Welcome to the stages and phases of labor.
One of the keys to really understanding the
whole process of labor is knowing how it begins.
So we first want to look at, what
are the triggers for the onset of labor?
There are several, let's look at four of them.
The first one is uterine distension.
As the fetus grows, it actually sends a signal to
let the body know that it's time for labor to start.
There are also hormones
that are produced by the fetus,
that may send a message that the baby
is ready, and it's time for labor to begin.
The next one has to do with
the estrogen and prostaglandins.
These are two hormones that are secreted
and if you'll remember the prostaglandins
in the menstrual cycle lecture,
they lead to uterine contractions.
They do the same thing here.
And finally, a decrease in
the level of progesterone.
Progesterone is also one of those hormones
you might remember from the menstrual cycle.
And as hormone levels go down in
progesterone, then we begin to have contractions.
So these are four triggers.
The next thing we want to think about in terms
of labor is recognizing true versus false labor.
So everybody that's in labor who,
or who thinks they might be in labor,
that might not actually be the case.
So how can the nurse recognize
those signs and symptoms?
If someone is really in labor, then
they may have regular contractions.
So they're not going to have contractions that are 3
minutes, and then 5 minutes, and then 10 minutes,
They're going to come every 3
minutes, or every 5 minutes, that's a sign.
they also find that over time,
the contractions get stronger.
So as more time begins to progress, the
contractions are not going to get less strong,
they're going to be more
and more uncomfortable.
Also thinking about the location of
the pain that they may be experiencing.
So the patient may find that
the pain starts from the back,
and then it wraps around like a great big hug
to the front of the lower part of the abdomen.
And finally, the patient may experience
bloody discharge, we also call this 'bloody show',
and that results from the capillaries that burst
around the cervix as the cervix begins to dilate.
So these are signs of true labor.
What are some signs of false labor?
Well, if regular contractions
are a sign of true labor,
irregular contractions are a sign of false labor.
Contractions, if they slow down with
position changes, so if the patient is walking,
and then they sit down, and the contraction
slow down, then that's consistent with false labor.
And also, if there's only discomfort
in the front part of the abdomen,
then usually that's not a sign of labor.
Now, the ultimate sign out of all of
this is that we have cervical change.
So the true definition of someone being
in labor is that the cervix makes a change.
Without cervical change, no matter what
happens with the other signs and symptoms,
it's not really labor.
Now I want to give you a rule.
So we have 911 for most of us if
we want to call emergency services,
the rule for labor is called the '511 rule'.
And what that means is that
contractions will be five minutes apart,
they will be 5 minutes apart, and
then they will last at least 1 minute.
they will be 5 minutes
apart, last at least 1 minute,
and that pattern will be
consistent for at least 1 hour.
So that's the 511 rule of labor.
So now I have a case, so let's see if we
can work through what we've done so far,
to see if we're starting to
put these pieces together.
So we're going to learn about Grace and
what we're going to look for are the indications
that Grace might actually be in labor.
Grace is a 26 year old Gravida 1 Para 0,
G1P0, who presents at 38 weeks to labor triage.
She reports that she has back
pain that radiates to the front
and comes and goes every
15 minutes for the last 4 hours.
She's tried walking, she's had some water,
but she just really can't seem to get comfortable.
The pain started off as mild, and
now it's becoming more uncomfortable,
and it's more pronounced in
the lower part of her abdomen.
Grace has also noticed a very small amount
of pink-colored discharge when she wipes
after going to the bathroom.
So read through this case study again and
see if you can think about what are the signs that
the nurse may have picked up on to
let them know that Grace is in labor.
Let's test it.
Back pain that radiates to the front, check!
And it comes and goes every 15 minutes.
That seems to signal that there's
some regularity to the contractions, check!
It's been going on for at least four hours, check!
The patient has tried walking and drinking a
glass of water but can't seem to get comfortable.
This implies that the contractions
are likely getting stronger.
Definitely not getting less
strong, so check on that one too.
Now Grace is becoming more uncomfortable,
and the pain is in the lower part of the abdomen.
And we have pink color discharge when
grace wipes after going to the bathroom.
So these are all indications that if
Grace were to call and talk to the nurse,
might be a sign, it's labor and it's time
to maybe make their way to the hospital.