EVERYTHING YOU NEED TO KNOW ABOUT NATURAL LABOR
The labor process comes in different forms for different women. Women are known to assist each other during this natural process. Child birth is a natural process that occurs on its own without any gravies complications in most women. Pillars of safe motherhood include delivery in s a safe and clean environment. There are many methods that can be applied to prevent maternal mortality and mobility.
As a midwife your role is to offer support, care and supervision of the mother during the pregnancy period, perperium and labor. You must be prepared to help in the delivery by yourself and act in case of any complications that may arise. It is your duty to not only act promptly but also recognize when it is time to refer the mother when presented with an abnormal situation. Some of these abnormalities may include obstructed labor, mal-presentation, neonatal and obstetric emergencies.
However it is vital to take note that a mother who is well prepared psychologically throughout her prenatal care will go through the labor process with ease. In addition to you must understand that if a mother has confidence with her care giver during labor and delivery will have lower levels of discomfort during labor.
Therefore you must put into account that professionalism, attitude and calmness of the caregiver is the greatest tranquiliser to a mother in labor pains than any medicine.
What is the definition of labor?
The term labor is used by all in both in the non medical and medical fields. Labor is described as a process where uterine contractions are coordinated that progressively lead to cervical dilation and effacement, whereby the placenta, membranes and foetus are expelled after 28 weeks of gestation through the birth canal. Labor can be classified as abnormal or normal.
There are distinctive characteristics that define natural labor that you must always remember.
1.) Duration-labor to delivery should be completed within 18 hours
2.) Labor is spontaneous
3.) Labor occurs at term
4.) The foetus is vertex presented
5.) There are no complications of both mother and baby
6.) The newborn baby requires very minimal resuscitation
Terms used during after labor
Precipitate Labor-These is a labor process that is very rapid. It occurs in less than 3 hours finalizing with the foetus delivery.
Premature Labor-These is a labor process that starts before 37 weeks of pregnancy is completed from the Last monthly period (LMNP)
Parturient-term used to refer to all that relate to the childbirth process
Antepartum- This the period prior to labor or birth of a child
Postpartum-It is the duration after childbirth
Peripartum-The period that includes before, during and after child birth
The Commencement of Labor
Labor happens in stages and there are mechanisms that are involved in the process. Before labor starts there are changes that occur in the reproductive system of a woman. This happens days and weeks prior to the true signs of labor can be identified. A woman can diagnose the start of labor by herself. There are a number of symptoms and signs that are evidence of labor
1.) Uterine contractions that increase in strength pain and are regular
2.) The cervix is taken up to the lower segment which causes dilation of the cervix
3.) Presence of show-this is a mucoid blood stain discharge
4.) There can be membrane rapture with causes the drainage of amniotic fluid
Some first time or young mothers mainly Primigravidae may fail to recognize true labor. It vital for the midwife to offer assistance on differentiating between true and false labor signs.
True labor-contractions are intense and regular too
False labor-Contractions are sporadic also known as Braxton-Hicks contractions. They mainly occur during the last weeks of the gestation period.
The factors that trigger the start of labor are not known. However there are many theories offered which try and indicate that mechanical and hormonal factors play a great role in this process.
Progesterone is believed to drop towards the end of the gestation period while oestrogen rises (Hormone responsible for sensitizing muscles in the uterus).Oestrogen rise triggers oxytocin production that is responsible for uterine contractions. Foetal hypothalamus produces releasing factors that stimulate anterior pituitary glands that produce adrenocorticotrophic hormone (ACTH).ATCH is known to stimulate foetal adrenal glands that secretes cortisol which is responsible for placental hormones rise.
Uterine activities can come from mechanical simulations of both the uterus and cervix. It can be due to the excessive stretching which is the case in Polyhydromnios and multiple pregnancies. It can also be caused by pressure on the cervix. Therefore both hormonal and mechanical factors influence the onset of labor.
Premonitory /Pre-labor Labor Signs
It is the duration of two to three weeks before start of labor when several changes occur.
During these weeks the lower part of the uterus expands allow the foetus head sink deep. This descent of the head gives space to the mother’s lungs, heart and stomach which gives your organs room to function with ease. There is widening of symphysis pubis while the pelvic floor softens, more relaxed giving room for further descent of the uterus into the pelvis.
The continued descent of the foetal head increases the pressure on the pelvis. It limit the bladders capacity which can be a cause of irritation. Due to the laxity of the pelvic floor muscles there is poor sphincter control which causes stress incontinence. You can experience headaches congestion of circulation of your lower limbs due to the pressure.
Talking up of the cervix
It is taken up progressively and merges into the uterine lower segment. When labor is to be induced they check for the shortening of the cervix.
