PREGNANCY AND

LABOR
 Introduction
Definition :
Labor is known as the process by which the products of
conception are expelled from the uterine cavity after the
24th week of gestation or pregnancy.
Labor typically occurs between the 37th and 42nd week
of gestation and can be classified into three stages.
Labor usually starts two weeks before or after the
estimated date of delivery.
 The first stage :

 of labour begins with the onset of regular rhythmic contractions and culminates when the
cervix is fully dilated to ~ 10 cm.

 During early labour, contractions are fairly weak, occurring 15 - 20 minutes apart and lasting
~ 30 seconds in duration.

 Contractions begin in the fundus of the uterus and travel downwards and outwards towards
the cervix.

 This phenomenon is known as fundal dominance, whereby the contractions are strongest in
the upper uterine segment and weakest in the lower uterine segment.
 Overview
Another phenomenon, known as polarity, also occurs during contractions,
whereby the upper uterine segment contracts while the lower uterine segment
dilates to accommodate the baby.

 Following each contraction, the uterine muscle fibres undergo retraction.

 Instead of relaxing completely the muscle fibres remain shortened allowing for
gradual progression of the baby downward through the uterus.

 At the same time contractions are occurring the cervix will begin to dilate and
will undergo effacement (or thinning of the uterus).

As the cervix dilates, the mucus plug formed during pregnancy is lost and
women might notice a bloody mucoid discharge.
The first stage of labour can further be divided into 3 phases: the
latent phase, the active phase and the transitional phase.
Latent Phase: This phase lasts for approximately 6-8 hours,
achieving a cervical dilation of ~3-4 cm.
Active Phase: In this phase, cervical dilation occurs more rapidly,
reaching a total dilation of ~7 cm. In primigravida mothers (or first-
time mothers), dilation occurs at a rate of 1cm/hour and in
multigravida mothers (or second-time mothers), dilation occurs at a
rate of 1.5 cm/hour.
Transitional Phase: Cervical dilation slows down in this phase and
the cervix reaches full dilation (10 cm).
Second Stage
The second stage of labour begins when the cervix is fully dilated and ends when
the baby is born.
 Stage two can be divided into two phases: the latent phase and the active phase.
The average duration of stage two is 50 minutes for primigravida mothers and 20
minutes for multigravida mothers.
 During the latent phase, the mother will feel no urge to push.

In this phase, the baby's head will continue to descend down through the uterus
via the force of the uterine contractions until it is visible at the vaginal orifice.
 Contractions are longer and stronger in stage two, however, they are less
frequent to allow the mother time to recover between each contraction.

 As the baby is descending through the uterus it will change its position
Once the baby's head is visible at the vaginal orifice, the active phase of stage
two begins. In this phase, there is an increased pressure exerted on the rectum
and pelvic floor from the fetal head.

 This results in the initiation of the Ferguson Reflex, which provides the
mother with the urge to push.

 Women with epidurals might not feel this urge to push as strongly.

 The mother can adopt different birthing positions to increase the diameter of
their pelvic outlet and allow for accommodation of the baby's head upon
delivery.
The mother will typically push with her contractions. In between each contraction and
push, the uterus relaxes and the baby recedes. At a certain point, the perineum will
start to bulge and the baby’s head will become visible. This is termed crowning.
 Once the head is born, the shoulders and body follow with the next contraction.

During crowning, there is intense stretching of the perineal tissue, increasing the risk
of perineal trauma. Perineal tears can be classified into four degrees

• First Degree Tear: involves the skin of the fourchette (the inner fold of the vulva)
only
• Second Degree Tear: involves the skin of the fourchette, the perineum and the
perineal body
• Third Degree Tear: involves the skin of the fourchette, the perineum, the perineal
body and the anal sphincter[2]
• 3A: less than 50% of the external anal sphincter is torn
• 3B: greater than 50% of the external anal sphincter is torn
Third Stage
The third stage of labour involves the delivery of the placenta and the
control of bleeding to prevent a hemorrhage

This stage normally lasts from 5 to 30 minutes in duration but may last as
long as one hour.

