Stages of Childbirth

Stages of Childbirth

• Prodromal phase
• Dilation phase
• Expulsion phase
• Placental phase
• Post-placental phase

Prodromal Phase

• This phase prepares the body for birth, it is considered the "zeroth" phase but isn't technically a part of labor, though it's significant.
• Hormones and pre-labor contractions are at play.
• The cervix softens.
• The mucus plug is expelled, potentially with some blood due to the cervix's blood vessel content.
• The cervix thins (effaces) and begins to dilate.
• The fetus descends into the lesser pelvis, typically around the 36th week for first-time mothers.

Pre-Labor Contractions

• These contractions are irregular.
• They mainly occur in the final days of pregnancy.
• Can cause a feeling of unease or mild back pain.
• May last a few hours and then stop, acting as 'false starts'.
• These contractions intensify towards the end of pregnancy and evolve into labor contractions.

Prodromal Phase vs. Labor Contractions

• Labor contractions (true contractions) dilate the cervix.
• True contractions are regular, with a defined duration and intensity.
• 3 phases include: an increase, a peak, and a gradual decrease (exercise leg).

Dilation Phase

• This is the first stage of labor.

Dilation Phase Length

• For first-time mothers: 8-18 hours.
• For Mothers who have given birth before: 5-12 hours.
• Prolonged labor: >24 hours.
• Precipitous delivery: characterized by immediate pushing without dilation.

Factors influencing the dilation phase include:

• Pelvic structure.
• Fetal size and position.
• Intensity and frequency of contractions.
• Cervical resilience.

Strategies to Prevent Difficult Childbirth

• Support the Psyche of the mother
• Ensure an open passageway.
• Consider the passenger (fetus).
• The position of the mother
• The force of the contractions and pushing.

Beginning and Ending of Dilation

• Begins with consistent contractions and cervical dilation
• Ends when the cervix is fully dilated (approximately 10 cm)

Sub-phases of Dilation

• Latent phase: Cervical dilation of 2-3 cm, contractions may or may not be noticeable
• Transition phase: Cervical dilation of 4-5 cm, stronger contractions lasting about 1 minute.
• Acceleration phase: Cervical dilation until 9 cm, contractions become more frequent, longer, and more intense.
• Deceleration phase: Full cervical dilation, the last centimeters progress more slowly.

Guidelines

• Labor duration varies and is influenced by the pregnancy history of the woman.
• Labor does not always progress linearly.
• Admission recommended for regular contractions, cervical effacement >50%, and dilation of 3-4 cm.
• Women with painful contractions but not in active labor should receive support and may return home until active labor begins.
• Early admission to the maternity ward or during the latent phase is associated with more interventions like oxytocin, epidural anesthesia, and newborn intubation.

Expulsion Phase (Pushing Stage)

• This happens in the second phase of labor.

Duration of Expulsion Phase

• For first-time mothers: 15-45 minutes, maximum of 3 hours. If no progress after 2 hours, consider intervention.
• For Mothers who have given birth before: 5-15 minutes, maximum of 2 hours. If no progress after 1 hour, consider intervention.

Beginning and End of Expulsion

• Happens after complete cervical dilation.
• Ends once the baby is entirely born.

Details of the Expulsion Phase

• It is best if the second phase occurs while the mother is upright with spontaneous pushing.
• There are two sub-phases
  • Passive/latent phase: Complete dilation without active pushing. Contractions may seem weaker or unnoticeable, this phase represents rest.
  • Active phase: Visible signs of the baby, pushing with signs of complete dilation, active pushing from the mother with or without the sensation of pushing.
• Keep in mind, these phases are separate from uterine pathology, which is from a lack of a contraction stimulator.

Guidelines:

• Upright or lateral positions are associated with a shorter second stage of labor, fewer assisted deliveries, lower episiotomy rates, less acute pain, and fewer abnormal fetal heart rate patterns.
• These positions are also associated with more second-degree tears and postpartum hemorrhages of more than 500 ml.
• Birthing on hands and knees reduces lower back pain, increases comfort, reduces perineal pain, and gives a perception of shorter labor, though the actual duration isn't different.
• An upright position leads to shorter labor for people who have received epidural anesthesia.

Placental Phase

• This is the third phase of labor.

Duration of Placental Phase

• Begins 5-15 minutes after the baby is born.
• Active approach: up to 30 minutes. Active management to deliver the placenta.
• Physiological approach: up to 60 minutes, waiting for natural expulsion.

Beginning and End of Placental Phase

• Begins immediately after the birth of the child.
• Ends with the delivery of the placenta and membranes.

Placental phase Process:

• Separation of the placenta.
• Expulsion into the lower uterine segment.
• Complete expulsion.

Post-Placental Phase

• This is the fourth stage of labor.
• Lasts 1-2 hours following the delivery.

Interventions during Post-Placental Phase:

• Skin-to-skin contact
• Suturing
• Initiating feeding if possible
• Resting
• Paperwork
• Observation of health and vitals
• Watchfulness for pathologies like postpartum hemorrhaging.