Guide her through her contractions with encouragement
Ask her to relax between contractions
Do not mind if the mother is angry - it is a normal  part of transition.

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