Separation and delivery of the placenta occurs spontaneously via

contractions and these contractions are typically less painful than what is
experienced in stage two.

 Once the placenta is delivered, control of bleeding can be achieved

naturally or pharmacologically.
Physiotherapy Management
Transcutaneous Electrical Stimulation (TENS)

provides a non-pharmacological method for pain

relief.
It has been used in clinical practice to relieve both
acute and chronic pains as well as treat various
conditions including dysmenorrhea and back pain.
Massage Therapy
Massage therapy, which involves the manipulation of
the body’s soft tissue, can be performed by a massage
therapist, a physiotherapist, a midwife, or a woman's
partner.
Massage therapy may be used to relax tense muscles, potentially providing
pain relief during labour.

Additionally, given that it involves physical contact with the women, some
evidence has stated that it can have a role in relaxation and emotional stress.

Thermotherapy and/or Cryotherapy

 Warm compresses are used during labour with the intention Warm
compresses are used during labour with the intention to reduce perineal pain
and increase comfort during labour.
 Heat promotes dilation of blood vessels, increases blood flow, and interrupts
the transmission of pain.
Accupuncture and/or Accupressure:

 Acupuncture is a technique that involves the insertion of needles into

different points of the body, whereas acupressure involves applying pressure
to different points of the body using one’s thumb or fingers.

Relaxation Technique

 Relaxation techniques aim to help women cope with their labour pains by
slowing down breathing, lowering blood pressure, and providing a sense of
wellbeing.
 Relaxation techniques encompass guided imagery and progressive relaxation
and breathing techniques.
Breathing Techniques

 Breathing techniques can interrupt the transmission of pain from the uterus to
the brain by decreasing sympathetic activity and providing emotional
regulation.
 Slow and deep breathing has been encouraged during labour to increase
relaxation and decrease pain.
Positioning
 The position a woman adopts during labour varies depending on which stage
of birth they are in, whether they have received epidural anaesthesia and the
risks and benefits that are associated with each position.
 Birthing positions can be divided into two different categories
vertical/upright positions and horizontal or recumbent/semi-recumbent
positions
 Exercises to train for labor and delivery
Start with relaxation

Ocean breathing technique

1. Focus on your breathing: take a slow, deep breath in, which feels like a yawn,
and then breathe out with your mouth wide open.

2. This is called the ‘ocean breathing technique’ and you will know you are doing
it right if your breathing sounds like waves swooshing in and out.
 Early stage labor exercises
The Butterfly Stretch
1. will help your hard-working inner-thigh muscles relax

2. Sit on a cushion with your back against the wall, bend your knees and place the
soles of your feet together. As you exhale, let your thighs relax downwards as
far
The Deeply Relaxing Dip

For labour to progress, your baby’s head needs to move

down into the right position
Squatting can help with this, allowing gravity to work with
your body to help your baby’s head to engage

Stand behind a chair, holding on to its back, with your legs

slightly wider than hip-width apart, and your feet turned out
a little. Bend your knees, allowing your hips to flex, and
your pelvis and bum to stick out, as if you are about to sit
down in a chair. You should feel your pelvis widen as you
bend your knees.
The Pressure-Easing Lunge

widen your pelvis and turn your baby so he is facing your

back.

Place a chair against the wall, making sure it is stable. Stand

by the side of the chair and place your left hand on the wall
for stability. Put your left foot on the seat and point your knee
and foot towards the wall. As you lunge forward, bend your
knee to make a 90° angle and move diagonally towards the
wall. Hold the lunge for a few seconds, and then repeat on the
other side.
The Gentle Circle
If you feel your baby is pressing against your spine, this
will ease the pressure.

Carefully get on your hands and knees, keep your knees

wide apart, and your hands just wider than your
shoulders. Your back should be flat. Slowly shift your
weight in a clockwise circle by leaning over your right
arm, then over your right hip, then your left hip, before
moving forwards over your left arm.

