Pregnancy and labor are important phases in the life of a woman. However, these natural phenomena can influence a woman’s attitude to child birth when self-disregard and ignorance to healthcare occur.
The W.H.O defines labor as a spontaneous process. Here, the baby is born in the vertex position through the vagina without complication. Around the globe, there are approximately 19 births/1000 population.
Two important factors affect a normal delivery process. The pelvic shape, and fetal presentation. In the general population, the gynecoid & anthropoid pelvis type persists to support a natural delivery process. The android type supports a natural delivery only when the vertex is in a posterior position.
Child birth process through the pelvis
For illustration purposes, let’s use the gynecoid pelvis type. The pelvis consists of the inlet, mid part & outlet, and each are numbers in stations -5cm to +5cm. The mid part is 0, where the care provider can properly feel the presenting fetal part.
The pelvic inlet is wider in diameter than it is long, while the outlet is longer than wide. This formation favors a more sagittal engagement in a vertex anterior position in the pelvic inlet. Cephalic presentation can either be vertex, sinciput, brow, or face.
Cardinal movements of the fetal head
Cardinal movements are arranged in such a way as to allow smooth passage of fetal head within the pelvis:
- During engagement the fetal head is aligned with width of the pelvis inlet.
- The descent allows for further movement within pelvis cavity up to -1 station.
- Head flexion allows for near further movement up to station 0
- At station 0, internal rotation occurs to allow vertical alignment as head rotates more anteriorly.
- Between station +1 & +2 the head extends
- At the pelvic floor, external rotation of the head releases fetal head out of pelvic outlet.
- Expulsion allows complete pull of baby beginning with anterior hand. Abnormal expulsion can lead to Erb’s palsy.
The cardinal movements are landmarks during normal labor, and caution is needed to avoid a traumatic birth experience for the mother. In the mid trimester period, a mother experiences Braxton hicks’ contraction. This contraction is irregular and indicates a false labor.
Stages of labor
Several biochemical processes are involved during labor. They include estrogen, oxytocin, prostaglandins to aid in uterine contraction and cervix dilation. The first stage of uterine is a long 12 hours process that requires regular uterine contraction.
In the first stage of labor, partograph is required to monitor progress of labor. Evaluate mother’s pulse, measure cervix dilation, check fetal presentation. This stage requires complete emotional support by the care provider.
The second stage of labor is the birth of the child. This is possible when cervix is completely dilated (9-10cm). When there is an arrest of labor in the first stage, this stage may require C-section, hence secondary care is required. Episiotomy can be done incase of difficulty during expulsion of newborn.
The third stage is the delivery of the placenta which can take about between 20 to 60 minutes. Proper care is needed to avoid postpartum hemorrhage. Do the Kustner maneuver to check placenta detachment before manual delivery of placenta.
Yes, labor can either be a good or bad experience for women depending on:
- Lack of financial support can prevent women from seeking antenatal care from doctors.
- Improper communication between care providers and pregnant women. They should be given opportunity to decide position of labor suitable. This could be sitting, standing, or supine.
- Complications requiring C-section.
- Uncomfortable pain form uterine contraction.
- Post-traumatic stress from prolonged hemorrhage, & complications.
- Insufficient supportive care in providing analgesia & emotional strength when necessary.
Enabling a positive child delivery experience for mothers should be a priority. This can help minimize postpartum depression or psychosis, fear of future child birth, & newborn negligence.