Labor
Labor is not a random proccess , only god planned for its sequences sence early pregnancy .
Early in pregnancy:
-The uterine muscles is calm.
-The uterus lost its responsiveness to any external stimuli that may let it to contract .
-The cervix is firm and closed by mucous plug to prevent any ascending infection , ( if the cervix gets short or soft early labor is threatining ).
-The head is kept high in the abdomen till late in pregnancy ( 2 weeks in fist pregnancy , and during labor in next labor ) not to press on cervix and causes labor.
-Three layers made by god pre-systemised to protect the baby till its expected date.
1-Amnion:
It is the herd tough cover that resists tearing and penetration by any micro organisms - tumor cells - white blood cells from maternal side.
It also protect the mother from the fatal effects of fetal cells enterance as skin or lung cells.
It also secretes muscle relaxant its receptors are in the uterine muscles.
2-Chorion:
It protect the baby from being exposed to rejection from maternal immune system.
It is rich in enzymes that inactivate uterine exitors as prostaglandin - oxytocin ----
3- Decidua ( the inner linnig layer of the uterus ):
During pregnancy it produces protectors of uterine muscles against any stimuli .
but during labor after the formation of the bag of forewater the decidua is exposed and fragmented so it starts to produce substances to start labor.
-Pelvic floor:
Levator ani ( main floor muscle ) and its fascia close the lower pelvis , vagina , rectum .
Late in pregnancy :
Gradual changes happen to wake up the uterus and make it sensitive to stimuli ( prostaglandin - oxytocin - mast cells - platelet activation factors.
The uterus wakes up as some uterine contractions start to occur as painless recurrent abdominal tightness much at lower back and lower abdomen with groin discomfort .
The cervix softens in the last couple of weeks not to be torn when dilated.
God has made the cervix with special component to do this job.
It is made of collagen - smooth muscles - connective tissue.
Near labor collagen breaks down by prostaglandin effect and there is an increase in certain acids which retain water and make the cervix softer.
The muscles of the uterus restors its sensitivity to contraction by :
Increase oxytocin receptors.
Increase oxytocin responsiveness.
The top of the uterus is harder and lower uterine segment is soft , this causes the fetal head to drop to pelvic inlet which is noticed by
-Decrease pressure symptoms high in the abdomen as heart burn , indigestion with increase pelvic pressure symptoms as frequency of urination .
This happens 2 weeks before labor in first pregnancy , and during labor in subsequent labor.
preparations of the mother:
1-Prepare your labor bag , it should contain the followings:
Two sets of baby clothes.
Two blankets.
Two towels.
baby diapers.
Baby oil.
Easy dressed clothes for you.
Your diapers .
Towels.
2- Prepare food:
Freeze meat.
Cut and prepare food to be easily cooked.
Precook your kids favorite food to be easily done for them after labor ( not to be ignored )
Prepare herbs needed after labor.
House cleaning:
As we mentioned before there is a cleaning spurt near labor,use it to -Clean blankets - curtains -carpets.
- Keeping your house clean keeps you relaxed.Better to save your coming time for your baby.
Prepare your baby room :
Bed
Garbage basket
Comode on top of it:
Light source.
Alarm clock.
Thormos.
Towels
Diapers
Baby oil
Feeding bottle
Clips
Easily prepared herbs
Cupboard :contains ( Towels - clothers - diapers----
Bathing stuff:
Tub
Baby soap
Baby shampoo and oil
Stress on that you will need their help .
The coming baby may cry too much but he loves them.
Prepare your nipples:
Using lubricants press on it 1 cm near the aerola till it becomes prominent , repeat several times/day .
If it doesnot come out turn it and then push many times if no response use inverted syring to suck it.
Breathing exercise:
Many names are implicated in this exercise but it is important to take deep breath from nose and expire it from mouth , repeat it as much as possible , as to relax your body - get more oxygen to your baby during contractions when oxygen is in its least level.
Exercise:
Best is walking for 30 min.in a comfortable place ( 10 min. fast steps ) it relaxes your body - remove stress - strengthen your musles - decrease mecomium - helps normal labor.
