Detailed Labor Process

Childbirth is a natural physiological process. Understanding the various stages and characteristics of labor helps expectant mothers prepare, reduce anxiety, better cooperate with medical staff, and achieve a smooth delivery.

Signs Before Labor Starts

Pre-labor Signs

Bloody Show (Antepartum Hemorrhage)

• Characteristics: Small amount of bloody vaginal discharge
• Color: Usually pink, red, or brown
• Amount: Not much, similar to the amount at the beginning of menstruation
• Timing: Usually appears 24-48 hours before delivery
• Principle of Handling: Generally no need to see a doctor immediately, but contact the doctor

Water Breaking (Rupture of Membranes)

• Sensation: Sudden flow of fluid from the vagina
• Fluid Characteristics: Clear, pale yellow, or pale green
• Flow Characteristics: Amount may be large or small, continuous
• Odor: Colorless and odorless or slightly sweet
• Handling Method: Once it happens, lie flat immediately and contact the hospital

Regular Contractions

• Contraction Characteristics: Contractions change from irregular to regular
• Standard for Primiparas: Once every 5-6 minutes, lasting more than 30 seconds
• Standard for Multiparas: Once every 6-8 minutes, lasting more than 30 seconds
• Trend: Contractions gradually become stronger, more frequent, and last longer
• Relief Method: Cannot be relieved by rest or changing position

Situations Requiring Immediate Medical Attention

Emergency Situations

• Water Breaking: Whether accompanied by contractions or not, water breaking requires immediate medical attention
• Abnormal Bleeding: Vaginal bleeding exceeding menstrual flow
• Abnormal Fetal Movement: Fetal movement significantly reduced or disappeared
• Severe Symptoms: Severe abdominal pain or headache, blurred vision
• Hypertension Symptoms: Symptoms related to high blood pressure

Preparing for Admission

• Regular Contractions: Contractions meet the above standards
• Sufficient Gestational Age: Gestational age ≥ 37 weeks
• Doctor's Advice: Doctor recommends admission for observation

First Stage: Cervical Dilation Stage

Early Latent Phase (Cervical Dilation 0-3cm)

Characteristics

• Contraction Characteristics: Irregular contractions, gradually strengthening
• Duration: 8-12 hours for primiparas, 6-8 hours for multiparas
• Pain Level: Mild to moderate pain
• Contraction Frequency: Once every 5-10 minutes

Maternal Feelings

• Ability to Talk: Able to talk and communicate normally
• Mobility: Can eat and move around
• Emotional State: Emotionally relatively stable
• Psychological State: May feel excited or nervous

Coping Strategies

• Rest at Home: Rest at home to save energy
• Light Activity: Engage in light activities, such as walking
• Diet: Eat easily digestible food
• Skill Practice: Practice breathing and relaxation techniques
• Contraction Recording: Record contractions

Active Phase (Cervical Dilation 3-7cm)

Characteristics

• Contraction Regularity: Regular and strong contractions
• Duration: 3-5 hours for primiparas, 2-3 hours for multiparas
• Pain Level: Moderate to severe pain
• Contraction Frequency: Once every 2-5 minutes

Maternal Feelings

• Attention Requirement: Need to concentrate on coping with pain
• Appetite Change: May not want to eat
• Sensitivity: Sensitive to external stimuli
• Support Need: Need more support

Coping Strategies

• Pain Relief: Seek various pain relief methods
• Breathing Coordination: Use breathing techniques and relaxation exercises
• Position Adjustment: Change position (standing, squatting, kneeling)
• Seek Support: Accept support from family and medical staff
• Avoid Pushing: Avoid pushing too early

Transition Phase (Cervical Dilation 7-10cm)

Characteristics

• Strongest Contractions: Strongest and most frequent contractions
• Duration: 0.5-1.5 hours
• Pain Level: Severe pain, unbearable
• Contraction Frequency: Once every 1-3 minutes

Maternal Feelings

• Pain Peak: Pain reaches its peak
• Physical Reaction: May experience trembling, nausea
• Psychological State: Feel unable to continue
• Urge to Push: Strong urge to push

Coping Strategies

• Psychological Suggestion: Tell yourself "This is the peak"
• Focus on Breathing: Focus on every breath
• Professional Guidance: Accept guidance from medical staff
• Avoid Premature Pushing: Avoid pushing too early (unless allowed by the doctor)
• Trust Instincts: Trust yourself and your body's instincts

