Labor and Delivery Stages

• Obstetrics is the field of medicine focused on pregnancy, childbirth, and the postpartum period
• Labor refers to the process of childbirth, starting with uterine contractions and ending with the delivery of the baby and placenta
• Delivery refers to the actual birth of the baby

Stages of Labor

• First stage: begins with the onset of regular uterine contractions and ends with full cervical dilation (10 cm)
• Second stage: begins with full cervical dilation and ends with the delivery of the baby
• Third stage: begins immediately after the delivery of the baby and ends with the delivery of the placenta
• Fourth stage: the first few hours after delivery, during which the mother's body begins to stabilize

Monitoring During Labor

• Fetal heart rate monitoring helps to assess the baby's well-being during labor, can be done intermittently or continuously via electronic fetal monitoring (EFM)
• Maternal vital signs (temperature, blood pressure, pulse, respiration) should be monitored regularly
• Contraction monitoring assesses the frequency, duration, and intensity of uterine contractions
• Vaginal examinations are performed to assess cervical dilation and effacement, as well as fetal position

Pain Management During Labor

• Non-pharmacological methods include breathing techniques, massage, hydrotherapy, and position changes
• Pharmacological methods include epidural anesthesia, spinal anesthesia, and systemic opioids

Mechanisms of Labor

• Engagement: fetal head enters the pelvic inlet
• Descent: downward passage of the fetal head through the pelvis
• Flexion: fetal head flexes to present the smallest diameter to the pelvis
• Internal rotation: fetal head rotates to align with the longest diameter of the pelvis
• Extension: fetal head extends as it passes under the pubic arch
• External rotation (restitution): fetal head rotates externally to align with the shoulders
• Expulsion: delivery of the fetal body

Types of Delivery

• Vaginal delivery: delivery of the baby through the birth canal
• Cesarean section (C-section): surgical delivery of the baby through an incision in the abdomen and uterus, can be planned or performed in an emergency
• Assisted vaginal delivery: use of forceps or vacuum extractor to assist in the delivery of the baby

Indications for Cesarean Section

• Fetal distress
• Failure to progress in labor
• Malpresentation (e.g., breech)
• Placenta previa or abruption
• Multiple gestation
• Previous C-section

Postpartum Care

• Monitoring maternal vital signs, uterine involution, lochia (postpartum vaginal discharge), and perineal healing
• Pain management
• Breastfeeding support and education
• Emotional support and screening for postpartum depression
• Contraception counseling

Common Obstetric Complications

• Gestational diabetes: diabetes that develops during pregnancy
• Preeclampsia: pregnancy-specific condition characterized by high blood pressure and proteinuria
• Eclampsia: occurrence of seizures in a woman with preeclampsia
• Preterm labor: labor that occurs before 37 weeks of gestation
• Postpartum hemorrhage: excessive bleeding after delivery
• Placental abruption: premature separation of the placenta from the uterine wall
• Placenta previa: placenta that covers the cervix
• Ectopic pregnancy: implantation of the fertilized egg outside of the uterus

Fetal Presentations

• Vertex presentation: head-first presentation, with the occiput as the presenting part
• Breech presentation: buttocks or feet present first
• Transverse lie: fetus lies horizontally in the uterus

Induction of Labor

• Stimulation of uterine contractions to initiate labor before it starts on its own
• Indications include post-term pregnancy, preeclampsia, and maternal medical conditions
• Methods include administration of prostaglandins, oxytocin, and mechanical methods (e.g., Foley catheter)