📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ Introduction / Definition
Labor is the physiological process by which the fetus, placenta, and membranes are expelled from the uterus through the birth canal.
It is typically accompanied by regular uterine contractions, cervical dilatation, and effacement.
Labor generally occurs between 37 to 42 weeks of gestation.
✅ “Labor is a series of coordinated, involuntary uterine contractions leading to the progressive effacement and dilatation of the cervix, culminating in the birth of the baby and placenta.”
📚🩺 Difference Between True Labor Pain and False Labor Pain (Braxton Hicks Contractions)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
True Labor Pain:
Indicates the onset of actual labor leading to progressive cervical dilation and delivery.
Associated with regular, increasing uterine contractions.
False Labor Pain (Braxton Hicks Contractions):
Irregular, non-progressive uterine contractions that do not lead to cervical dilation.
Often called “practice contractions” and are common in late pregnancy.
📖 II. Point-Wise Differences Between True and False Labor Pain
Feature
True Labor Pain
False Labor Pain
1. Timing of Contractions
Regular, rhythmic intervals (every 5–10 minutes).
Irregular, infrequent contractions.
2. Duration and Intensity
Increases progressively in duration and intensity.
Remain the same or diminish over time.
3. Pain Location
Starts in the lower back and radiates to the abdomen.
Confined to the lower abdomen or groin.
4. Effect of Activity
Intensifies with walking or movement.
Subsides with rest or change in position.
5. Cervical Changes
Progressive effacement and dilation of the cervix.
No cervical changes.
6. Show/Bloody Discharge
May be present.
Not present.
7. Membrane Status
May lead to rupture of membranes (ROM).
Membranes remain intact.
8. Outcome
Leads to delivery of the baby.
Does not lead to delivery.
📚 Golden One-Liners for Quick Revision:
True labor pains are regular, progressive, and associated with cervical changes.
False labor pains are irregular, mild, and relieved by rest.
Braxton Hicks contractions are common after 28 weeks of gestation.
True labor leads to the delivery of the baby; false labor does not.
✅ Top 5 MCQs for Practice
Which of the following is a key feature of true labor pain? 🅰️ Pain relieved by rest 🅱️ Irregular contractions ✅ 🅲️ Progressive cervical dilation 🅳️ Pain limited to the abdomen
What is another name for false labor pains? 🅰️ Lightening ✅ 🅱️ Braxton Hicks Contractions 🅲️ Stationary Contractions 🅳️ Afterpains
Where does true labor pain typically begin? 🅰️ Lower abdomen ✅ 🅱️ Lower back radiating to the abdomen 🅲️ Upper abdomen 🅳️ Chest
Which of the following is NOT a feature of true labor? 🅰️ Cervical dilation ✅ 🅱️ Pain subsides with rest 🅲️ Membrane rupture possible 🅳️ Regular contractions
False labor pain typically: 🅰️ Leads to delivery 🅱️ Increases in intensity and duration ✅ 🅲️ Is relieved by rest and position change 🅳️ Causes cervical effacement
📚🩺 Mechanism of Labor
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
The mechanism of labor refers to the series of passive movements that the fetus undergoes to successfully pass through the birth canal during vaginal delivery.
These movements allow the fetal head to adapt to the maternal pelvis for safe expulsion.
✅ “Mechanism of labor is the sequence of positional changes and adjustments made by the fetus during its passage through the birth canal.”
📖 II. Cardinal Movements of Labor (In Sequential Order)
🟢 1. Engagement
The widest transverse diameter of the fetal head (usually biparietal diameter – 9.5 cm) enters the pelvic inlet.
Occurs before labor in primigravida and during labor in multigravida.
🟢 2. Descent
Downward movement of the fetal head through the maternal pelvis.
Occurs throughout labor but most rapidly in the second stage.
🟢 3. Flexion
The fetal chin moves toward the chest, allowing the smallest head diameter (suboccipitobregmatic – 9.5 cm) to present.
Facilitates easier passage through the birth canal.
🟢 4. Internal Rotation
The fetal head rotates to align with the maternal pelvis (usually rotates from transverse to anterior position).
Occurs at the level of the ischial spines.
🟢 5. Extension
As the head reaches the vulva, it extends to pass through the birth canal.
Occurs at the perineum; the head is born by extension.
🟢 6. Restitution
After the head is born, it realigns with the shoulders (external rotation of the head to match the position of the shoulders).
🟢 7. External Rotation
The shoulders rotate to the anteroposterior diameter of the pelvis, aligning for delivery.
🟢 8. Expulsion
The anterior shoulder slips under the pubic arch, followed by the posterior shoulder and rest of the body.
Marks the end of the second stage of labor.
📖 III. Clinical Significance of Mechanism of Labor
Helps anticipate and manage normal and abnormal labor progress.