Second Stage: Fetal Delivery Stage

Delivery Process Characteristics

Basic Features

• Full Dilation: Cervix fully dilated (10cm)
• Fetal Descent: Fetus begins to descend and rotate
• Urge to Defecate: Strong urge to defecate appears
• Pushing Cooperation: Need to cooperate with contractions to push

Time Range

• Primiparas: 1-3 hours
• Multiparas: 0.5-1 hour
• Second Child and Above: May be shorter
• Individual Differences: Individual differences exist

Pushing Techniques

Correct Pushing Method

• Timing: Push when contracting
• Frequency: Push 2-3 times per contraction
• Duration: Each push lasts 5-7 seconds
• Breathing Coordination: Take a deep breath and hold it to push
• Direction: Push down like having a bowel movement

Common Mistakes

• Premature Pushing: Pushing when the cervix is not fully dilated
• Facial Pushing: Excessive use of facial muscles
• Holding Breath Too Long: Holding breath for too long
• Improper Method: Improper pushing method

Position Selection

Supine Position

• Traditional Position: Traditional delivery position
• Medical Convenience: Convenient for doctors to operate and observe
• Disadvantages: May affect fetal descent
• Applicability: When medical intervention is needed

Semi-Sitting Position

• Gravity Utilization: Use gravity to help fetal descent
• Comfort: Relatively comfortable position
• Pushing Effect: Helpful for pushing
• Implementation: Raise the head of the bed 30-45 degrees

Squatting Position

• Pelvic Expansion: Expand the pelvic outlet
• Gravity Utilization: Make full use of gravity
• Pushing Effect: Best pushing effect
• Implementation: Requires support and assistance

Side-Lying Position

• Tear Prevention: Reduce the risk of perineal tearing
• Comfort: More comfortable position
• Applicability: When the perineum is tight or the fetus is large

Perineal Protection and Handling

Natural Birth Protection

• Doctor Protection: Doctor controls the speed of fetal delivery by hand
• Pushing Guidance: Guide the mother to adjust pushing method
• Perineal Massage: Appropriate perineal massage
• Stretching Wait: Pause appropriately to wait for perineal stretching

Indications for Episiotomy

• Fetal Distress: Fetal distress requiring rapid delivery
• Tight Perineum: Perineum is too tight or has poor elasticity
• Macrosomia: Macrosomia or risk of shoulder dystocia
• Instrumental Delivery: Need for forceps or vacuum extractor assistance

Episiotomy Process

• Anesthesia Choice: Local anesthesia
• Incision Timing: When the fetal head is crowning
• Incision Angle: 45-degree angle incision
• Suturing: Suturing after fetal delivery

Fetal Delivery Process

Delivery Sequence

1. Head Presentation: Head presentation, flexion and rotation
2. Head Delivery: Clear the airway immediately after head delivery
3. Shoulder Delivery: Shoulders delivered successively (anterior shoulder then posterior shoulder)
4. Body Delivery: Body slides out smoothly
5. Umbilical Cord Handling: Immediately assess newborn condition

Newborn Handling

• Score Assessment: Newborn Apgar score
• Airway Clearance: Clear airway secretions
• Umbilical Cord Handling: Cutting the umbilical cord
• Early Contact: Skin-to-skin contact and early suckling

Third Stage: Placental Delivery Stage

Placental Delivery Process

Process Characteristics

• Contraction Relief: Contractions temporarily subside after fetal delivery
• Placental Separation: Contractions resume after a few minutes, placenta begins to separate
• Medical Assistance: Doctor may press the abdomen to help placental delivery
• Duration: Usually 5-30 minutes

Signs of Placental Delivery

• Fundal Height Increase: Uterine fundus rises, uterus becomes hard
• Vaginal Bleeding: Small amount of vaginal bleeding
• Umbilical Cord Lengthening: Umbilical cord lengthens outward
• Complete Placenta: Placenta completely separated

Handling Process

• Placenta Inspection: Check if the placenta is intact
• Umbilical Cord Inspection: Check umbilical cord and membranes
• Soft Birth Canal Inspection: Check for soft birth canal injuries
• Injury Treatment: Suture if there are injuries

