SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
1 FIRST STAGE OF LABOR:
DEFINITION:
It starts from the onset of true labor pains and ends
till full dilatation of the cervix {cm}. Duration is
approximately 12 hours for primi and 6 hours for
multipara.
2 PHASES OF FIRST STAGE OF LABOUR:
The first stage is divided into three phases:
1. 2. 3.
LATEN ACTIV TRANS
T E ITION
PHASE PHASE PHASE
1. LATENT PHASE:
It is defined as the period between the onset of true
labor pains and completion of cervical dilatation of
3-4 cm.
Rate of cervical dilatation is about 0.35 cm/hours.
Duration: in primigravida average duration is 8
hours and multipara it is 5 hours.
Frequency and interval: During this phase, initially
contraction comes at the interval of 15-30 minutes
with duration of about 30 seconds. But gradually the
interval becomes shortened with increasing intensity
and duration and contraction comes at interval of 5-
7 minutes and lasts for about 40 seconds.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
2. ACTIVE PHASE:
The active phase of labor begins when the cervix is
3-4cm dilated and ends with cervical dilatation of 8
cm.
During this phase, contraction occurs every 3-5
minutes and lasts up to 6 seconds.
Duration: in primigravida it lasts for 6 hours and
multigravida 4 hours.
Dilatation rate; 1.2-1.5 cm/hr.
3. TRANSITION PHASE:
The last and shortest part of 1st phase of labor is
transition: it is more intense phase of laboring
women.
This phase is starts from cervix is 8 cm dilated and
ends with 10cm cervical dilatation.
The contractions occur every 2-3 minutes lasting
60-90 seconds.
Duration: in primigravida it lasts for 2 hours and
multigravida 1 hour.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
SIGNS AND SYMPTOMS OF FIRST STAGE
OF LABOR:
Contraction and retraction of uterine muscles.
Formation of upper and lower uterine segments.
Development of retraction ring {Bandl’s ring}
Bloody show
Formation of bag of waters
Rupture of membranes.
3 PHYSIOLOGY OF FIRST STAGE OF
LABOR:
There are three factors of physiological changes
occur during first stage of labor,
Namely,
1. Uterine changes
2. Cervical changes
3. Mechanical changes
I. UTERINE CHANGES:
A. FUNDAL DOMINANCE:
Each uterine contraction starts in the fundus near
one of the cornua and spreads across downwards.
The contraction lasts longest in the fundus where
it is also most intense, but the peak is reached
simultaneously over the whole uterus and the
contraction fades from all parts together.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
B. POLARITY OF THE UTERUS:
It is the neuromuscular harmony between upper
and lower pole of the uterus throughout the labor.
C. CONTRACTION AND RETRACTION:
Contraction is temporary shortening of muscle
fibre followed by relaxation.
Relaxation is regaining of original length of
muscle fibres.
Retraction is a phenomenon of the uterus in labor
in which muscle fibre are permanently shortening
once and for all.
D. FORMATION OF UPPER AND LOWER
UTERINE SEGMENTS:
Before the onset of labor, there is no complete
anatomical or functional division of the uterus.
During labor the demarcation of an upper segment
and a relative passive lower segment is more
pronounced.
The wall of the upper segment becomes
progressively thickened with progressive thinning
of the lower segment
This is pronounced in late first stage, especially
after rupture of the membranes and attains its
maximum in second stage.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
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E. DEVELOPMENT OF RETRACTION RING
{BANDL’S RING}:
When upper uterine segment contracts and retracts,
the lower segment thins out to accommodate the
presenting part and the ridge is formed between
upper and lower segment called Bandl’s ring.
II. CERVICAL CHANGE:
A. CERVICAL RIPENING:
Cervical ripening refers to the softening of the
cervix that typically begins prior to the onset of
labor and is necessary for cervical dilatation and
passage of the fetus.
B. CERVICAL EFFECEMENT:
It is defined as the thinning of the cervix and
shortening of the cervical canal {normal length of
2-3 cms}.
