Signs of True Labour

SIGNS OF LABOUR
BY
AUGUSTINA HERZUAH
SIGNS OF LABOUR
Recognition of labour is grouped into two;
1. False / Premonitory signs of labour/prelabour
signs
2. True labour
PRE-LABOUR SIGNS
• It is the term given to the changes that occur
within the last few weeks of pregnancy.
• It is a major transitional period with both
physical and psychological changes.
• Mood swings and a surge of energy are usually
present.
• The pre-labour signs include;
1. Spurious labour {Braxton Hicks contraction}
2. Frequency of micturition {Incontinent in
nature mistaken for loosing liquor.}
3. Taking up of the cervix {cervical Effacement}
4. Lightening
1. Spurious labour {Braxton Hicks
contraction}
• This is the contractions before the onset of
true labour , it may be painful and rhythmic
for sometimes but is not accompanied with
retraction and dilatation of the cervix.
• Note that the discomfort is present but have
not yet settled into the rhythmic pattern of
true labour
2. Frequency of micturition
• This comes as a result of pelvic congestion
thereby limiting the capacity of the bladder
causing frequency of micturition
• Laxity of the pelvic floor muscles may give rise
to poor sphincter control and stress
incontinence
3. Taking up of the cervix
• During the latter part of pregnancy the cervix
of the primigravida is taken up
• The cervix is drawn up and gradually merges
into the lower uterine segment as a results of
descent of the foetal head exerting downward
pressure on the cervical tissue around the
internal os
3. Taking up of the cervix contd
• The internal os widens and the cervix thins out
becoming closely applied to the presenting
part but the external os does not dilate
NB
• In a primigravida, this may result in complete
effacement but in the multigravida, it is more
common for the fetal head not to engage till
labour is established
• Effacement and dilatation of the cervical os in
the multigravida then occurs simultaneously
once labour commenced
4. Lightening
• It is the relief experienced by the pregnant
woman during the later part of pregnancy
During this stage:
• The lower uterine segment expands and allows
the fetal head to descend into the pelvic brim.
• The fundus of the uterus descends and there is
more room for the lungs, breathing is easier, the
heart and stomach can function more easily
4. Lightening contd
• The woman feels less congested and breathes
more easily.
• The symphysis pubis widens and the pelvic
floor becomes more relaxed and softened,
allowing the uterus to descend further into
the pelvis
NB
• Engagement of the foetal head occurs in
primigravida due to good muscle tone
• In multiparous woman, lightening may not
take place until later when uterine
contractions are established and true labour
starts
Effects on the woman include
• Difficulty in walking and backache in some
women due to increases mobility and
relaxation of the sacroiliac joint
• Increased pressure and venous congestion in
the pelvis
• Vaginal secretions may also increase
SIGNS OF TRUE LABOUR
a. Onset of painful rhythmic uterine
contraction
• As birth approaches, the non-progressive
Braxton hicks contractions change and intensify
to become the progressive form of labour
• Contractions are painful rhythmic which occurs
at regular interval , the uterus becomes hard to
touch
• Each contraction starts painless reaching its
peak and becomes intensity, very painful and it
diminishes and end painless
Contractions and retractions are intermittent for
• To relieve foetal head from the cervix for the
mother to rest
• Restore circulation to placental site to prevent
foetal hypoxia
b. Dilation of cervix
• It is the process of enlargement of the cervical
os (external os)from a tightly closed aperture
to an opening large enough to permit passage
of the foetal head.the cervix become fully
dilated when no cervix is felt on vaginal
examination.it is measured in centimeters and
full dilation is 10 cm. see in the diagram below
b. Dilation of cervix contd
b. Dilation of cervix contd
• Dilatation of the cervix occurs as a result of
uterine action and the counter-pressure
applied by the bag of membranes and the
presenting part
• A well flexed foetal head closely applied to the
cervix favors dilatation
c. Show (when the operculum is unplugged
and the blood is stained/mixed with
mucoid/mucus)
It is blood stained mucous discharge seen few

hours to or after labour has started the
dilatation of the cervix, leads to the
dislodgement of the operculum
• Show is the dislodgement of operculum from
the dilated cervix accompanied with streaks of
blood from ruptured capillaries in the parietal
decidua where the chorion has become
detached
d. Spontaneous rupture of membrane in some
instances
DIFFERENCE BETWEEN TRUE AND FALSE
LABOUR
TRUE LABOUR FALSE LABOUR
Presence of retraction Absence of retraction
Dilation of the cervix No dilation of the cervix
Pain is regular Pain is irregular
Membranes bulge out Membranes do not bulge

during uterine contraction out during contraction.
FACTORS AFFECTING LABOUR; 1st and 2nd
STAGE DURATION
The length of labour varies widely and is
influenced by;
1. Parity
2. maternal age
3. abour position
4. Birth interval
5. degree of expulsive efforts
6. Psychological/emotional state of mother
7. Presentation/position of fetus
8. Moulding, rotation, descent
9. Maternal pelvic shape and size
10. Character of uterine contractions
11.Resistance and relaxation of pelvic floor
muscles and tissues
This stage is expected to be
completed in 18hrs in primipara
and 14hrs in multips.
i.e. Active phase (4-10cm)
Multips Primips
6hrs 8hrs
FACTORS INFLUENCING LABOUR
• Successful labour and childbirth requires
coordination of four (4) essential factors, sometimes
called the “Four P’s”
1. Passenger (the fetus,placenta,cord, membranes
and liquor)
2. Passage (the pelvis, pelvic floor, uterus)
3. Powers or Pain (uterine contraction and bearing
down efforts)
4. Person /Psychological response (mum coping or
not, emotionally disturbed or exhausted)
THANK YOU
ANY QUESTIONS

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SIGNS OF LABOUR

It is blood stained mucous discharge seen few

Presence of retraction Absence of retraction

Dilation of the cervix No dilation of the cervix

Pain is regular Pain is irregular

Membranes bulge out Membranes do not bulge

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