Immediate Postpartum Observation

Maternal Observation

• Vital Signs: Monitor blood pressure, pulse, respiration
• Bleeding: Observe vaginal bleeding
• Uterine Contraction: Check uterine contraction status
• Bladder Status: Observe bladder filling

Newborn Observation

• Vital Signs: Respiration, heart rate, temperature monitoring
• Body Measurements: Weight, length measurement
• Deformity Check: Check for physical deformities
• Early Feeding: Early feeding assessment

Labor Pain Management

Non-Pharmacological Pain Relief

Breathing Techniques

• Lamaze Breathing: Systematic breathing training method
• Shallow Breathing: Shallow and fast breathing (panting) at the peak of contractions
• Deep Slow Breathing: Deep slow breathing in the interval of contractions
• Breathing Coordination: Breathing coordinated with pushing

Position and Activity

• Standing Activity: Standing or walking, using gravity
• Kneeling Support: Knee-chest position to relieve back pain
• Squatting Posture: Squatting posture, opening the pelvis
• Support Posture: Using support equipment (yoga ball, etc.)

Massage and Touch

• Back Massage: Relieve back pain caused by contractions
• Perineal Massage: Reduce risk of perineal tearing
• Foot Massage: Promote general relaxation
• Hand Massage: Distract attention, relax

Temperature Therapy

• Hot Compress Application: Hot compress on lower abdomen to relieve contraction pain
• Back Hot Compress: Relieve back pain
• Hot Bath: Warm water or hot bath to relax muscles
• Cold Compress Effect: Cold compress on forehead to relieve feverish feeling

Water Birth

• Benefits: Water temperature relieves muscle tension, buoyancy reduces weight
• Indications: Singleton head position, 37-42 weeks gestation, no complications
• Contraindications: Multiple pregnancy, abnormal amniotic fluid, infection, etc.

Psychological and Emotional Support

• Doula Support: Continuous support from professional birth companion
• Family Support: Husband's companionship gives a sense of security
• Relaxation Techniques: Progressive muscle relaxation, imagery, etc.
• Music Therapy: Listening to soothing music to distract attention

Pharmacological Pain Relief

Epidural Anesthesia

• Mechanism: Injecting local anesthetic into the epidural space to block pain nerve conduction
• Implementation: Requires anesthesiologist operation, puncture and catheterization
• Advantages: Most significant analgesic effect, mother remains awake
• Disadvantages: May prolong labor, increase instrumental delivery rate
• Side Effects: Headache, backache, difficulty urinating, etc.

Spinal Anesthesia

• Characteristics: One-time injection, rapid onset
• Analgesic Effect: Strong analgesic effect
• Applicability: Cesarean section, second stage analgesia, emergency situations

Intravenous Analgesia

• Common Drugs: Dolantin (Pethidine), Fentanyl, Remifentanil
• Administration: Intermittent injection, Patient Controlled Analgesia (PCA)
• Advantages: Convenient to use, relatively fast onset
• Disadvantages: May affect newborn respiration, analgesic effect is relatively weak

Inhalation Analgesia

• Nitrous Oxide: Mixture of 30% nitrous oxide and 70% oxygen
• Usage: Self-controlled use, inhale 15-20 seconds before contraction starts
• Advantages: Safe to use, does not affect newborn, few side effects
• Disadvantages: Limited analgesic effect, requires high cooperation

Special Situation Handling

Abnormal Fetal Position

Breech

• Types: Complete breech, footling breech, incomplete breech
• Handling Options: May attempt external cephalic version, or plan cesarean section
• Natural Birth: Requires special handling and skills if natural birth
• Increased Risk: Increased risk of umbilical cord prolapse and fetal distress

Transverse Lie

• Danger: Absolute indication for cesarean section
• Emergency Treatment: Requires emergency treatment
• Preventive Measures: Regular prenatal checkups, timely detection and treatment

Occiput Posterior

• Impact: May prolong labor time
• Treatment: Needs position adjustment, may increase risk of cesarean section
• Techniques: Mother changes position, doctor assists rotation

Fetal Distress

Characteristics

• Abnormal Fetal Heart Rate: Fetal heart rate too fast, too slow, or irregular
• Abnormal Fetal Movement: Fetal movement abnormally reduced or disappeared
• Meconium Stained Amniotic Fluid: Amniotic fluid stained with meconium

Principle of Handling

• Change Position: Change mother's position
• Oxygen Therapy: Give mother oxygen
• Accelerate Delivery: Accelerate delivery process if necessary
• Emergency Cesarean Section: Perform emergency cesarean section if necessary

