Definition

Labour
Labor is defined as the onset of rhythmic contractions and the relaxation of the uterine
smooth muscles, which results in effacement or progressive thinning of the cervix,
and dilation or widening of the cervix. This process culminates with the expulsion of
the fetus and expulsion of the other products of conception (placenta and membranes)
from the uterus.
WHO defines normal birth as: "spontaneous in onset, low-risk at the start of labour
and remaining so throughout labour and delivery. The infant is born spontaneously in
the vertex presentation between 37 and 42 completed weeks of pregnancy. After birth
mother and infant are in good condition"
Series of events that take place in the genital organs in an effort to expel the viable
products of conception out of the womb through the vagina in to the outer world is
called labour. (From DC Dutta)
Labor is a physiologic process during which the products of conception (i.e. the fetus,
membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is
achieved with changes in the biochemical connective tissue and with gradual
effacement and dilatation of the cervix as a result of rhythmic uterine contractions of
sufficient frequency, intensity, and duration.
Labor is a series of rhythmic, progressive contractions of the uterus that gradually
move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to
the outside world.

Normal labour
Normal labour or eutocia is a physiological

process by which fetus, placenta and

membrane are expelled through the birth canal between 38 to 42 weeks. Labour is
called normal if it fulfills the following criteria-

Spontaneous in onset and at term

With vertex presentation

Without undue prolongation

Natural termination with minimal aid.

Without having any complications affecting the health of the mother and /or
the baby.

The process of human childbirth is categorized in three stages of labour: the

shortening and dilation of the cervix, descent and delivery of the infant, and delivery
of the placenta.

Abnormal labour
Any deviation from the definition of normal labour is called abnormal labour.
Dystocia of labor is defined as difficult labor or abnormally slow progress of labor.
Other terms that are often used interchangeably with dystocia are dysfunctional labor,
failure to progress (lack of progressive cervical dilatation or lack of descent), and
cephalopelvic disproportion (CPD). It is the consequence of four distinct
abnormalities that may exist singly or in combination.

Uterine forces that is not sufficiently strong or appropriately

coordinated to efface and dilate the cervix.

Forces generated by voluntary muscles during the second stage of labor that
are inadequate to overcome the normal resistance of the bony birth canal and
maternal soft parts.

Faulty presentation or abnormal development of the fetus of such character

that the fetus cannot be extruded through the birth canal.

Abnormalities of the birth canal that form an obstacle to the descent of the
fetus

Delivery
Delivery is the expulsion or extraction of viable fetus out of the womb. It is not
synonymous with labour. It can be take place without labour as in elective caesarean
section. Delivery may be vaginal, either spontaneous or aided and or may be
abdominal.
Delivery is also known as the second stage of labor, or part of the second stage of
labor. It begins with complete dilatation and ends when the baby is completely out of
the mother.
As the fetal head descends below 0 station, the mother will perceive a sensation of
pressure in the rectal area, similar to the sensation of an imminent bowel movement.
At this time she will feel the urge to bear down, holding her breath to try to expel the
baby. This is called "pushing." The maternal pushing efforts assist in speeding the
delivery
Premature labour Premature labour is defined as labour occurring before the 37th
week of gestation.

True labour
The contraction of true labour produce prograssive dilatation and effacement of the
cervix resulting the birth of the baby.The features of true labour pains are:

Contraction may be irregular at first then painful uterine contractions at

regular intervals.

Contractions that gets longer, stronger, and closer together as time progresses.

Walking usually makes them stronger.

Presentation of show.

