Labor

• In the first stage ,the contraction last for 30 se. initially but gradually increase in duration, with progress of labor. Thus in the second stage, the contraction last longer than in first stage.
   
• In early stage of labor contraction come at intervals of ten to fifteen minutes. The interval gradually shorten with advancement of labor until in the second stage, when it comes every two/three minutes. It is important to note that all the features uterine contraction mentioned are very effective only when they are in combination.
   
• Retraction is phenomenon of the uterus in labor in which the muscle fiber are permanently shorten. The uterine muscles having been endowed with this property become shortened once & for all.
   
• First stage of labor concerned with the preparation of the birth canal so as to facilitate expulsion of the fetus in the stage. The main events that occur in the first stage are
  a) Dilatation & taking up of the cervix
  b) Formation of lower uterine segment.
  Maternal System: General  condition, remains unaffected, although, a feeling of transient fatigue appears following a strong contraction. Pulse rate is increases by 10-15 beats/min during contraction which settled down to its pervious rate in between contraction and also blood pressure is increased.
  Fetal Effect : So long as the membranes are intact ,there is hardly any adverse effect on the fetus. However during contraction there is slowing of fetal heart rate is about 100-120/min which is soon returns to its normal rate about 140/min as the intensity of contraction diminished provided the fetus is not compromised.
   
• The second stage begins with the complete dilatation of the cervix and ends with the empulsion of the fetus. The stage is concerned with the descent & delivery of the fetus thro the birth canal. The intensity of pain increases. Pain are come at interval of 2-3 minutes.
  Uterine contraction and retraction become stronger. The uterus become enlarged during contraction. Delivery of the fetus is accomplished by downward thurst offered by uterine contraction supplementary by voluntary contraction of abdominal muscles against the resistance offered by bony & soft tissues of the birth canal.
  Second stage begins with full dilatation.
  It is the additional voluntary expulsive efforts that appear in the 2nd stage occasionally bearing down efforts may appear even in 1st stage associated with abnormal uterine action  is ominous sign.
   
• At the beginning of labor the placental attachment roughly corresponds to an area of 20 cm in diameter.
   
• The series of movement that occur on the head in the process of adaptation during its journey thro pelvis is main process of labor. In  normal labor the head enters the brim commonly through the available transverse diameter to a lesser extent thro of the oblique diameter.
   
• The movement  are engagement, descent, flexion, some degree of flexion head is noticeable at the beginning of labor, internal rotation, crowing, extension, restitution, external rotation, expulsion of trunk.
   
• The 3 rd stage of labor comprises the phase  of placental separation its descent to the lower segment & finally its expulsion the membranes.
   
• The 3 rd stage concerns with separation, descent and expulsion of placenta with its membranes. For short time, the patient experiences no pain. However intermittent discomfort in the lower abdomen reappears, corresponding with the uterine contractions.
   
• There may be slight tricking of blood length of the umbilical cord as visible from outside, remains static.

Pain relief during labor :

The feel relax during labor ,rubbed back during labor helps with the pain. Suggest patient that try and walk around or at least stay in an upright position for as long as possible. Squatting, hands and knees or standing during delivery increases the pelvis size by over 30% giving you a faster, easier and safer delivery. Best natural way in labor is Eating and drinking fluids during labor. Help your baby move into the optimal position for birth in your third trimester by making sure that your knees are lower than your hips when driving, sitting or relaxing.
 

Place of Delivery:

Although in about 85% of cases the delivery remains uncomplicated & uneventful but in the remaining unforeseen complication may arise which require urgent & skilled management. Effective antenatal care reduces the hazards of delivery significantly but to get an optimum outcome equally adequate supervised intranatal care is mandatory. Thus, ideally all women should be delivered in hospital. Inconvience to the patients & relatives for staying a few days way from home psychycological upset & cross infection to the mothers & specially to the neonates are some of the drawbacks of hospital delivery.

the organization of flying squad setup adds significantly to the improvement of obstetric services specially in the developed countries to cover up the women having home delivery. The squad consists of a team of experienced obstetricians, anesthetist and nursing staff,  equipped with sterile packs of equipments & containers with store blood. Ambulance car with squad is rushed to the spot on call.

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