Abnormal Labor

Prolonged Labor

• Causes: Uterine inertia, abnormal fetal head position, pelvic abnormalities, etc.
• Treatment: May need oxytocin to strengthen contractions or cesarean section
• Monitoring: Closely monitor maternal and infant conditions

Precipitate Labor

• Definition: Total labor duration less than 3 hours
• Risk: May increase maternal and infant complications
• Treatment: Requires close monitoring and timely treatment

Arrest of Labor

• Diagnosis: Cervical dilation stops for more than 2 hours in active phase
• Causes: Uterine inertia, abnormal fetal position, pelvic problems, etc.
• Treatment: Oxytocin, artificial rupture of membranes, or cesarean section

Delivery Preparation

Admission Preparation

Hospital Bag Preparation

• Maternal Supplies: Change of clothes, sanitary products, nursing pads
• Newborn Supplies: Clothes, diapers, bottles, swaddles, etc.
• Documents: ID card, medical insurance card, pregnancy health manual
• Important Items: Mobile phone charger, cash, etc.

Psychological Preparation

• Understand Process: Understand the labor process and various possibilities
• Learn Techniques: Learn pain coping and relaxation techniques
• Build Confidence: Build a positive mindset for delivery
• Prepare Support: Prepare support system and accompanying persons

Birth Plan

Content Includes

• Desired Method: Desired delivery method (natural birth, painless delivery, etc.)
• Pain Management: Pain management preferences and choices
• Companionship Arrangement: Arrangement of accompanying persons
• Special Requests: Special requests or contraindications

Communication with Doctor

• Discuss Expectations: Discuss delivery expectations with doctor
• Understand Policies: Understand hospital policies and procedures
• Clarify Emergency: Clarify emergency plans and handling methods
• Flexible Adjustment: Remain flexible and ready to cope with changes

Immediate Postpartum Care

Maternal Care

Physical Recovery

• Rest and Nutrition: Ensure rest and nutritional supplementation
• Perineal Care: Perineal care and wound treatment
• Uterine Massage: Uterine massage to promote contraction
• Early Activity: Early ambulation to prevent complications

Emotional Regulation

• Accept Experience: Accept and integrate the birth experience
• Seek Support: Seek emotional support and understanding
• Build Connection: Build mother-infant connection and intimacy
• Prevent Depression: Prevent postpartum depression

Newborn Care

Early Care

• Skin Contact: Skin-to-skin contact and keep warm as soon as possible
• Early Suckling: Early suckling and breastfeeding
• Umbilical Cord Care: Umbilical cord care and observation
• Safety Monitoring: Newborn safety monitoring

Parent-Child Relationship

• Early Connection: Establish early parent-child connection
• Learn Parenting: Learn basic parenting skills
• Adapt to Role: Adapt to the transition of parental roles
• Seek Guidance: Seek professional guidance and help

Conclusion

Although childbirth is full of challenges, understanding its process helps reduce anxiety and improve the quality of the birth experience. Key points include:

1. Timely Identification: Learn to identify signs of labor starting and seek medical attention in time

2. Understand Process: Be familiar with the characteristics, duration, and coping methods of the three stages of labor

3. Learn Techniques: Master effective methods for breathing, relaxation, and coping with pain

4. Flexible Adaptation: Be prepared to cope with possible special situations and changes

5. Seek Support: Accept professional support from family, medical staff, and doulas

6. Stay Positive: Believe in your body's ability and maintain a positive mindset

7. Safety First: Regardless of the method chosen, maternal and infant safety always comes first

8. Enjoy the Process: Under the premise of safety and comfort, enjoy the process of welcoming a new life

Remember, every woman's birth experience is unique. Understand the birth process and be prepared, but also maintain an open mind and accept what actually happens. The most important thing is maternal and infant safety, followed by creating a positive birth experience. With adequate preparation and a positive mindset, most women can successfully go through the birth process and welcome the arrival of a new life.

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Friendly Reminder: Childbirth is a natural physiological process, but every woman's experience is unique. Please trust your body and the professional ability of the medical staff. Regardless of the birth process, the most important thing is the safety and health of the mother and baby. Maintain an open mind, respond flexibly to various situations, and believe that you can successfully welcome the arrival of a new life.