![]() SEE: birthing chair SEE: Credé method for assisting with the expulsion of the placenta Other factors such as episiotomy or perineal laceration will also affect the amount of blood loss. ![]() ![]() ![]() The above probability is less than 5% if the fetus weighs 5 lb (2268 g) or less. The probability that blood loss will exceed 500 mL is increased with a large fetus or multiple fetuses, as the placental attachment area on the uterine wall is larger and the uterus is more distended, meaning it does not contract as well after delivery of the fetus, placenta, and membranes. The amount of blood loss will vary with the size of the fetus, but the average is 200 mL. After this, there is some bleeding from the uterus. Uterine contractions return, and usually within 8 to 10 min the placenta and membranes are delivered. As soon as the fetus is delivered, the remainder of the amniotic fluid escapes. Third stage (placental stage): This is the period following the birth of the fetus through expulsion of the placenta and membranes. There is usually a gush of amniotic fluid as the shoulders are delivered. When the head is completely removed out of the vagina it falls posteriorly later the head rotates as the shoulders turn to come through the pelvis. If done, it is most commonly a midline posterior episiotomy. This continues until more of the head is visible and the vulvar ring encircles the head like a crown (therefore often called crowning).Īt this time the decision is made concerning an incision in the perineum (episiotomy) to facilitate delivery. With cessation of each contraction, the fetus recedes from its position and then advances a little more when another contraction occurs. As labor continues the perineum bulges and, in a head presentation, the scalp of the fetus appears through the vulvar opening. The patient directs all her strength to bearing down during the contractions. The muscles of the abdomen contract involuntarily during this portion of labor. Rupture of the membranes (bag of water) usually occurs during the early part of this stage, accompanied by a gush of amniotic fluid from the vagina. Labor pains are severe, occur at 2- or 3-min intervals, and last from a little less than 1 min to a little more than 11/2 min. Second stage (stage of expulsion): This period lasts from complete dilatation of the cervix through the birth of the fetus, averaging 50 min in primigravidas and 20 min in multiparas. The loss of more than a few milliliters of blood at this time, however, must be regarded as being due to a pathological process. The appearance of a slight amount of vaginal blood-tinged mucus is a good indication that labor will begin within the next 24 hr. False labor pains do not cause effacement and dilation of the cervix as do true labor pains.Ī reliable sign of impending labor is show. The conclusive distinction is made by determining the effect of the pains on the cervix. False labor pains do not increase in frequency and duration with time and are not made more intense by walking. False labor pains are quite irregular, are usually confined to the lower part of the abdomen and groin, and do not extend from the back around the abdomen as in true labor. Its diagnosis is complicated by the fact that many women experience false labor pains, which may begin as early as 3 to 4 weeks before the onset of true labor. The identification of this stage is particularly important to women having their first baby. This stage averages 12 hr in primigravidas and 8 hr in multiparas. This stage is subdivided into the latent phase and the active phase.įirst stage (stage of dilation): This is the period from the onset of regular uterine contractions to full dilation and effacement of the cervix. The first stage of labor, progressive cervical dilation and effacement, is completed when the cervix is fully dilated, usually 10 cm. Traditionally, labor is divided into three stages.
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