Important for identifying malpresentations and malpositions.
Aids in deciding when interventions like episiotomy or assisted delivery (forceps/vacuum) are needed.
📖 IV. Nursing Responsibilities
Monitor fetal position and progress using Leopold’s Maneuvers.
Observe for signs of delayed labor or fetal distress.
Assist the obstetrician in managing malpresentations.
Provide emotional and physical support to the mother throughout labor.
Prepare for emergency interventions if abnormal mechanisms are observed.
📚 Golden One-Liners for Quick Revision:
Engagement involves the passage of the biparietal diameter through the pelvic inlet.
Flexion reduces the presenting diameter to suboccipitobregmatic (9.5 cm).
Internal rotation aligns the fetal head with the maternal pelvis.
The head is delivered by extension, and shoulders by lateral flexion.
Malpositions often interfere with the normal mechanism of labor.
✅ Top 5 MCQs for Practice
Which is the first movement in the mechanism of labor? 🅰️ Flexion 🅱️ Descent ✅ 🅲️ Engagement 🅳️ Extension
The fetal head is delivered by which movement? 🅰️ Flexion ✅ 🅱️ Extension 🅲️ Restitution 🅳️ Internal Rotation
Restitution refers to: 🅰️ The descent of the fetal head. 🅱️ Flexion of the fetal head. ✅ 🅲️ Realignment of the fetal head with the shoulders after birth. 🅳️ Rotation of the shoulders in the pelvis.
Which diameter of the fetal head is involved during flexion? 🅰️ Occipitofrontal 🅱️ Submentobregmatic ✅ 🅲️ Suboccipitobregmatic 🅳️ Mentovertical
Which movement is responsible for the alignment of the shoulders in the pelvis? 🅰️ Restitution ✅ 🅱️ External Rotation 🅲️ Internal Rotation 🅳️ Flexion
📚🩺 Stages of Labor
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Labor is the physiological process by which the fetus, placenta, and membranes are expelled from the uterus through the birth canal.
It typically begins between 37 to 42 weeks of gestation and involves regular uterine contractions, cervical dilatation, and effacement.
✅ “Labor is a sequence of events that results in the expulsion of the fetus and placenta from the uterus at term.”
📖 II. Stages of Labor
🟢 1. First Stage of Labor (Stage of Dilatation)
Begins with the onset of true labor pains and ends with full cervical dilatation (10 cm).
Duration:
Primigravida: 12–16 hours.
Multigravida: 6–8 hours.
Phases of First Stage:
Latent Phase:
Cervical dilatation: 0–4 cm.
Mild, irregular contractions.
Duration: 6–8 hours.
Active Phase:
Cervical dilatation: 4–7 cm.
Strong, regular contractions every 3–5 minutes.
Duration: 4–6 hours.
Transition Phase:
Cervical dilatation: 7–10 cm.
Intense, frequent contractions every 2–3 minutes.
Duration: 0.5–2 hours.
🟢 2. Second Stage of Labor (Stage of Expulsion)
Begins with full cervical dilatation (10 cm) and ends with the delivery of the baby.
Duration:
Primigravida: 30 minutes to 2 hours.
Multigravida: 15–30 minutes.
Events:
Strong uterine contractions.
Descent and birth of the baby.
Active maternal pushing efforts.
🟢 3. Third Stage of Labor (Placental Stage)
Begins immediately after the delivery of the baby and ends with the expulsion of the placenta and membranes.
Duration: 5–30 minutes.
Methods of Placental Expulsion:
Schultze Method: Central separation; placenta expelled fetal side first.
Duncan Method: Marginal separation; maternal side presents first.
🟢 4. Fourth Stage of Labor (Observation Stage)
First 1–2 hours after the delivery of the placenta.
Critical period for monitoring the mother for hemorrhage, uterine contraction, and vital signs stabilization.
📖 III. Clinical Significance
Accurate identification of each stage ensures timely interventions.
Helps prevent complications like postpartum hemorrhage, prolonged labor, and fetal distress.
Critical for determining when to provide emotional support and analgesia.
📖 IV. Nursing Responsibilities During Each Stage
First Stage:
Monitor uterine contractions and fetal heart rate.
Encourage relaxation techniques and provide pain relief.
Ensure bladder is emptied regularly.
Second Stage:
Assist with positioning for effective pushing.
Prepare delivery equipment and assist during birth.
Provide emotional reassurance.
Third Stage:
Observe for signs of placental separation.
Administer oxytocin to prevent hemorrhage.
Inspect the placenta for completeness.
Fourth Stage:
Monitor mother’s vital signs and uterine firmness.
Check vaginal bleeding (lochia).
Encourage bonding and initiation of breastfeeding.
📚 Golden One-Liners for Quick Revision:
The cervix dilates 0–10 cm during the first stage of labor.