Uterine contractions are coordinated by 2 pacemakers in cornua region. They are situated in the area where the fallopian tubes connect the uterine body. These muscle contractions commence at the top part of the uterus and then spread to the fundus and later downwards. When the pregnancy is normal the uterus normally contract intermittently though the contractions are not too strong to triumph over the resistance of a normal cervix and does not result to dilation. Contractions not only become stronger but powerful towards the end of the term. A multipara may characterise these false pains some days before labor begins. A patient may come to hospital thinking that it is time but this is what is referred to as false labor.
At the end of any pregnancy the uterus is anatomically divided into two parts thee upper and lower uterine sections.
Upper uterine segment
This section is thick and muscular where the contractions start. There are longitudinal fibres that retract, pulling the lower section which causes it to stretch and pushes the head down.
Lower Uterine Segment
This segment is
thin which develops from isthmus of the uterus which is eight to ten cm and is
prepared for dilation. This lower segment stretches when it is pulled by the
longitudinal fibres. The force that is applied by the foetus descending head or
breech also helps in stretching.
Retraction ring is an imaginary ridge that forms between the lower and upper uterine segment. This ridge is present in all pregnancies during labor and is in perfect normal position as long a it is not noticeable above symphysis pubis
During a contraction of the uterus feels firm to touch. At the start of the process, contractions are easy and involuntary, and are guided by the nervous system under the pressure of endocrine system.
The contraction start off at the top part of fundus, distributed across, and by the time they get to the lower fundus, they last for longer period and are very intense. The pinnacle of the contraction is arrived simultaneously over the entire uterus and fades from all parts collectively. This pattern gives the cervix room to dilate and the contracting fundus to expel the foetus.
Polarity depicts the neuromuscular synchronization between the two segments of the uterus throughout the labor process. The upper section contracts sturdily and retracts to push out the foetus. The lower segment contracts vaguely and dilates to allow ejection of the foetus to take place.
Contraction and Retraction
Labor starts, roughly 280 days from the foremost day of the (LMP) last Normal menstrual period, the contractions vary in character. They develop into regular and extra painful. Labor contractions vary from those of pregnancy since they are followed by retraction. This is a characteristic of uterine muscle in labor. The contracted muscle doesn’t return to its novel length once the contraction passes off. Each successive contraction leads to further decrease of the muscle fibres so that the uterine opening becomes smaller and smaller. This is what makes the cervix dilate.
When discussion about contractions, the midwife is concerned with 3 factors,
1.) The strength
2.) The duration
3.) The frequency of the contraction.
The power of a contraction is well-known in 3 categories
2.)Fair or fairly strong,
The strength of the contraction is measured by the time taken. Therefore a contraction, which takes 10- 30 seconds is referred to be weak, while one that takes 30-40 seconds is said to be fair.
The duration refers to the time taken by a contraction, for example a weak contraction lasts for 10 to 30 seconds. Frequency, on the other hand refers to the number of intervals between one contraction and the next. If a mother has one contraction after every 45 minutes, the frequency is written as 1:45.
The Shortening and Dilation of the Cervix
prior to labor the cervix of a primagravida is a thick hard cone, that protrudes into the vagina. The canal is at least one inch in length. When labor begins the powerfully contracting upper section of the uterus starts draw in and gets shorter, while the thinner lower segment of the uterus gets pulled away from the presenting part. This stretches the lower segment. The latter, in turn, pulls the internal Os. The dragging away of the internal Os from the presenting part starts dilating the upper part of the cervical canal. This goes on until the canal is shorter and shorter and finally there is no canal at all. The canal becomes part of the uterine cavity, with only the un dilated external Os and the thinly stretched cervix separating this cavity from the vagina. When this happens, it is said that the cervix has been 'effaced' or 'taken up' (see the Figure below). After this, further progress in labor leads to dilation of the cervix.
In a primigravida, the cervix more often than not becomes almost fully effaced before any dilation takes place, while in multiparous women the two processes take place together. The cervix of a multipara might be already effaced and be dilated enough to admit a finger up to the internal Os even before labor starts. These signs of labor are assessed by doing a vaginal examination.
all the way through pregnancy, the cervical passage is sealed by a plug of mucus referred to as an operculum. Together with the intact membranes this puts off organisms rising into the uterine cavity. When labor begins, the internal Os is pulled away from the foetal membranes and the canal is opened up. This let loose the mucous plug, which oozes out of the vagina mixed with a little blood. This is called the 'show'.
It is vital to communicate the evaluation results to the mother and assure her at each stage as it has enormous sway on the advancement of her labor.