1. Spontaneous in onset and at term
2. With vertex presentation
3. Without undue prolongation
4. Natural termination with minimal aids
5. Without having any complications affecting the health of the mother and /or the baby

Stages of labor :

1. FIRST stage of labor
2. SECOND stage of labor
3. THIRD stage of labor
4. FOURTH stage of labor

FIRST STAGE OF LABOR :

1. Dilatation and effacement of the cervix
2. Full formation of lower uterine segment

Dilatation of the cervix :

1. Softening of cervix
2. Fibromusculoglandular hypertrophy
3. Increase vascularity
4. Accumulation of fluid in between collagen fibers
5. Breaking down of collagen fibrils by enzymes collagenase and elastase
6. Change in the various glycosaminoglycans (e.g. increases in hyaluronic acid, decrease in dermatan sulphate ) in the matrix of the cervix

Effacement or taking up of cervix :

1. In primigravida , effacement precedes dilatation of cervix
2. Whereas in multipara both occur simultaneously

Lower uterine segment :

• Pain are felt more anteriorly with simultaneous hardening of uterus
• Initially , pain are not strong enough to cause discomfort and come at varying intervals of 15 to 30 minutes with duration of about 30 sec .
• But gradually the interval become shortened with increasing intensity and duration so that in late first stage the contraction comes at interval of 3-5 min and last for about 45 sec
• In normal labor , pain are usually felt shortly after the uterine contraction begin and pass off before complete relaxation of the uterus .
• clinically pain are said to be good if the come at interval of 3-5 min and at the height of contraction the uterine wall cannot be indented by fingers.

Dilatation and effacement of cervix :

Complications can arise during this stage, including:

1. Prolonged Labor: This occurs when labor lasts longer than expected (generally over 20 hours for first-time mothers), which can lead to fatigue and increased risk of infection.
2. Failure to Progress: Sometimes the cervix may not dilate adequately despite strong contractions, necessitating medical interventions.
3. Fetal Distress: If the baby shows signs of distress (e.g., abnormal heart rate patterns), immediate medical attention may be required.
4. Maternal Exhaustion: Prolonged or intense labor can lead to physical and emotional fatigue, impacting the mother’s ability to cope.
5. Infection: Prolonged rupture of membranes can increase the risk of infection for both mother and baby.
6. Uterine Hypertonicity: This is when contractions are excessively strong or frequent, which can cause distress to the baby or lead to uterine rupture in severe cases.
7. Bleeding: Abnormal bleeding, particularly if it is heavy or accompanied by pain, may indicate complications like placental abruption.

Management of first stage of Labor :

Management of the first stage of labor focuses on ensuring the safety and comfort of both the mother and baby, while promoting effective labor progression. Key aspects include:

1. Monitoring

• Fetal Heart Rate: Continuous or intermittent monitoring to assess the baby’s well-being.
• Maternal Vital Signs: Regular checks to monitor the mother’s health.
• Cervical Exam: Periodic assessments of cervical dilation and effacement.

2. Comfort Measures

• Pain Relief: Options include epidurals, intravenous pain medication, or non-pharmacological methods (breathing techniques, relaxation, hydrotherapy).
• Positioning: Encouraging movement and position changes (e.g., walking, sitting, squatting) to enhance comfort and aid labor progression.
• Support: Emotional and physical support from partners, doulas, or healthcare providers.

3. Hydration and Nutrition

• Fluids: IV fluids may be administered if the mother is unable to eat or drink due to nausea.
• Nutrition: Light snacks may be offered, depending on the mother’s preferences and hospital protocols.

4. Assessing Labor Progress

• Regular evaluations of contraction patterns, cervical changes, and the baby’s position.

5. Addressing Complications

• Interventions for Prolonged Labor: If labor stalls, options like oxytocin may be considered.
• Fetal Distress Management: If the baby shows signs of distress, repositioning the mother, administering oxygen, or preparing for emergency delivery may be necessary.

6. Education and Communication

• Keeping the mother informed about the progress of labor and available options.
• Encouraging questions and addressing concerns throughout the process.

7. Preparation for Transition

• As the first stage of labor nears completion (cervix fully dilated at 10 cm), preparation for the second stage (pushing) should begin, including gathering necessary equipment and staff.

Effective management during the first stage of labor is crucial for promoting a positive experience and ensuring the safety of both mother and baby.