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Labor Initiation: Getting It Going
Introduction to Stages of Labor
Stage 1 of Labor & Birth: Contractions, Dilation & Effacement of the Cervix
Stage 3 of Labor & Birth: Delivery of the Placenta
Stage 4 of Labor & Birth: Immediately Postpartum
Uterine Myometrial Fibers.
Strong, criss-crossing of muscle fibers of the uterus with the force behind them that can open up a woman's cervix and push a baby from the uterus, through the cervix, into and out of the vagina and through the strong pelvic floor muscles of the perineal region.
STAGE 2 OF LABOR
This stage of labor lasts begins at complete dilation or the cervix and ends with the birth of the baby. It may last from a few minutes to 3 hours. The contractions becomes longer as the cervix dilates, with contractions lasting longer and becoming more intense. The baby continues to descend into the pelvis.
Contractions continue about every 2 to 5 minutes and last for 60 to 90 seconds. Pushing down is done during contractions.
The baby is moving down through the birth canal aided by the mother's desire to push with her abdominal muscle force combined with the uterine contractions. Depending on how the labor is progressing and the baby's position, different positions for the mother might be tried, such as squatting, sitting or kneeling.
The baby's head flexes and rotates as it descends through the birth canal.
In the hospital setting, a surgical incision (episiotomy) may be made in the perineum (area between the vagina and the rectum) to widen the birth opening. This is often done to aid in forceps and vacuum extraction placement for instrument assisted births. This procedure may require a local analgesic or other anesthetic option such as a spinal, epidural, pudendal, paracervical, or local in the perineum.
In a homebirth setting, an episiotomy is rarely indicated or used. Proper perineal support by the midwife and controlled breathing-pushing efforts by the mother allow the perineum to stretch slowly and move over the crowning baby's head without need for a surgical incision or pain medication. Forceps or vacuum extraction assistance is very rarely used or needed in a homebirth setting since patience, position changes and birthing techniques, and proper support for mother and her perineum are used. If an episiotomy is indicated, it is done at the fullest extent of crowning, allowing the incision much smaller and easier to repair, usually only requiring a few sutures.
Toward the end of this stage, the perineum begins to bulge with the baby's head pushing against it and then appears at the vaginal opening (crowning).
to assist with smooth delivery of head with few, if any, tears or need of an episiotomy.
The baby's head emerges and then rotates either to the left or to the right maternal leg. As soon as the head emerges, the midwife runs her fingers around the baby's neck to check for a cord. If the cord is present, she either tries to loosen it up and slip it over the baby's head or make it large enough that the baby slides through the middle. If the cord is tight around the neck and/or unable to budge, the midwife may have to cut the cord "on the perineum" to keep the baby from strangling (this is rarely needed since the baby usually slips right through the cord once it has been loosened or unwrapped).
At this time, the shoulders emerge and the rest of the body follows quickly.
The baby is placed upon the mother's abdomen.
In a hospital setting, the cord is clamped and cut right away. The baby is removed from the mother's abdomen, suctioned (usually with an electrical suction unit) and examined.
In a homebirth setting, the midwife usually waits for the cord to cease pulsating before clamping and cutting. This allows the baby to continue to receive needed oxygen and nutrients via the umbilical cord until normal breathing patterns are achieved.
If the mother request it, often times the cord will remain unclamped until after the placenta has been expelled (unless the woman may be expecting twins and there is a possibility that the babies may be sharing a placenta). The baby remains on the mother's abdomen, covered with warmed blankets or towels and is massaged gently to stimulated breathing responses and aid in circulation efforts.
If the baby needs to be suctioned, it is usually with a bulb ear syringe. The baby's nose and mouth may be suctioned while still on the perineum, if needed, but this is done very gently. If there is blood (such as in an episiotomy or tear), a excess of mucus, or meconium present, then the baby may need some extra gentle suctioning after the birth. Otherwise, suctioning is usually not necessary. Aggressive suctioning can actually cause serious adverse reactions with the baby and can create problems and should only be used if there is a great deal of meconium present in and around the baby's face, mouth and nasal area that can be inhaled by the baby after breathing is initiated.
Quick APGAR assessments are made for the baby and breastfeeding is started. This aids in the expulsion of the placenta. The delivery of the placenta is Stage 3 of Labor & Delivery.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has questions or concerns about labor and delivery.
If you have problems with second stage labor and feel you need medical assistance such as the labor stalling out, malposition of the baby preventing it from being born, etc.
If the baby has difficulty breathing or other life-threatening situations arise, call for emergency help (911) immediately and begin emergency techniques (CPR, Respirations, etc.).
Labor Initiation: Getting It Going
Introduction to Stages of Labor
Stage 1 of Labor & Birth: Contractions, Dilation & Effacement of the Cervix
Stage 3 of Labor & Birth: Delivery of the Placenta
Stage 4 of Labor & Birth: Immediately Postpartum
Some photos obtained from "Attending Ob/Gyn Patients" Nursing Photobook by Nursing Books, Intermed Communications, Inc. Others were from MoonDragon client births.
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