Here is some pictures for exercises helping you to get easy labor:
Labor:
Labor is a physiological unique event but it carries a great risks and complications to both mother and baby.
labor has 3 stages:
First stage:
Starts from onset of labor pain and ends when the cervix is fully dilated.
It takes 6-12 hrs in first labor,
and 2-10 hrs in subsequent labors.
Progress of labor during this stage depends on:
cervical thinning
cervical dilatation
head descent
not on labor pain intensity.
So , only the doctor via vaginal examination can evaluate labor progress.
second stage :
Starts from fully dilated cervix and ends with delivery of the baby.
It takes 1/2 : 3 hrs in first labor
5 : 30 min in subsequent labors.
Labor progress depends on:
desend
flexion
rotation
So, only the doctor can evalute labor progress.
Third stage :
Starts from delivery of the baby and ends with placental delivery.
It takes up to 30 min in all labors.
First stage of labor:
(Pain - bloody show- rupture of membrane ).
How god prepares for labor pains
Labor Pain:function of uterine muscle:
When labor pains start , pain intensity is affected by many factors:
Feto pelvic relationship.
Emotional stress and fear from pain.
Severe physical stress.
Labor pains start as low back and lower abdominal pain then they increase in intensity , frequency , lenghth.
At the end labor pains last for 1 min repeated every 3 min , the uterus touches as bone of forehead.
these pains must be accompanied by cervical effacement and dilatation ( 1.2 cm/hr in first labor and 1.5 cm / hr in subsequent labors ) .
labor progress is assessed by cervical dilatation - effacement -fetal descent and not by labor intensity which may be exagerated as listed before.
Substances prepared by god for labor pain:
Oxytocin:
this hormone is secreted from (linning of uterus - placenta - baby - posterior pituitary of the mother).
-There is increase in the sensitivity of the uterus to oxytocin.
-Increase in oxytocin receptors in chorion - amnion - uterine muscles.
-Increase of oxytocin will increase prostaglandin release from uterine linning layer.
-Increase in oxytocin in maternal blood late in labor will cause :
Milk let down
Uterine contractions to prevent after labor bleeding.
Prostaglandins ( E2 - F2 alpha ):
- Increased in maternal blood - maternal urine - amniotic fluid.
-Increased in fetal lung - urine - umbilical cord near labor , increase with advance of labor .
-When the forewater bulge is formed it dilates the cervix ,
so, the membranes at lower uterus is separated from the linning of the uterus and protrudes in the vagina which normally contains ( micro organisms - bacterial toxins - -cytokines (cell killers ) -prostaglandins ) all of them cause changes in cervix leading to its softness.
-Prostaglandins levels increase with advance of labor , when the cervix dilates more.
Mast cells:
It increases histamine and serotonine in uterine muscles.
All the previous substances cause the muscles of the uterus to contract as follows to expel the baby:
-The musles are arranged in a way to creat a great force of contraction.
-After each contraction there a shortening of the muscles to get the net result of baby delivery.
-No extra or self control.
-Dilatation of the cervix increases uterine contraction and vice versa till delivery.
-The uterus during active labor is divided into:
Upper thick active part to give the power of contraction.
Lower thin soft to give a space for a baby to pass.
So, the upper contracts - shortens - pushes , and lower dilates and thinned to accomodate the baby when the upper shortens , so,the net result is baby delivery.
After each contraction the upper uterus is shorter , thicker , more powerfull till after delivery to compress the large blood vessles from bleeding and help make thrombosis in the vessles to stop bleeding also.
-The baby during his delivery causes vaginal dilatation and stretches
the muscles of the pelvis with thinning of its central parts with dilatation of the anus up to 3 cm with large vessles in it.
Bloody show : cervical changes.
The cervix contains ( collagen - connective tissue - smooth muscle ).
When the cervix starts to dilate , the mucous plug which was closing the cervical canal detaches and become bloody from the ruptured blood vessles few hours to few days before labor.
The cervix first softens to facilitate dilatation.
Cervical dilatation got 3 stages:
1-Preparatory: with little dilatation and is sensitive to sedation.
2-Active : rapid dilatation and not sensitive to sedation.
