Question

1. During the first stage of labor, what position should we encourage our patient to be in? Why?

2. There are some premonitory signs to labor. What are these?

3. If a mom's membranes rupture spontaneously or an amniotomy is performed, what is your priority?

4. What is the difference between true and false labor? 5. There are 4 stages of labor. What is going on in the first stage?

6. There are 4 stages of labor. What is the second stage entail?

7. There are 4 stages of labor. What is going on in the third stage of labor?

8. What will you teach pregnant mom to do if her water breaks at home?

9. What is cervical effacement? Dilation?

Answer 1

Laboring and birthing process in a woman is the time when she not only experiences physical challenges but also emotional trials. At this time it is necessary that the nurse or the care giver be respectful, supportive, and encouraging towards her. This enables to have a fruitful and successful childbirth experience.

1. Labor refers to a series processes during which fetus is expelled from the mother’s uterus. During the first stage of labor there is progressive dilation of the cervix. It ends with the cervix dilating up to 10 cm in diameter. At this time, the cervix is large enough to allow the passage of an average size fetal head. This phase is generally divided into three phases, namely latent or early phase, active phase, and transition phase.

During this stage those positions are encouraged which are greatly comfortable for the mother. The position must also control and benefit in smooth child birth. Changing positions frequently (for every 30 minutes) is helpful in relieving pain. These positions include

• Sitting upright
• Sitting and leaning forward with support
• Sitting on toilet or commode
• Semi-sitting (bed should be set at a 45 degree angle and the back and head should be supported by pillows)
• Walking
• Standing and leaning over on something
• On all fours or getting on hands and knees
• Kneeling forward
• Using birthing balls (doing lunges on birthing balls).
• Lying down towards a side

Position changes have a profound effect on uterine activity and efficiency. This helps in speeding labor and a favorable fetal rotation. Supine position must be avoided as it can interfere with labor progress and result in compression of vena cava and decrease blood return to heart. Apart from this, swaying from side to side, rocking, or any form of rhythmic movement is also comforting and helpful.

2. The exact reason for the initiation of labor is difficult to determine. A combination of factors are responsible for labor which include uterine stretch, increased sensitivity to oxytocin, or increased release of prostaglandins.

A series of changes occur during the onset of labor. Certain signals or premonitory signs can be observed two to three weeks or a few hours prior to the onset of labor. Some of these signs include:

• Lightening is a sensation of the fetus settling or descending into the pelvis. As a result, there is decreased abdominal distension and feels more relieved than earlier.
• A feeling of discomfort especially pain in lower abdomen, lower back, and pelvis.
• Increased urinary frequency.
• Mild incontinence.
• Fetal head descent can also reduce pressure in the pulmonary area and hence, the mother may experience a relief from breathlessness.
• Walking becomes difficult.
• Increase in vaginal discharge.
• Irregular and painless contractions are felt.

3. Amniotomy refers to the deliberate rupture of amniotic sac in order to release amniotic fluid.

If the rupture occurs pre-term, there is an increased chance of infection and higher chance of preterm delivery. In such a condition, the patient must be closely monitored and prescribed with medications so as to avoid infections, ensure proper growth of the baby, and to avoid pre-term labor.

If the membranes rupture or amniotomy is performed, most women go into labor within 12 hours. At this time, the nature of amniotic fluid (whether it is clear or bloody, etc.) must be checked. Monitor baby movements and fetal heart rate frequently. During this time, the patient must be advised use a pad and drink plenty of fluid while waiting for labor.