LITERATURE REVIEW
2.0. AN OVERVIEW OF LABOUR, DELIVERY AND
POSTPARTUM
A. Introduction
The physiological transition from being a pregnant woman to
becoming a mother means an enormous change for each woman both physically and
psychologically. It is time when every system in the body is affected and the
experience, though unfortunately not joyous for all, represents a major
occurrence in the woman's life [17].
According to the American Academy of Pediatrics (AAP) and the
American College of Obstetricians and Gynecologists (ACOG), labour is a
sequence of uterine contractions that results in effacement and dilatation of
the cervix and voluntary bearing-down efforts leading to the expulsion per
vagina of the products of conception. Delivery is the mode of expulsion of the
foetus and placenta [18].
The puerperium, or postpartum period, generally lasting 6-12
weeks is the period of adjustment after delivery when the anatomic and
physiologic changes of pregnancy are reversed, and the body returns to the
normal non-pregnant state [19].
B. Normal Labour and Delivery
B.1. Physiologic Preparation for Labour [20]
Prior to the onset of true labour, several preparatory
physiologic changes commonly occur:
The settling of the foetal head into the brim of the pelvis,
known as lightening, usually occurs 2 or more weeks before the onset of labour
in first pregnancies.
Braxton Hicks contractions, which are irregular, painless
uterine contractions occurring with slowly increasing frequency, during the
last 4-8 weeks of pregnancy. They are distinguished from true labour
contractions by lack of cervical change in response to such contractions.
Several weeks before the onset of true labor, the cervix
begins to soften, efface, and dilate (1-2cm), the mucus plug within the
cervical canal may be released as small amount of blood-tinged mucus from the
vagina known as bloody show.
B.2. Characteristics of True Labour [21]
These signs are usually indicative that true labour has begun:
1. Regular painful uterine contractions occurring frequently
about 3-6 times in every 10-20 minutes.
2. Dilatation of the cervical os.
B.3. Physiology of Normal Labour [22]
Normal labour is a continuous process that has been traditionally
divided into three stages for purposes of study: the first, second and third
stages.
· The first stage of labour, further subdivided into the
latent, active and transitional phases, is the interval between the onset of
labour and full cervical dilatation.
· The second stage is the interval between full cervical
dilatation and delivery of the baby.
· The third stage of labour is the period between the
delivery of the baby and the delivery of the placenta.
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