3-Pelvic :slow dilatation with descent of the baby.
Uterine contractions cause cervical dilatation up to 10 cm to pass the baby head.
And cause thinning of the cervix from 2 cm to be paper thin and fused with lower uterus.
Rupture of the mambranes:
Sudden gush of a variable amount of clean or turbid fluid.
It may rupture only during baby delivery.
It may not rupture at all and the baby is borned covered with it.
If it occurs with passage with large amount of fluid and labor does not start , labor has to be completed any way not to harm the baby , not to let any infection in.
Rupture of membrane causes sterlization of the vagina and eases delivery.
Maternal preparations for stage one of labor:
As we explain labor pain intensity depends on :
Feto pelvic relationship.
Contraction intensity.
Emotional stress, fear of pain.
Severe physical stress.
So,the mother may use the folowing ways to decrease the pain:
1-Reassurance about what is happening is quit normal to avoid extra pain.
2-Stay at home as long as you can ( till you cannot bear ),as home is the best place to feel free, you can dim the light - listen to music - use comfortable chair - take bath.
3-Breathing ( deep breath allows your body to relax and gives your body more oxygen ).
4-Changing position ( walk - sit - lie- squating ) this decreases the pain.
5-Walking will relax the muscles and decrease stress.
6-Bouncing ball relieves the pressure from abdomen and legs.
7-Massage of lower back helps relaxation.
8-Olive oil massage to perineum avoids extra tears.
9-Smell your favorate fragrance.
10-Hot shower or sit in a hot water tub this will relax your muscles and decrease the pain.
11-Hot pack for nape and forehead.
12-Get a lot of fluids to get energy for uterine contraction , late in labor fluids are better taken intravenously.
13-Husband and family support.
14-Measure blood pressure and pulse every 3 hours.
15-Fetal monitoring reassures the mother for fetal well-being.
16-If the mother asks for medication or anaethesia this request should be respected.
Second Stage Of Labor:
- Starts from fully dilated cervix till delivery of the baby.
- It takes 1/2 : 3 hours in first labor.
5 : 30 minutes in next labors.
- Depends on pushing force of the mother - uterine contraction - type of anaethesia.
- Progress of labor depends on fetal descends.
-When the cervix is fully dilated, there's an increase in intra-abdominal pressure coming from contraction of abdominal and respiratory muscles, so the pushing force increases amd the mother feels a desire to bear down.
-The vagina is soft and dilated , the muscles of the perineum are thined out.
-So after the cervix is fully dilated, fetal descend is the only predictor of labor progress, fetal descend rate measures the relation of the fetal head to the maternal pelvis.
Stages :
- Engagment of fetal head at pelvis two weeks before labor in first delievery and only during labor in other delieveries.
-Descend depends on relation of fetal head to pelvis.
-Internal rotation to pass pelvic spines.
-Extention to complete head delievery.
-External rotation to help shoulder delivery.
Preparations for mother and doctor:
-During delivery the mother should lie on her back.
-Olive oil to perineum makes it more elastic with less tears.
-Episiotomy is made to give a space when the head is on perineum to minimize bleeding from vascular vagina , perineum .
Episiotomy is done and repaired under local or general anaethesia.
-After delivery , the blood still flow to the baby from the placenta.So,don't lower the baby below the vagina and don't delay ord clamping , as both cause extra amount of blood to pass to the fetus and this causes jundice.
-Better to put baby skin to skin to his mother , clamp 15 : 20 seconds.
Third stage of labor:
-Starts from delivery of the baby and ends by delivery of the placenta.
It takes from 2 : 30 min in all deliveries.
-After the baby is born , the contractions and shortening of the uterine muscles is at its peak leading to much decrease in uterus so, the placenta got small area then it separates from its weakest point with hematoma formation and spreading and more hematoma formation till the whole placenta and membranes are separeted and deliverd , then the uterine cavity is empty ,its wall thickness is 5 cm.
-After delivery of the placenta the oxytocin is secreted from posterior pituitary gland of the mother to help more uterine contraction to prevent bleeding and causes milk let down.
Now labor is completed , the baby is yours , no more pains but happiness to you and your family.
