Birth Process Cheatsheet

Cheatsheet Content

Stages of Labor Labor is typically divided into three main stages: First Stage: Cervical Effacement and Dilation Second Stage: Pushing and Birth of the Baby Third Stage: Delivery of the Placenta First Stage of Labor This is the longest stage, characterized by uterine contractions causing cervical changes. Phases of the First Stage: Latent Phase: Cervix dilates from 0 to 6 cm. Contractions are mild, irregular, and become more frequent and stronger. Duration: Varies greatly, can be hours to days (primigravida often longer). Maternal feelings: Excitement, anxiety, able to cope. Active Phase: Cervix dilates from 6 to 10 cm. Contractions become stronger, longer (45-60 seconds), and more frequent (every 2-5 minutes). Rate of dilation: Approximately 1.2 cm/hr for primigravida, 1.5 cm/hr for multipara. Maternal feelings: More serious, focused, increasing discomfort, need for pain management. Transition Phase: Very intense, short phase, usually from 8-10 cm dilation. Contractions are strong, long (60-90 seconds), and very frequent (every 1-2 minutes). Maternal feelings: Irritability, nausea, vomiting, shaking, desire to push (often before fully dilated). Key Measurements in First Stage: Effacement: Thinning of the cervix, measured in percentage (0% to 100%). Dilation: Opening of the cervix, measured in centimeters (0 cm to 10 cm). Station: Relationship of the fetal presenting part to the ischial spines, measured in cm (-3 to +3). $-3$: Presenting part 3 cm above ischial spines. $0$: Presenting part at ischial spines (engaged). $+3$: Presenting part 3 cm below ischial spines. Second Stage of Labor Begins when the cervix is fully dilated (10 cm) and ends with the birth of the baby. Duration: Varies (primigravida often 1-3 hours, multipara shorter). Contractions: Strong, expulsive, often with an urge to push. Fetal Descent: Baby moves through the birth canal. Cardinal Movements of Labor: Engagement: Fetal head enters pelvic inlet. Descent: Movement of head through birth canal. Flexion: Chin to chest, presenting smallest diameter. Internal Rotation: Head rotates to align with pelvic outlet. Extension: Head extends as it passes under symphysis pubis. Restitution: Head rotates back to align with shoulders. External Rotation: Shoulders rotate, baby's head turns further. Expulsion: Delivery of shoulders and body. Maternal Effort: Active pushing with contractions. Third Stage of Labor Begins immediately after the birth of the baby and ends with the delivery of the placenta. Duration: Typically 5-30 minutes. Signs of Placental Separation: Gush of blood. Lengthening of the umbilical cord. Fundus (top of uterus) rises and becomes firm. Uterus changes shape to globular. Placental Expulsion: Schultze Mechanism: Fetal side (shiny, grey) presents first ($80\%$). Duncan Mechanism: Maternal side (red, raw) presents first ($20\%$). Management: Active management often includes oxytocin administration to promote uterine contractions and prevent postpartum hemorrhage. Postpartum Period (Fourth Stage) First 1-4 hours after placental delivery, critical for monitoring maternal recovery. Uterine Involution: Uterus contracts to prevent excessive bleeding. Monitoring: Vital signs, fundal height and tone, lochia (vaginal discharge), bladder function. Bonding: Initial skin-to-skin contact and breastfeeding encouraged. Pain Management Options Non-Pharmacological: Breathing techniques (e.g., Lamaze, Bradley). Relaxation, massage, hydrotherapy. Movement, position changes. Acupressure, heat/cold packs. Pharmacological: Systemic Analgesia: Opioids (e.g., Fentanyl, Morphine) - can cause sedation, respiratory depression. Nitrous Oxide: Self-administered, quick onset/offset, minimal fetal effects. Regional Analgesia: Epidural: Most common, continuous infusion into epidural space, good pain relief, can cause hypotension, motor weakness. Spinal: Single injection into subarachnoid space, rapid onset, used for C-sections or rapid pain relief. Combined Spinal-Epidural (CSE): "Walking epidural," rapid onset of spinal with continuous epidural. Pudendal Block: Local anesthetic injected near pudendal nerve for perineal pain relief during pushing/delivery.