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| Normal Delivery |
Series of events that
take place in different organs in an effort
to expel a live baby out of uterus through the
vagina into the outer world is called labour.
It may occur prior to 36 weeks of pregnancy
and is called preterm labour.
The labour is divided into 3 stages - first,
second & third. |
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| First
Stage : |
| It starts from the
beginning of true labour pains and ends with full
dilatation (opening) of cervix. The average duration
is approximately 12 hours in first pregnancy &
6 hours in 2nd or more pregnancies. Initially
pains are not strong and come at intervals of
15 to 30 minutes & last for 30 seconds. Gradually
the interval shortens & intensity & duration
increases. In late first stage the pains come
at every 3-5 minutes & last for 45 seconds.
Pains are usually felt shortly after uterine contraction
begins and pass off before complete relaxation
of uterus. Maternal & foetal condition remains
unaffected except during contraction. |
Management:
Non interference with watchful expectancy so as
to prepare the woman for a smooth delivery in
2nd stage. |
- The
progress of labour, maternal condition &
foetal behaviour is monitored so that any
deviation from the normal is detected at the
earliest possible moment.
- Woman is admitted in hospital, allowed to
be in a comfortable position, walk, sit or
lie down, enema is given, asked to empty her
bladder frequently, adequate fluid intake
is adviced but should avoid solid food.
- Relief of pain- Various pain killers can be
given to help the woman tolerate the pain.
Epidural injection can be given if required
or opted by the patient.
- Regular monitoring of blood pressure, foetal
heart rate & progress of labour is done
by the doctor.
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| Second
Stage : |
| Starts from full dilatation
(opening) of cervix and ends with expulsion of
the foetus. Its average duration is 2 hours in
the first delivery & 30 minutes in 2nd or
more deliveries. This stage concerns with coming
down of foetus and delivery of the foetus through
the birth canal. The intensity of pain increases.
It comes at interval of 2-3 minutes & lasts
for 1 - 1 1/2 minutes. It becomes successive &
unbearable in terminal stage. The patient feels
like pushing the baby down & out called "bearing
down". The head comes out first followed
by shoulders & rest of the body. Patient shows
signs of exhaustion. |
| Management: |
- Is to assist expulsion
of foetus.
- To prevent injury to
perineum
- Patient is better lying
down under constant supervision of the doctor.
- Nothing has to be taken
by mouth except water or ice.
- Patient is shifted
to the labour table & given the position
for delivery.
- With help of the doctor
the head of foetus slowly passes out of the
vagina then the shoulder & rest of the body
slips out.
- The slow process prevents
injuries to the perineum of the patient.
- The umblical cord is
clamped (tied) & cut.
- If the paediatrician
is present, baby is handed over to him.
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| Third
Stage : |
| It begins after the expulsion of foetus &
ends with expulsion of placenta & membranes.
Its average duration is 15 minutes. The pain stops
for a short time. However, intermittent discomfort
in the lower abdomen re-appears, corresponding
with the uterine contractions. Placenta is expelled
by "bearing down" efforts or manual
manipulation. Slight bleeding may be present.
The patient may have chills and shivering.
Management:
This is a very crucial stage of labour. This can
be done by.
- Watchful expectancy or
- Active management.
The placental
descent into vagina is allowed to occur spontaneously.
If this does not happen spontaneously it can be
manually removed by the doctor |
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| Normal
Puerperium : |
Puerperium is the period following child birth
during which the body & the organs involved
in pregnancy & child birth, revert back to
approximately the pre-pregnant state both anatomically
& physiologically.
It starts with the expelling
of placenta and lasts 6 weeks. It can be divided
into
- Immediate within 24
hours.
- Early - up to seven
days.
- Remote - up to 6 weeks.
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| Lochia
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It is the vaginal discharge
for the first fortnight during puerparuim. It
comes from uterus, cervix & vagina. It has
a fishy smell. Depending up the colour its divided
into-
- Lochia rubra-red and lasts
for 1-4 days.
- Lochia serosa yellowish or
pink and lasts for 4-10 days.
- Lochia alba-pale white and
lasts for 10-15 days.
- It may be seen up to 3 weeks.
Clinical
Importance:
It's smell, colour, amount & duration give
an idea of infection, retained bits, subinvolution
or other lesions. |
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| Menstruation: |
| If the woman is not breast feeding it starts by
6 weeks. If breast feeding it may be delayed.
But usually comes before stoppage of breast feeding. |
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