STAGES OF LABOR IN AYURVEDA - Dr. Archana Asok.pdf

Stages of labor

2. PRELABOR
STAGE

3. Begin 2-3 weeks before onset of true labor especially in primi and few days before in multi.
PRELABOR
Cervical changes
Appearance of false
pain
Lightening

4. PRELABOR ( PREMONITORY STAGE)
1) LIGHTENING:
Few weeks prior to onset of
labor especially in primi, the
presenting part sinks into
the true pelvis
Signifies incorporation of
the lower uterine segment
into the wall of uterus
Diminishes the fundal height and
hence minimize the pressure on
diaphragm ( a sense of relief from
mechanical cardiorespiratory
embarrassment )
Frequency of micturition
increase / constipation may
occur due to the pressure by
the engaged presenting part
It is a WELCOME SIGN as it
rules out CPD/ other
conditions preventing head
from entering the pelvic
inlet.

7. 2) CERVICAL CHANGES
ØCervix becomes ripe
ØA ripe cervix is Soft
80% effaced ( < 1.5cm in lenght)
Admits one finger
Cervical canal is dilatable

8. 3) FALSE PAIN/ FALSE LABOR/ SPURIOUS LABOR
More found in primi
Appears 1-2 weeks prior to onset of
true labor pain in primi and few
days in multi
Due to stretching of the cx and lower
uterine segment with consequent
irritation of the neigboring ganglia.

9. Expulsion of cervical mucus plug mixed with blood is SHOW

10. DILATATION OF INTERNAL OS
With the onset of labour pain cervical canal begins to dilate more in the upper
part than in the lower
The former being accompanied by corresponding stretching of the lower uterine
segment.

12. FORMATION OF BAG OF WATER
ALMOST A CERTAIN SIGN OF ONSET OF LABOR
Due to the stretching force in the lower uterine segment the membranes are detached easily because of its loose attachment to the
poorly formed decidua. With dilatation of the cervical canal, the lower pole of the fetal membrane becomes unsupported and bulge into
the cervical canal. As it contains liquor which has passed below the presenting part it is called “ BAG OF WATER”

14. DIFFERENCE BETWEEN TRUE AND FALSE PAIN
TRUE PAIN FALSE PAIN
PAINFUL CONTRACTIONS AT REGULAR INTERVALS DULL IN NATURE
GRADUAL INCREASE IN FREQUENCY OF CONTRACTIONS CONFINED TO LOWER ABDOMEN AND GROIN
INTENSITY AND DURATION OF CONTRACTION INCREASES PROGRESSIVELYNOT ASSO WITH HARDENING OF UTERUS
ASSOCIATED WITH SHOW NOT RELIEVED BY ENEMA / SEDATIVES
PROGRESSIVE EFFACEMENT & DILATATION OF CX
DESCENT OF PRESENTING PART
FORMATION OF BAG OF FOREWATERS
NOT RELIEVED BY ENEMA OR SEDATIVES

15. STAGES OF
LABOR

16. FIRST STAGE
Starts with the onset
of true labor pain
and ends
with full dilatation of
cx
Called as
CERVICAL
STAGE
12 hours in
primi
6 hours in
multi

17. SECOND STAGE
•STARTS FULL DILATATION OF CX
•ENDS WITH EXPLUSION OF FETUS FROM BIRTH CANAL
1 ST STAGE
•THE PROPULSION PHASE- FULL DILATATION TO DESCEND OF PRESENTING PART
2ND STAGE
•THE EXPULSIVE PHASE- DISTINGUISHED BY MATERNAL BEARING DOWN AND ENDS
WITH DELIVERY OF THE BABY
•2 HOURS IN PRIMI
•30 MINUTES IN MULTI

18. THIRD STAGE
BEGINS AFTER EXPULSION OF FETUS AND ENDS
WITH EXPULSION OF PLACENTA AND MEMBRANE
15 MINUTES IN MULTI AND PRIMI

19. FOURTH STAGE
STAGE OF
OBSERVATION-
ATLEAST 1 HR
UTERINE RETRACTION
MATERNAL VITALS
VAG BLEEDING
BABY IS
EXAMINED

20. EVENTS IN
EACH STAGE

21. Main event in first stage is :

1) Dilatation & effacement of cx
2) Full formation of lower uterine segment

22. Factors responsible for dilatation of Cx
Uterine contraction & retraction
Fetal axis pressure
Bag of membrane
Vis-a-tergo

23. 1) DILATATION OF CX
FACTORS RESPONSIBLE FOR DILATATION OF CX
§ Uterine contraction and retraction
The longitudinal muscle fibers of upper segment are attached with the circular muscle fibers of
the lower segment and upper part of cx in a bucket-holding fashion.

24. •There is some co-ordination between fundal contraction and cx dilatation called POLARITY OF
UTERUS
•When the upper segment contracts, retracts and pushes the fetus, lower segment and cx dilate
in response to the forces of contractions of upper segment.