C. CERVICAL DILATATION:
It is the process of enlargement of external os from
closed external os to permit passage of fetus head.
The full dilatation of cervix is 10 cm.
D. BLOODY SHOW:
It is defined as mucus plug stained with blood is
known as bloody show.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
It is caused by separation of the membranes due to
over stretching of the lower uterine segment
III. MECHANICAL FACTORS:
A. GENERAL FLUID PRESSURE:
While the membranes remain intact, the pressure
of the uterine contraction is exerted on the fluid
and as fluid is not compressible, the pressure is
equalized throughout the uterus and the fetal
body: it is known as general fluid pressure or
fetal axis pressure.
B. RUPTURE OF MEMBRANE:
Rupture of membrane is a term used during
pregnancy to describe a rupture of the amniotic
sac.
Normally, it occurs spontaneously at full term
either during or at the beginning of labor.
ROM is also known as ‘breaking the water’ or as
ones ‘water breaking’.
C. FETAL AXIS PRESSURE:
In longitudinal lie there is tendency of
straightening out of the fetal vertebral column
due to contractions of circular muscles of the
body of uterus, this exerts pressure on cervix and
dilates cervical canal.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
D. DESCENT OF THE PRESENTING PART:
If there is no undue bony or soft tissue
obstruction, descent is a continuous process.
It is slow or insignificant in first stage but
pronounced in 2nd stage.
Presenting part is expected to reach the pelvic
floor by the time the cervix id fully dilated.
4 PREPARATION OF LABOR ROOM:
A labor room is an area in a hospital that is
equipped for delivering babies. It is a room or an area set
aside for making or receiving deliveries, as for circulating
book in a library.
Obstetrical unit shall be located in such a way to
prevent unrelated traffic, to protect the mother from
infection and cross infection.
Labor room shall be located so as to permit visual
observation of each room from the nurses working
station.
Facility should provide an emergency
communication system connected to the operations
and control station.
Resuscitation facilities for neonate shall be provided
within the obstetrics and neonatal unit.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
A labor room shall be provided and meet the
following equipments:
Minimum 80 sq.ft. of area shall be provided to
per labor bed.
Labor room shall afford privacy and shall be
conveniently located with the delivery room.
Labor room shall be equipped to handle
obstetrics and neonatal emergencies.
At least two labor beds with adjacent toilet shall
be provided for each delivery room.
A toilet with hand washing facilities shall be
provided for the staff.
No more than two labor beds may be located in
one labor room.
A separate recovery room may be located in one
labor room.
Prearrangement of all the articles, drugs and
healthcare team members including; Anesthetist,
Pediatrician, Obstetrician and nursing officer.
Visitors and unnecessary people should not be
allowed to enter in the labor room.
Delivery room should be properly cleaned the
spread of infection and for keeping it ready to
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
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Delivery table, mattress, mackintosh on the
delivery table be thoroughly cleaned after each
use.
There should be good source of light in the labor
room.
Use special lights with each labor table.
5 ARTICLES NEED FOR NORMAL
VAGINAL DELIVERY:
a. A sterile delivery tray containing,
FOR MOTHER:
Articles for cutting and suturing an episiotomy:
A pair of straight, blunt ended scissor-to
cut down suture thread
Episiotomy scissor-1
Artery clamp-3
Tissue forceps-1
Needle holder-1
Syringe and needle for infiltration-10cc
Scissors for cutting the cord-1
Bowl containing antiseptic solution
Basin to receive placenta
Cotton balls for cleaning the perineum
Gauze pieces {size 4×4 pieces}
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
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Sterile gown, apron, gloves and mask {delivery
kit}
Sterile perineal pads
FOR NEWBORN:
2 Flannel clothes one to receive and dry the baby
of excess secretion and another to wrap the baby
Suction machine
Mucous sucker
Radiant warmer
Cord clamp/ thread
Measuring tape
Rectal thermometer
Oxygen source with tubing
Identification band {blue for male baby, pink for
female baby}
Baby clothes
Baby blanket
A clean tray containing:
Antiseptic lotion-savlon or dettol
Suture material
Oxytocis drugs
Sterile gloves and syringes
Methargine and Lignocaine
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
6 MANAGEMENT OF FIRST STAGE OF
LABOR:
1. GENERAL EXAMINATION:
Aseptic precautions should be followed throughout
the labor process.
