LABOR PROCESS &

INFLUENCING
FACTORS
Stage of Labor
◦ First stage : Laten phase and Active phase
◦ Second Stage : Delivery
◦ Third stage : Placental delivery
First Stage
Laten Phase
◦ The cervix is thinning and begins to open. You will feel mild contractions that last
for 30-90 seconds. The longer, the contractions will be more regular, for example
every 5 minutes.
◦ Over time, the cervix will begin to open little by little. Usually there will be mucus
mixed with blood coming out of the vagina.
◦ The latent phase for most women ends at between 3 and 5 cm of dilatation
First Stage
Active Phase
◦ Active phase can be devided into 3 phases, Acceleration phase, maximum slope
phase, and deceleration phase.
◦ Cervical dilatation more than 5 cm, in the presence of uterine contractions, can
be taken to reliably represent the threshold for active labor.
◦ The cervix will continue to open until it reaches a maximum width of 4-9 cm
First Stage
Second Stage
◦ This stage begins when cervical dilatation is complete(10 cm) and ends with fetal
delivery.
◦ In a woman of higher parity with a previously dilated vagina and perineum, two
or three expulsive efforts after full cervical dilatation may suffice to complete
delivery.
◦ Conversely, in a woman with a contracted pelvis or a large fetus or with impaired
expulsive efforts from conduction analgesia or sedation, the second stage may
become abnormally long
Cardinal movement of labor
1. Engagement :
The largest diameter compilation from the presentation of
the fetal part (usually the head) has been moved to the
pelvic cavity. Involvement has occurred compilation of
the lowest part of the fetus has activated the zero or lower
station. In nullipara, engagement often occurs before the
onset of labor. However, in multiparas and nulliparas,
engagement does not occur until after labor has begun
Cardinal movement of labor
2. Descent ;
Descent occurs when the lowest part of the fetus has passed through the pelvis. Descent occurs due
to three forces namely pressure from the amniotic fluid, direct pressure of the contraction of the
fundus on the fetus and contraction of the diaphragm and the muscles of the mother's abdomen
during labor, with the axis of the birth canal:
◦ Sinklitismus ; when the sagittal suture is parallel to the axis of the birth canal
◦ Asinklistismus anterior ; The fetal head approaches the promontorium so that the os parietalis is
lower
◦ Asinklistismus posterior ; The fetal head approaches the symphysis and is held back by the
symphysis pubis
Cardinal movement of labor
2. Descent
Cardinal movement of labor
3. Flexion ;
As soon as the lower part of the fetus that has descended is
blocked by the cervix, pelvic wall, or pelvic floor, under normal
circumstances flexion occurs and the chin is brought closer to
the fetal chest.
4. Internal Rotation;
starting in fields as high as the spina ischiadika. Each time a
contraction occurs, the fetal head is directed under the pubic
arch and the head rotates when it reaches the pelvic muscles
Cardinal movement of labor
5. Extention;
When the fetal head reaches the perineum, the head will be
deflected anteriorly by the perineum. The occiput first passes
through the lower surface of the symphysis pubis, then the
head comes out following the axis of the birth canal due to
extension.
6. External rotation;
The outer axis of rotation occurs when the head is born with
anterior occiput, the shoulder must rotate internally so that it
is aligned with the anteroposterior diameter of the pelvis.
External rotation of the head accompanies the internal
rotation of the baby's shoulder.
Cardinal movement of labor
7. Expulsion ;
After the shoulders are out, the head and shoulders
are raised above the mother's pubic bone and the
baby's body is removed with a lateral flexion
movement toward the symphysis pubis.
Third Stage
After a normal delivery, the mother's uterus will contract again and expel the
placenta and other tissues through the vagina. This is also known as the third stage
of labor. After the placenta is released, delivery is complete.
Factors affecting labor
◦ Power;
Labor for birth consisting of his or uterine contractions and straining
power from the mother. His strength and pressure pushes the fetus downward
causing passive stretching, resulting in a rotation of the inner axis and decrease of
the head, pressing the cervix where there is a frankenhauser plexus causing a
striking effect. Both forces cause the head crowning and thinning of the birth canal
so that the head is born. The strength factor in labor is divided into two, Primary
strength (involuntary contraction), and Secondary strength (voluntary contraction)
Factors affecting labor
◦ Passage;
The birth canal (passage) is classified into two types, namely the soft birth canal
and the hard birth canal.
The soft birth canal consists of the cervix, vagina and uterine muscles. Hard birth
canal is the pelvic bone
◦ Passenger;
Fetus, Placenta, Amniotic fluid
Fetal presentation, the size of the fetal head, the location of the placenta in the
uterus, and the condition of the amniotic fluid affect how labor goes