25. RETRACTION
It is the phenomenon of uterus in labor in which muscle fibers are permanently shortened.
Its effects are:
Formation of lower
uterine segment,
dilatation & effacement
of Cx
Maintain advancement
of fetus & ultimately
help in expulsion
Reduce surface area
of uterus
Facilitates
separation of
placenta
Hemostasis after
seperation of
placenta

26. § Fetal axis pressure

27. §Bag of membrane

28. §Vis-a-tergo
The final phase of dilatation and retraction of the cervix is achieved by downward
thrust of the presenting part of the fetus and upward pull of the cervix over the
lower segment.
vis-a tergo - A force operating from behind; a propulsive force.

29. EFFACEMENT OR TAKING UP OF Cx
EFFACEMENT
§ Is the process by which the muscular fibers of the Cx are pulled upwards and
merges with the fibers of the lower uterine segment.
§ In primi effacement preceds dilatation.
§ In multi effacement & dilatation occurs simultaneously.

31. 2) FULL FORMATION OF LOWER UTERINE SEGMENT
The lower segment corresponds to the isthmus in the non-pregnant uterus. The formation
of the lower segment starts at approximately 26 weeks and is not completed until after 32
weeks. The lower segment contains more fibrous tissue and less muscle fibre than the
upper segment.

33. Clinical significance of LUS
Implantation of placenta in LUS is known as
PLACENTA PREVIA
CS is performed through this segment
In obstructed labor, LUS is very much stretched and
thinned out and can cause even rupture in multi
Due to poor retractile property, there is chance of PPH if
placenta is implanted over the area

34. EVENTS IN SECOND STAGE OF LABOR
This stage is concerned with the descend and delivery of the fetus through birth canal
PROPULSIVE
From full dilation
until head touches
the pelvic floor
PHASE
1
EXPULSIVE
Since the time mother
has irresistible desire
to “ BEAR DOWN”
and push until baby
is delivered.
PHASE
2

35. Diagram showing the expulsive forces. Increased intra-
abdominal pressure augments the downward expulsive
force of uterine contraction

36. STEPS IN 2ND STAGE
Full dilatation of Cx
Rupture of membrane
Escape of good amount of liquor
volume of uterine cavity thereby reduced
Simultaneous uterine contraction & retraction become stronger
Delivery of the fetus against the resistance offered by the pelvic floor by power of retraction
BEARING DOWN EFFORTS
•It occurs due to voluntary expulsive effort by the patient because of nerve reflexes initiated by
stretching of vaginal wall (FERGUSON REFLEX)

37. Ferguson reflex / Fetal ejection reflex
The Ferguson reflex is a neuroendocrine reflex in which the fetal distension of the cervix
stimulates a series of neuroendocrine responses, leading to oxytocin production.

38. EVENTS IN 3RD STAGE OF LABOR
PHASE 1:
Seperation of placenta
PHASE 2:
Expulsion of placenta

39. SEPERATION OF PLACENTA
There is two ways of seperation
1) Central separation/ Schultze
•Starts at the centre
2) Marginal separation/ Mathews- Duncan
•Starts at the margin & more frequently seen

40. Seperation of membrane
Contraction of uterus Weight of placenta

41. MECHANISM
OF NORMAL
LABOR

42. The series of movements that occurs on the head in the process of adaptation
during its journey through pelvis is called MECHANISM OF LABOR.
As the OCCIPITOLATERAL position is the most common,the mechanism of labor
in such position is described.

43. Principal movements are:
•ENGAGEMENT
•DESCENT
•FLEXION
9
MOVEMENTS
•INTERNAL ROTATION
•CROWNING
•EXTENSION
•RESTITUTION
•EXTERNAL ROTATION
•EXPULSION OF THE TRUNK

44. ENGAGEMENT
This is when the widest part of
baby's head has entered the pelvis.

45. DESCENT
This is when baby's head moves down
(descends) further through your pelvis.

46. FLEXION
When descent is complete and the fetal head meets
the cervix, the fetal head flexes to allow the chin to
make contact with the fetal chest

47. INTERNAL
ROTATION
Turning of the head in such a
manner that the occiput
gradually moves anteriorly
towards the symphysis pubis

48. CROWNING
Is when you can see the top of baby's
head through the opening of the vagina

49. EXTENSION
As the fetus moves through the
vaginal opening for birth, the head
extends pushing the occiput out
first followed by the face and chin.

50. RESTITUTION &
EXTERNAL ROTATION
Once the head is outside of the vaginal opening,
the fetus rotates to realign the head with the
shoulders and back allowing for the shoulders
to move out of the vaginal opening.

51. EXPULSION OF
TRUNK
After the head and shoulders have exited
the vaginal opening, the fetal head and
shoulders move upward allowing for the
rest of the baby to be born.