Normal labor & Delivery
It is the nature’s way of bringing baby out of mother’s womb after a safe carrying time of 37weeks.
Labor is divided into three stages-
- First stage- Onset of true labor pains to full (10cm) dilatation of cervix.
- Second stage – Full dilatation of cervix to Delivery of baby
- Third stage- Delivery of Baby to delivery of placenta
Normal Labor is heralded by spontaneous onset of painful contractions of the uterus which result in softening and dilatation of the cervix (mouth of uterus). Mostly, it is associated with blood stained mucoid discharge from vagina (show).You would be advised to get admitted to labor ward at this stage. As these contractions of uterus increase gradually in severity and come more frequently they may result in, leaking of amniotic fluid through vagina, breaking of the water bag.
The initial part of first stage of labor is called the latent phase. The standard duration of the latent first stage has not been established and can vary widely from one woman to another. As the cervical dilatation progresses from 5 cm until full dilatation, regular painful uterine contractions become more intense and this characterizes the active first stage of labor and usually does not extend beyond 10-12hours.
- Fetal well being is assessed in healthy pregnant women in labor by auscultation of fetal heart rate
- Per vaginum (PV) examination is required to check the progress of labor in active phase.
- Relaxation techniques, including progressive muscle relaxation, breathing, music, mindfulness and other techniques are recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences. . Manual techniques, such as massage or application of warm packs may also be used. Parenteral opioids, such as fentanyl, diamorphine and pethidine may be prescribed on request for pain relief. Labor analgesia can be requested by inhalational analgesia, epidural analgesia at the start of active first stage.
- Mostly you are encouraged to assume the position of choice and be mobile and in upright position.
- Mostly you are allowed drinking liquids & eating food to stay hydrated and energized.
- You may be given intravenous fluids with or without medication to augment labor pains.
- High risk women may require more intensive monitoring with continuous CTG.
Second stage of Labor
During this stage, expulsive uterine contractions cause an involuntary urge to bear down.The duration of the second stage varies with birth completed within 2 to 3 hours.
- Need for episiotomy is assessed by your doctor depending on the size of baby and rigidity of the perineum. If required then a local anesthetic drug is infiltrated so that you don’t feel the pain while a small cut is given to widen the introitus and facilitate delivery.
- The baby is delivered and placed on your abdomen.
Third stage of labor
- An oxytocic drug(Oxytocin (10 IU, IM/IV)) is given to prevent excessive blood loss after delivery.
- The cord is clamped after cord pulsations disappear and cut. Cord blood sample may be taken for stem cell preservation if desired.
- Baby is handed over to pediatrician.
- Placenta is removed by controlled cord traction and examined for completeness.
- Maternal perineum is inspected for any injuries and a digital rectal examination is performed.
- Episiotomy or any tears are stitched under local anesthesia using absorbable sutures.
Usually the mother is observed for some time after delivery and encouraged to take a light snack.
Skin to skin contact of baby and mother and initiation of breast feeding are encouraged as soon as possible.
Complications
- Prolonged labor- usually pains are augmented with drugs
- Failure to baby to descend in birth passage or failure of cervix to dilate
- Obstructed labor- bigger baby gets stuck in smaller passage or if baby is in an unfavourable position or attitude- cesarean section is required
- Heart beat of baby becomes abnormal- fetal distress
- Baby passes meconium in early labor with unfavourable cervix
- Cord comes out as the water bag breaks
- Mother is exhausted and unable to push in second stage- instrumental delivery with vaccum may be required
- Fetal distress in second stage with head at perineum- outlet forceps may be required
- Complete Perineal tear- may require to be stitched in OT
- Cervical tear
- Post partum hemorrhage- medical +/- surgical management
- Vulval hematoma- drainage and resuturring
Experience
Comprehensive
Care for
Women's Health
Dr. Neha Gupta is a compassionate and competent Obstetrician and Gynecologist with a more than 17years of experience in conducting normal deliveries, difficult vaginal/ instrumental deliveries, and complicated cesarean sections in reputed hospitals of Delhi/NCR. She is a well known laparoscopic surgeon in NCR with expertise in medical and surgical treatment of gynecological problems.