Then circle your body anticlockwise, keeping your

movements smooth.
Quadruped cat/cow

ease discomfort and decrease lower back pain.

Get on your hands and knees. Exhale and round your

back as you tuck your chin toward your chest. Then
inhale and gently arch your back downward and look
up at the sky
Get on your hands and knees. Exhale and round your
back as you tuck your chin toward your chest. Then
inhale and gently arch your back downward and look
up at the sky
Pelvic tilt
helps to strengthen your tummy muscles and ease back pain,
and may also help your baby to get into a good position for
birth

Get down on your hands and knees. Your arms should be

shoulder-width apart and your knees hip-width apart. Your
arms should be straight, but not locked at the elbows.
Arch your back up as high as it will go, so that your
tailbone is tucked underneath you, and then arch it the
opposite way, so that your bottom or tailbone (coccyx) is
sticking out. Repeat rhythmically and smoothly, and go at
your own pace.
To do this exercise sitting, slump down and then arch your
back, so that your chest and bottom are sticking out.
Pelvic Floor Stretching
stretch and release these muscles you've been working so hard
to strengthen."
Place a yoga block or stack of pillows against the wall. Stand
with your back to the wall with your feet out in front of you.
Inhale through the nose as you slowly slide down the wall.
Exhale a long, slow, even breath out the mouth continuing
down the wall, allowing the pelvic floor to fully release until
you reach your yoga block/pillows. Once down, butterfly your
knees open and gently apply pressure just above the knees for
an additional stretch. Hold for 90 seconds. Close knees and
repeat.
Late stage exercises
The Tension Reliever
this position can help give your body a little break.

Place a chair against the wall or use the side of the bed. Kneel
on the floor and rest your elbows on the chair, shoulder-
width apart. Press the palms of your hands together, then
point your fingertips up to the ceiling and relax your neck.
Rest your forehead on the edge of the chair, placing a towel
or cushion under your forehead, if you need it. Keep your
back straight, then tilt your pelvis and arch your back so the
base of your spine points up and out. Take three slow breaths,
then rest back on your heels and repeat when ready
The Curl-Up

open up your pelvis to make that crucial little bit

of extra room for your baby’s head to squeeze
through.
Start on your hands and knees, then widen your
knees and come down onto your elbows. Interlace
your fingers. Now slowly shift your body-weight
backwards, curling the base of your spine down
towards the floor. Pause, then slowly move your
body-weight forwards onto your elbows again.
Perineal bulges

This trains you to push during delivery without

holding your breath
length-wise from front to back. Gently press your
perineal body, or the area between the vagina and
rectum, into the towel. Think about gently moving
the sit bones – the bones you can feel in your glutes –
apart and moving the tailbone away from the pubic
bone.
The cobbler pose

To open your pelvis and loosen your hip joints, ready

for labour. It can also improve your posture and ease
tension in your lower back
Sit up straight against a wall, with your back slightly
arched, and with the soles of your feet touching each
other. Sit on a folded towel, if it’s more comfortable.
Gently press your knees down and away from each
other, but don’t force them..
Exercises to Induce Labor
Naturally
Precautions to Take When Doing Exercise to Induce Labor

Here are a few things to take care of when doing exercises to induce labour
1. Drink plenty of water before, during and after your exercise.
2. Be sure to keep hydrating yourself.
3. Make sure to wear a bra that supports your breasts completely and keeps you
comfortable.
4. Keep yourself moving constantly.
5. This does not mean that you don’t sit and take rest; it means that you should try
avoiding laying on your back or sitting all the time, as it can cause your muscles to
stiffen.
6. Constantly moving your legs, arms, and the rest of your body every now and then
will also help with your exercise.
7. Regular exercises throughout pregnancy help prepare your body for a natural birth.
8. They are also a wonderful way to induce labour naturally while keeping you warmed
up for the stresses of childbirth. So, don’t hesitate to keep yourself active and watch
your birthing process go smooth.
Here are some exercises that will help induce labour and get your body
ready for the baby

