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until they finally cause the cervix to dilate (to open) to a diameter of 10 cm (4 inches).
As the uterine contractions become stronger, longer, and closer together, abdominal
muscles contract, causing the woman to feel like bearing down or pushing.
Contractions of two sets of muscles (uterine and abdominal) expel the fetus and the
placenta. The woman often feels uterine contractions as high or low back pain.
b. Progress of Contractions. As labor progresses, you can feel the
contractions by placing your hand on the mother's abdomen, just above the umbilicus
(the navel). An early sign of labor is the discharge of a blood-containing mucus called
the bloody show. This mucus has accumulated in the cervical canal during pregnancy.
Another early sign is the rupture of the amniotic sac, allowing clear fluid to trickle or
gush from the woman's vagina.
c. True Labor. The mother is in true labor if:
(1) Uterine contractions are occurring at regular intervals.
(2) Contractions of the uterus are painful and hard.
(3) Pain is felt in both the front and back of the abdomen.
(4) Dilation and effacement of the cervix is accomplished.
(5) The fetal head is starting to descend.
(6) The fetal head is fixed between contractions.
(7) Bulging or rupture of the membranes of the cervix occurs. (This sign
may or may not occur in true labor.)
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2-4. THREE STAGES OF LABOR
The period of labor can be divided into three stages. The first stage is dilation,
the second stage is expulsion, and the third stage is placental stage.
a. First Stage: Dilation. During this stage, the cervix dilates at a rate of one to
two centimeters per hour until dilation is complete at 10 centimeters (four inches).
Effacement (shortening of the cervix) takes place in this stage. The uterus contracts
regularly, and the amniotic sac ruptures. If the sac does not rupture by itself, it is
ruptured artificially.
b. Second Stage: Expulsion.
(1) This stage is the period of time from complete dilation of the cervix
through the delivery of the baby. During this stage, contractions take place every two to
three minutes. The contractions last about 60 seconds and are more intense than in the
first stage. The mother bears down involuntarily. She may bear down when she has
the urge. There is increased pressure on the mother's rectum which causes her to feel
as though she has to have a bowel movement.
NOTE: Bearing down during the first stage of labor is of no help and will tire the
mother. Also, bearing down at that stage may cause fetal distress.
(2) If you find a woman in the second stage of labor, observe her condition
and ask her these questions:
(a) Is this her first baby?
(b) How long has she been in labor?
(c) What are her contractions like? (Frequency? Duration?
Intensity?)
(d) Is the bearing down involuntary?
(e) Does she feel as if she has to have a bowel movement?
(f) Can you observe the baby's head crowning?
CAUTION: If you observe the baby's head crowning, DO NOT touch the vagina.
Touching the vagina could cause infection.
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(3) If the woman's answers and your observations indicate that she is in the
second stage of labor, prepare to assist in delivery. There is not enough time to get her
to a hospital.
(4) The second stage of labor ends with the delivery of the baby.
c. Third Stage: Placental Stage. This stage of labor covers the time period
after delivery of the baby when the placenta (the afterbirth) is expelled. In this stage,
the uterus contracts, causing the placenta to be expelled. This process can take from 1
to 30 minutes. DO NOT pull the placenta out. It will deliver by itself. If you have
assisted in a delivery outside a hospital, transport the placenta to the hospital with the
mother and child. There the placenta should be examined along with the mother and
child. The contractions of the uterus (in expelling the placenta) help constrict blood
vessels torn in delivery, thus reducing the possibility of the mother hemorrhaging.
Section II. COMPLICATIONS OF PREGNANCY
2-5. ABORTION
The termination of a pregnancy before the fetus is capable of living, thriving, and
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