Often begin in the back and move to the front

Cervix changes by becoming thinner and starts to open (dilates)

Formation of the bag of water

1. Labour pains - Throughout the pregnancy, painless braxon hicks contractions

with simultaneous hardening of the uterus occur. These contractions change
their charater, become more powerful, intermittent and are associated with
pain. The pains are more often felt in front of the abdomen or rediating
towards the thighs.
2. Show With the onset of labour, there is profuse cervical secretion.
Simultaneously, there is slight oozing of blood from rupture of capillary
vessels of the cervix and from the raw desidual surface caused by seperation
of the membranes due to stretching of the lower uterine segment. Expulsion of
cervical mucous plug, mixed with blood is called show.
3. Dilatation of internal os With the onset of labour pain, the cervical canal
begins to dilate more in the upper part than in lower, the former being
accompained by corresponding stretching of the lower uterine segment.
4. Formation of bag of water- Due to stretching of the lower uterine segment,
the membranes are datached easily because of its loose attachment to the
poorly formed decidua. With the dilatation of the cervical canal, the lower pole
of the fetal membranes becomes unsupported and tends to bulge into the
cervical canal. As it contains liquor which has passed below the presenting
part, it is called bag of water. During uterine contraction with consequent
rise of intra-amniotic pressure, this bag becomes tense and convex.

False (or "Practice") Labor

It is usually appears prior to the onset of true labour pain by one or two weeks in
primigravida and by a few days in multiparae. The feature of false labour are

Dull in nature and usually confined to the lower abdomen and groin.

Do not get longer, stronger, or closer together

Can last several minutes in length

Walking does not make them stronger, may even cause them to stop

Lying down may make them go away

May be felt more in the front area and in the groin area

Beneficial in preparation for true labor

Very little change or no change; does not thin or open cervix.

TRUE LABOR VS FALSE LABOR

Many women often experience "false labor" before "true labor" actually begin. False
contractions may begin as early as three or four weeks before the termination
pregnancy. Contractions, show, the cervix, and fetal movement all are vital in
distinguishing between true and false labor (see Table)
.

1. Contractions
a. True labor: The contractions of true labor produce progressive dilatation
and enfacement of the cervix. These contractions occur regularly and
increase in frequency, duration, and intensity. The discomfort of true labor
contractions usually starts in the back and radiates around to the abdomen
and is not relieved by walking.
b. False labor: False labor contractions are referred to as Braxton Hicks
contractions. They do not produce progressive cervical effacement and
dilatation. They are irregular and do not increase in frequency, duration, and
intensity. Discomfort is located chiefly in the lower abdomen and groin
area. Walking often offers relief.

2. Show
This is another sign of impending labor. After the discharge of the mucous plug that
has filled the cervical canal during pregnancy, the pressure of the descending
presenting part of the fetus causes the minute capillaries in the cervix to rupture. This
blood is mixed with mucus and therefore has a pink tinge.
a. True labor: Show is usually present in true labor. There will be pinkish
mucus or a bloody discharge. This mucus or discharge may also be from the
mucous plug from the cervix.
b. False labor: Show is not present in false labor. However, the mother may
have an old, brownish discharge especially if she had a vaginal exam within
the last 48 hours.

3. Cervix
a. True labor: In true labor, the cervix becomes effaced and dilates
progressively. This change can be identified within an hour or two hour.
b. False labor: In false labor, the cervix is usually un-effaced and closed.
There is no change identified if the cervix is rechecked in an hour or two
hour.
4. Fetal Movement.
a. True labor: There is no significant change in fetal movement even though
the fetal continues to move.
b. False labor: Fetal movement may intensify for a short period or it may remain the
same.

FACTOR

TRUE LABOR

FALSE LABOR

Contractions

-Start in the back and sweep around -Located chiefly in abdomen

to the abdomen.
- Produce progressive dilation and -Do

not

produce

progressive

effacement of the cervix.

dilatation and effacement.

-Occurs regular interval

-Are irregular

-Increase in frequency, duration, and -Do not increase in frequency,

intensity.

duration, and intensity.

-Start and then stop for some time
then start again

-Once started continue until the baby

comes

-Tends

to

decrease

number

of

contraction by sedation
-It remains long.
-Does

not

stop

contraction

by

sedation

-Interval gradually shorted

Show

Is present.

Becomes

Not present.

effaced

and

dilates Usually uneffaced and closed.

progressively.
- The membranes dont becomes
Cervix

-The membranes feel tense during a tense

contraction

Fetal

No significant change, even though May intensify for a short period or it

Movement

fetus continues to move.

may remain the same.