Pelvic Tilts
It is one of the best exercises to help induce labour naturally. Begin by
lying down on your back with your knees bent and your feet on the floor.
Flatten your back against the floor and slowly lift and push the pelvis up.
Hold it in this position for about 10 seconds and release slowly. Exercise
twice a day for 10 minutes for pelvic strength.
“the angry cat or the cat/cow stretch”. It is to be done on all fours, facing
the ground.
Squatting
Squatting opens up the pelvis. it helps to orient the baby into position for
delivery. Hold this position for 5 or 10 seconds, take a deep breath and
exhale as you rise back up.
Butterfly Pose
It opens up your pelvis and builds flexibility and strength in the surrounding
muscles, including the back and thigh.
Sit on the floor and put the soles of your feet together. Pulse your legs up and
down like the wings of a butterfly and feel the muscles in your thigh stretch.
Maintain a pace and range of motion that feels comfortable to you. A variant of
butterflies involves sitting in the same position and gently pushing the knees down
to the floor using your elbows and feeling the stretch in your inner thigh muscles.
Lunges
Lunges are effective in opening to let the baby rotate and descend. They can be
used to induce labour naturally. Stand with both the legs together and take one big
step forward. Descend your lower back while pivoting on the front knee while you
feel the muscles in your back and hind leg stretch. For added safety and balance,
push up against a wall while you do it. Alternate the legs and repeat the exercise
about 10 times with
Stair Climbing
Climbing stairs requires you to use all your lower back and leg muscles. The
stretching and movement of the hips help orient the baby’s head down towards
the birth canal. It also presses on the cervix, prompting it to dilate and open up the
pelvic region.

Kegel Exercises
Kegel exercises activate the pelvic floor muscles and gaining good control over
them can help during the pushing stage of labour. It is said that by voluntarily
relaxing them, you can ease the birthing process.

To find your pelvic floor muscles, tighten the muscles around your vagina
and like you interrupt the flow of urine when you pee. Contract the pelvic floor
muscles tighter for a count of five seconds, hold for five seconds, and release to a
count of five. Practice this 10 or 15 times a day.
Walking
This low impact aerobic exercise is a perfect way to induce labour naturally. It
is believed that walking helps the baby descend into the lower part of the
uterus, and also stimulates the cervix to dilate and get ready for labour.
helpful in stimulating uterine contractions in women who were advised bed
rest during pregnancy.
Birth ball exercises
Birthing balls are excellent tools to sustain a healthy pregnancy and successful
labor. Indeed, birthing ball exercises give the strength and stability that speed
up dilation, move baby down into the pelvis, and even manage labor and
delivery pain.
Rocking:
sitting on the birth ball, let your pelvis rock back and forth, and side to side. This
will help shift the pelvis into good spinal and pelvic alignment and can help with
discomfort between contractions. Simply sitting on the ball can also provide soft
support to the perineum when hard surfaces are no longer comfortable
Leaning against the ball:
if exhaustion is about to kick in, lean onto your birth ball. The best way to do
that is by standing up, placing the ball onto your hospital or birth-center bed
and leaning forward to hang onto the ball. Tipping the belly forward takes the
pressure off the lower back and can guide the baby deeper into the pelvis.
While you are resting on the ball, your birth partner can massage your back to
provide extra relief
Leaning against the ball, on all fours:

put the birthing ball on the floor and lean against it while on your knees.
This can also help with back pain. For extra stability, you can wrap your
arms around the ball and hug it. There too, your partner can massage
your back to take some of the pain away. With this position, gravity
pushes baby's head downward against the cervix, which may help
speed up dilation.
Bouncing:

Gently bouncing is a great way to cope with pain in between contractions.

You may find that you naturally feel the need to sway and bounce. Use that
time to figure out what your body instinctively wants to do, to trust that it
knows exactly what to do to help bring you comfort