As labour progresses, a pregnant woman goes through the three stages of labour, which are quite simply and aptly named the first, second, and third stages.
Labour, the process which results in the delivery of the baby and the
expulsion of the placenta, can occur at any time during pregnancy. Typically,
it is identified when a pregnant woman displays signs of labour which can include
the rupture of membranes (i.e. water breaking), the discharge of blood-tinged
mucous from the vagina (i.e. bloody show), and regular uterine contractions of
A woman experiencing any of the aforementioned signs should immediately
go to the hospital to ensure that she has the appropriate care if she is indeed
going into labour.
As labour progresses, a pregnant woman goes through the three stages of
labour, which are quite simply and aptly named the first, second, and third
stages, respectively. These stages, which are quite different and have their
own complications, are more fully described below.
First Stage of Labour
The first stage of labour is presumed to begin with the presentation of
labour signs such as painful, regular, low-intensity uterine contractions and
bloody show, and ends with the full dilation of the cervix (10 cm).
The first stage is further subdivided into the latent and active phases.
The latent phasepresents with mildly painful and irregular uterine
contractions that occur every 5 to 10 minutes with no significant distress to
the mother. During this phase, which lasts 4 to 7 hours, the cervix dilates
slowly: at a rate of 0.5 to 1 cm per hour for a total dilation of 3 to 4 cm.
Additionally, the woman’s water may break toward the end of this phase.
The active phase, which lasts 3 to 6 hours, is indicated by strong
and painful contractions that occur very frequently as well as rapid cervical
dilation. A vaginal examination is performed at the end of this phase to assess
and ensure that full cervical dilation, which occurs toward the end of this
phase, has been attained. At this point in the process of labour, the woman may
feel an urge to push. However, this is not advised as it may lead to
lacerations inside the cervix.
For women who are having their first child (nullipara), the first stage
lasts 8 to 12 hours, while for women who have given birth before (multipara),
the stage is shorter and last 5 to 9 hours.
Management of the First Stage of Labour
Typically, a woman is admitted to the hospital during the first stage of
labour, after which the doctor will likely receive her complete medical records
includingthe past medical history and any complications in previous and/or
current pregnancies. Then, a history is taken, symptoms are noted (i.e. rupture
of membranes and bloody show), and blood tests are run. The woman’s vitals
(blood pressure, temperature, and heart rate) are monitored every two hours.
Additionally, an abdominal examination is performed to assess the
position of the baby and a cardiotocogram (CTG) is conducted every 15 minutes
during the active phase to monitor the foetal heart rate (typically, 120 to 160
beats/minute). The frequency, regularity, and intensity of uterine
contractions are also closely monitored with a sterile vaginal exam, which is performed
every 4 hours to assess cervical dilation and foetal descent. During this time,
the healthcare providers inform the woman about the progress of labour and
discuss potential pain relief options.
Second Stage of Labour
The second stage of
labour is the most painful stage of labour, which begins with full cervical
dilation and ends with the delivery of the newborn baby. This stage is further
subdivided into the early second stage and the late second stage.
The early second
stage begins when the cervix is fully dilated and uterine contractions
become more frequent and very painful. At this point, contractions are regular,
occurring every 2 to 5 minutes with a duration of around 1 to 1.5 minutes.
help the foetus change position and descend deep into the pelvis of the mother.
Typically, on reaching the pelvis, the foetus’ head rotatesto make room for
himself or herself.
In the late
second stage, which ends with the delivery of the baby, begins with
crowning, the process by which part of the baby’s head slowly and visibly
emerges from the birth canal. The woman is then compelled to push in order to
completely release the head. During this period, mothers typically complain of
rectal pain and/or having the desire to pass stool due to the pressure exerted
by the foetal head.
After around 15
minutes of pushing, the anus opens, creating more space, and, with each
contraction and push, more and more of the head begins to appear. At this
point, the woman may push even when contractions are absent. Once the head is
born, the shoulders, trunk, and legs quickly follow.
For women who are having their first child (nullipara), the second stage
lasts 1 to 1.5 hours without the epidural and up to 3 hours with the epidural.
For women who have given birth before (multipara), the second stage is shorter,
lasting 25 minutes without the epidural and from 45 minutes to an hour with the
Management of the Second Stage of Labour
During this stage, the full cooperation of the mother is required (i.e.
pushing when instructed). As this stage brings tremendous pain, the pain relief
options that were discussed during the first stage should be administered.
Furthermore, a partner or attendant should be with the mother during this
period to provide both the emotional support and the encouragement needed to
bear the pain, push, and relax, as needed.
Additionally, a few other techniques may be applied to bring about an
easier and faster second stage. These include, propping up the bed at a 45
degree angle, making it easier to breath as well as push, and switching
positions (i.e. squatting, kneeling, or sitting up) as needed.
Third Stage of Labour
As the bulk of the hard work is done during the second stage, the third
and last stage of labour, which extends from the birth of the baby to the
expulsion of the placenta, is typically much smoother and much less painful.
The expulsion of the placenta occurs with the combined help of uterine
contractions, which are decreasing in intensity, and the retraction of the
uterus, which aids expulsion by reducing the size of placental tissues to a
fourth of their size during pregnancy.
Typically, this stage is indicated by the following signs:
gush of blood
or spherical appearance of the abdomen
of the umbilical cord
Management of the Third Stage of Labour
The healthcare providers typically wait 20 minutes for the
aforementioned signs to appear as premature
detachment of the placenta by pulling on the umbilical cord may lead to severe
blood loss and, in extreme cases, rupture of the uterus. When the placenta is
seen separated in the vagina, the uterus is massaged to create a contraction
that aids in smoothly and painlessly expelling the placenta.
Additionally, in some cases, when the expulsion of the placenta is
prolonged (i.e. takes more than 30 minutes), medical management, which has the
benefits of reducing blood loss and shortening the third stage of labour, may
be required. A form of medical management that is commonly seen is the
injection of oxytocin to increase uterine contractions. However, oxytocin may
also cause nausea and vomiting, side effects which are often seen with oxytocin
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