Continuous emotional support, encouragement and
assurance are to be given to boost the morale of the
mother.
Constant supervision is required.
2. CAREFUL EXAMINATION:
A complete and careful examination of the woman
is important.
Physical and pelvic examination is carried out and
laboratory tests are also performed.
3. PREVENTION OF INFECTION:
To prevent infection, aseptic technique should be
followed during vaginal examination and the
hygiene of the woman throughout the labor.
4. PERINEAL PREPARATION:
Shave the perineal area for easy viewing.
Vulval toileting is also to be done.
5. REST:
Generally, a woman in early normal labor may not
be kept confined to bed.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
While in bed she may take any comfortable
position.
Advise the mother not to lie down in dorsal supine
so as to prevent aortocaval compression.
6. AMBULATION:
If the membranes are intact, the patient is allowed
to walk. This prevents venacaval compression and
encourages descent of the head.
7. BOWEL CARE:
During vaginal examination if rectum feels
loaded, soap and water enema is given in early
stage to prevent soiling of the perineum during the
time of delivery.
Loaded bowel also inhibits uterine contractions.
Enema is contraindicated in conditions like kidney
failure, heart failure, intestinal
inflammation/blockage etc.
8. BLADDER CARE:
Mother is encouraged to pass urine by herself as
full bladder often inhibits uterine contractions and
may lead to infection or injury to the urinary
bladder itself.
If the women cannot go to toilet, provide bedpan
or catheterization is to be done with strict aseptic
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
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precautions.
9. DIET:
There is delayed emptying of the stomach in labor
so advice the women not to take solid food during
active labor.
Fluid in the form of plain water, ice chips or fruit
juice may be given in early labor.
In case of prolonged labor 5 percent dextrose may
be started.
10. RELIEF OF PAIN:
Pethidine is an effective analgesic. Dose given
during labor 50-100mg IM.
Metoclopramide 10mg IM is commonly given to
combat vomiting due to pethidine.
11. VITAL SIGNS:
MATERNAL:
o Pulse is recorded every 30 minutes and is marked
with dot {.}in the partograph.
o Blood pressure is recorded at every 1 hour and
marked with { } in the partograph.
o Temperature is recorded at every 2 hours.
FETAL:
o Fetal vital signs should be noted every half hour in
the first stage and every 15 minutes in second
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
stage or following rupture of membranes.
o Fetal heart rate should be recorded immediately
after uterine contraction. The count should make
for 60 seconds. Normal FHR range from 110-
150beats/minute.
12. ABDOMINAL EXAMINATION:
Note the frequency, intensity and duration of
contractions. The number of contractions in 10
minutes and duration of each contraction in
seconds are recorded in the partograph.
Note the position and presentation of the fetus.
Note the descent of the presenting part.
13. VAGINAL EXAMINATION:
Vaginal examination should be kept as minimum
{at least 4 hourly} to avoid risk of infection and
following point are to be noted:
o To note the dilatation of the cervix.
o To note the position of head and degree of
flexion.
o To know the station of head.
o Color of liquor
o Degree of molding of head.
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
14. INTAKE AND OUTPUT:
Careful recording of intake/output chart is to be
done.
Maintain intake/output chart every 4 hours.
15. EMOTIONAL SUPPORT:
Mother is supported emotionally.
She should be guided and communicated about the
observations and actions.
Maintain good interpersonal relation with the
mother so that she can verbalize her feelings
during the time of labor.
Allow any family members/husband to stay with
the mother, with which mother feels comfortable
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
7 CONCLUSION:
SL TIME SPECIFIC CONTENTS TEACHER’S LEARNER’S AV EVALUA
NO. OBJECTIVES ACTIVITIES ACTIVITIES AIDS TION
8 BIBLIOGRAPHY:
