The joy of motherhood is something that cannot be covered by a woman who just put to bed, seeing her child in her hands. You see, there is this unseen energy that you get when you see that innocent soul sleeping peacefully. You start to recollect every moment of the pregnancy, from the first trimester, Antenatal/ Antepartum hospital visits, maternity gymnastics, down to shopping and preparing the cradle a few weeks before the child came, and everything just looks beautiful. While the process of conception, and the stages of pregnancy is a fantastic journey to explain, I will be taken you on the journey of Labor.
When we say a woman is in labor, it means she is about to put to birth, another Homo sapien, having a combined gene of both parents. Labor can occur after 37 weeks of pregnancy, but remember that a full term labor is expected to happen between 37 weeks and 40 weeks gestation. One of the major sign to tell that a woman is in labor begins with the Bloody show (where the woman bleeds indicating she is at the end of pregnancy), or Water breaking (when the membrane breaks, known as Prelabor rupture of membranes (PROM)). These two signs indicates the beginning of a contraction (either true or false contraction).
The Process of a Successful Delivery is simple
Uterine Contractions => Cervical Changes => Delivery of Fetus => Delivery of Placenta.
During Uterine contraction, the Uterine muscles tightens and shortens. During a true labor, the contraction has higher frequency (the contraction happens more often), and amplitude (duration which always last longer). Women experience Uterine contractions during regular menstruation as well, but with labor, the difference is in the frequency and amplitude.
With Cervical Changes, the Cervix (lower part of the Uterus) starts to change, showing that the woman is in labor. These changes are Effacement (shortening, and thinning of cervix), and Dilation (Opening of the Cervix to 10 Centimeter when fully dilated). There are three stages to Labor, which are referred to as Stage 1, 2 and 3. The goal of the first stage is complete Effacement and Complete Dilation.
The Stage one has 3 phases (well, some midwives like to stick to 2 phases), which are the Latent (initial) phase, the Active phase, and the Transition phase.
At the Latent phase, the cervix is being stretched by the fetus, sending signals to the hypothalamus and the posterior pituitary gland. The magnocellular neurosecretory cells of the paraventricular nucleus (PVN) and supraoptic nucleus (SON) of the hypothalamus then releases Oxytocin, which travels to the Uterus, thereby stimulating Uterine contraction and easing stress during labor. Also, during this phase, as the fetus stretches, utero-placental tissues produce Prostaglandins to the fetal fluid sac, as well as in the uterine circulation, thereby helping in uterine contraction. The contractions during this phase are regular, between a span of 5 and 30 minute, with a lifespan of 30 seconds. During the Effacement (thinning of the cervix) will go from 0 - 30% and the dilation would increase to 3 cm in diameter.
In the Active phase, the cervix continues to dilate, and the contraction increases, as the pain becomes a little intense. The contractions are regular, occurring withing a span of 3 to 5 minutes, with a duration of about 1 minute. Effacement at this time is within 30% to 80%, with a dilation going from 4 cm to 7 cm in diameter. (at this point, pregnant women are advised to keep their bladder empty).
In the Transition phase, Pelvic and Rectum pressure are felt, where there are urges to push. In some cases, the women feel like going to ease their bowel. Pushing is prevented until the Cervix is completely dilated, and because the pushing is prevented, women usually, feel lots of pain, sweating, nausea, hiccuping and vomiting (in some cases). At this point, the contractions are strong withing the period of 30 seconds to 2 minutes and the contraction itself would last up to 1 minutes and 30 seconds, causing the contractions to overlap. Effacement always go from 80% to 100% and at this time, the cervix dilation increases to 10 cm in diameter. At this stage, crowning occurs (the baby's head can be seen) in most cases where the head comes first, but in some cases, the legs could come first (breech position) which could be very painful and stressful, and in most cases delivered through cesarean section. Once dilation is at 10 cm, the labor progresses to stage 2.
In Stage 2, the mother is delivered from the baby. The mother is helped through this process, to prevent her from getting tired. In cases where a lot of stretching is going on during the delivery, a small incision is done in the perineum (between the anus and the vaginal opening) called Episiotomy (Not done all the time). Once baby is out, stage three is inevitable.
Stage 3 has to do with delivering the placenta. It is important that the placenta is delivered completely, as not delivering it completely will prevent the uterus from contracting back to its original size. Not delivering the placenta with care could lead to hemorrhage. Still part of stage 3, Clamping both sides of the umbilical cord, and cutting the cord in the middle. An Apgar score test is done between 1 and 5 minutes of delivering the baby. Back to delivering the placenta. The Placenta has to separate from the Uterus to be able to come out. During the process of the delivering, the umbilical cord lengthens, as the Placenta is being delivered, the Fundus (upper part of the Uterus) starts to contract, and blood gush is accompanied, since the placenta is detaching from the Uterus. Then the placenta is delivered.
Delivering the baby and the placenta aren't all that has to be done in terms of delivery. Vital tests such as blood pressure and blood pulse are done in the mother. Also, Lochia (discharges in the form of blood, uterine tissues, and mucus after childbirth) care is important, and Lochia should reduce when being checked, every 15 minutes.
I hope this post is helpful to you. In cases where you are stranded with a pregnant woman in labor, reading this post should give you a very good idea of what you expect to face.
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