Ansali, Merlyn T.

BSN II-D

THEORIES OF LABOR ONSET

Labor normally begins when a fetus is sufficiently mature to cope with extrauterine life yet not too large
to cause mechanical difficulty with birth. Although in animals it has been shown that progesterone
withdrawal is the trigger that simulates labor, the association that converts the random,painless Braxton
Hicks contractions of pregnancy into strong, coordinated, productive labor contractions in women is still
largely undocumented (Crombleholme, 2009). In some instances, labor begins before a fetus is mature
(preterm birth).

In others, labor is delayed until the fetus and the placenta have both passed beyond the optimal point
for birth (post-term birth).Several theories including a combination of factors originating from both the
woman and fetus have been proposed to explain why progesterone withdrawal begins:

• Uterine muscle stretching, which results in release of prostaglandins

• Pressure on the cervix, which stimulates the release of oxytocin from the posterior pituitary

• Oxytocin stimulation, which works together with prostaglandins to initiate contractions

• Change in the ratio of estrogen to progesterone (increasing estrogen in relation to progesterone, which
is interpreted as progesterone withdrawal)

• Placental age, which triggers contractions at a set point

• Rising fetal cortisol levels, which reduces progesterone formation and increases prostaglandin
formation

• Fetal membrane production of prostaglandin, which stimulates contractions

COMPONENTS OF LABOR

A successful labor depends on four integrated concepts:

1. A woman’s pelvis (the passage) is of adequate size and contour.

2. The passenger (the fetus) is of appropriate size and in an advantageous position and presentation.

3. The powers of labor (uterine factors) are adequate. (The powers of labor are strongly influenced by
the woman’s position during labor.)

4. A woman’s psychological outlook is preserved, so that afterward labor can be viewed as a positive
experience.
  Passage

The passage refers to the route a fetus must travel from the uterus through the cervix and vagina to the
external perineum. Because the cervix and vagina are contained inside thepelvis, a fetus must also pass
through the bony pelvic ring.

 Passenger

The passenger is the fetus. The body part of the fetus that has the widest diameter is the head, so this is
the part least likely to be able to pass through the pelvic ring. Whether a fetal skull can pass depends on
both its structure (bones, fontanelles, and suture lines) and its alignment with the pelvis.

 Powers of Labor

The second important requirements for a successful labor are effective powers of labor. This is the force
supplied by the fundus of the uterus, implemented by uterine contractions, a natural process that causes
cervical dilatation and then expulsion of the fetus from the uterus. After full dilatation of the cervix, the
primary power is supplemented by use of the abdominal muscles. It is important for womento
understand they should not bear down with their abdominal muscles until the cervix is fully dilated.
Doing so impedes the primary force and could cause fetal and cervical damage.

 Psyche

The fourth “P,” or a woman’s psychological outlook, refers to the psychological state or feelings that a
woman brings into labor. For many women, this is a feeling of apprehension or fright. For almost
everyone, it includes a sense of excitement or awe.Women who manage best in labor typically are those
who have a strong sense of self-esteem and a meaningful support person with them. These factors allow
women to feel in control of sensations and circumstances that they have not experienced previously and
that may not be at all what they pictured as happening. Women without adequate support can have an
experience so frightening and stressful they can develop a post traumatic stress syndrome (Tam &
Chung, 2007).Encouraging women to ask questions at prenatal visits and to attend preparation for
childbirth classes helps prepare them for labor. Encouraging them to share their experience after labor
serves as “debriefing time” and helps them integrate the experience into their total life.