Procedure: First Maneuver: Fundal Grip Purpose: To determine fetal part lying in the fundus. To determine presentation.

Procedure: Using both hands, feel for the fetal part lying in the fundus. Findings: Head is more firm, hard and round that moves independently of the body. Breech is less well defined that moves only in conjunction with the body. Second Maneuver: Umbilical Grip Purpose: To identify location of fetal back. To determine position. Procedure: One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Findings: Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

Third Maneuver: Pawliks Grip Purpose: To determine engagement of presenting part. Procedure: Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side Findings: The presenting part is not engaged if it is not movable. It is not yet engaged if it is still movable. Fourth Maneuver: Pelvic Grip Purpose: To determine the degree of flexion of fetal head. To determine attitude or habitus. Procedure: Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands Findings: Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees. Poor atitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)

Recognizing the signs of labor can help you know when it's time to call your health provider and head to the hospital. Learning about the stages of labor can help you know what to expect during labor and delivery. Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). How long labor lasts and how it progresses is different for every woman. But each stage features some milestones that are true for every woman.

Stage 1: Early labor and active labor

The first stage of labor takes place in two phases: early labor and active labor. During early labor:

Your cervix will start to dilate. You may feel strong and regular contractions that last 30-60 seconds and come every 5 to 20 minutes. You may notice a bloody show. You may be in early labor for a few hours or days, especially for first-time moms. You may want to spend this phase at home or wherever you are most comfortable.

During active labor:

Your contractions will become stronger, longer and more painful. There may be very little time to relax in between contractions. You may feel pressure in your lower back. Your provider may tell you to get ready and head to the hospital. Your cervix will dilate fully to 10 centimeters so the baby can be born.

What you can do:

Rest and relax. Take a shower or bath (so long as your water hasn't broken). Watch TV or listen to music. Change positions. Take a walk around the house or room. With your provider's okay, drink or eat healthy snacks during the early part of labor. Place ice packs on your lower back. Place a cold washcloth on your forehead. Have your partner rub your lower back. Suck on ice chips.

Go to the bathroom often to empty your bladder. Stage 2: Baby is born

During the second stage of labor, your cervix is fully dilated and ready for childbirth. Your health provider will want you to begin pushing to allow your baby to be born. During stage 2 of labor:

It can last as short as 20 minutes or as long as several hours (especially for first-time moms). You may feel pressure on your rectum from your baby's head moving down the birth canal. You may feel the urge to push. Your provider may give you an episiotomy, a small cut to enlarge the vaginal opening. (Most women don't need an episiotomy.) Your baby's head begins to crown (show). Your provider will guide the baby out of the birth canal. Your provider may use special tools to help you in delivery. Your baby is born and the umbilical cord, which connected mother and baby, is cut.

What you can do:

Find a position that is most comfortable for you to push. Push when you feel the urge or when your health provider tells you. If you're uncomfortable or pushing has stopped, try a new position. Rest in between contractions.

Stage 3: Delivery of placenta

During the third stage of labor, the placenta, which gave your baby food and oxygen through the umbilical cord, is delivered. While you are bonding with your new baby during the first minutes of her life, your provider will get you ready for this final stage. During stage 3 of labor:

Contractions will begin 5 to 10 minutes after birth. You may have chills or shakiness. It may take 5 to 30 minutes to deliver the placenta.

What you can do:

Relax. Push when your health provider tells you. If you'd like, ask to see the placenta. Begin breastfeeding to provide your baby with important nutrients to help her stay health and grow.

Once you're done, give yourself a big pat on the back for all your hard work. You've made it through childbirth! Now, enjoy these first special moments with your new baby as you and your partner welcome him to the world.

Coping with labor pain

Some women prefer to deal with the pain of childbirth naturally, using breathing and relaxation techniques learned inchildbirth education classes. Other women decide to use pain medication to help manage labor pain. You may want to have a natural childbirth. But during labor, you may decide to use some pain medication, such asepidural or a spinal, to cope with the pain. It's okay to change your mind. Don't feel like you gave up or

let your baby down. Only you know how strong the pain feels. It's okay to talk with your provider and do what you think is best.