Second stage ends with the birth of the baby.
The third stage lasts until the placenta is delivered.
The fourth stage is critical for monitoring postpartum hemorrhage.
Which stage of labor ends with the delivery of the placenta? 🅰️ First Stage 🅱️ Second Stage ✅ 🅲️ Third Stage 🅳️ Fourth Stage
What is the duration of the second stage of labor in a primigravida woman? 🅰️ 1–3 hours ✅ 🅱️ 30 minutes to 2 hours 🅲️ 4–6 hours 🅳️ Less than 15 minutes
Which method of placental separation presents the fetal side first? 🅰️ Duncan Method ✅ 🅱️ Schultze Method 🅲️ McRoberts Method 🅳️ Brandt-Andrews Method
The latent phase of the first stage of labor involves cervical dilatation up to: 🅰️ 2 cm 🅱️ 3 cm ✅ 🅲️ 4 cm 🅳️ 6 cm
During which stage of labor is postpartum hemorrhage most likely to occur? 🅰️ First Stage 🅱️ Second Stage 🅲️ Third Stage ✅ 🅳️ Fourth Stage
📚🩺 Management of Labor
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Management of labor involves a series of clinical and supportive interventions provided to the mother during the stages of labor to ensure safe delivery for both the mother and the baby.
The goal is to prevent maternal and neonatal complications while promoting natural and healthy childbirth.
✅ “Labor management is the systematic monitoring and care of a woman in labor to ensure safe delivery and prevent complications.”
📖 II. General Principles of Labor Management
Ensure psychological support and comfort for the mother.
Monitor maternal vital signs and fetal well-being.
Maintain strict aseptic techniques to prevent infection.
Early identification and management of complications like fetal distress, prolonged labor, or hemorrhage.
Encourage hydration, nutrition, and bladder emptying.
📖 III. Stage-Wise Management of Labor
🟢 1. Management During First Stage (Dilatation Stage)
Admit the mother and assess using Partograph.
Monitor uterine contractions every 30 minutes.
Check fetal heart rate every 15–30 minutes.
Assess cervical dilatation and effacement periodically.
Encourage deep breathing, relaxation, and ambulation if no contraindications.
Ensure bladder is emptied every 2 hours.
Provide pain relief if needed (e.g., analgesics, epidural anesthesia).
🟢 2. Management During Second Stage (Expulsion Stage)
Assist the mother into a comfortable birthing position (lithotomy or squatting).
Encourage effective pushing during contractions.
Maintain strict aseptic techniques during delivery.
Support the perineum to prevent tears (perineal massage).
Perform episiotomy if indicated.
Suction the baby’s mouth and nose after delivery.
Clamp and cut the umbilical cord following delayed clamping if applicable.
🟢 3. Management During Third Stage (Placental Stage)
Administer uterotonic drugs (e.g., Oxytocin 10 IU IM) immediately after delivery of the baby (Active Management of Third Stage of Labor – AMTSL).
Inspect the placenta for completeness after expulsion.
Monitor for signs of postpartum hemorrhage.
🟢 4. Management During Fourth Stage (Observation Stage)
Observe the mother for at least 2 hours post-delivery for signs of bleeding and uterine contraction.
Monitor maternal vital signs every 15 minutes for the first hour.
Encourage early initiation of breastfeeding.
Promote bonding between mother and baby.
Ensure bladder emptying and provide perineal hygiene.
📖 IV. Nursing Responsibilities in Labor Management
Continuous emotional and physical support.
Regularly monitor fetal heart rate and maternal vitals.
Assist in maintaining maternal hydration and nutrition.
Prepare for emergency interventions like cesarean section if required.
Educate the mother on breathing exercises and effective pushing techniques.
Ensure safe and hygienic delivery practices.
📚 Golden One-Liners for Quick Revision:
Use of the Partograph helps monitor labor progress.
Active Management of Third Stage of Labor (AMTSL) prevents postpartum hemorrhage.
Oxytocin is the drug of choice to manage the third stage.
Continuous fetal monitoring helps identify early signs of distress.
Breastfeeding should be initiated within the first hour after birth.
✅ Top 5 MCQs for Practice
Which drug is preferred in Active Management of Third Stage of Labor (AMTSL)? 🅰️ Methylergometrine ✅ 🅱️ Oxytocin 🅲️ Misoprostol 🅳️ Carboprost
What is the purpose of using a Partograph? 🅰️ To monitor postpartum bleeding 🅱️ To assess newborn APGAR score ✅ 🅲️ To monitor labor progress 🅳️ To assess maternal nutrition
Which position is ideal for delivery during the second stage of labor? 🅰️ Supine 🅱️ Prone ✅ 🅲️ Lithotomy 🅳️ Trendelenburg
How often should maternal vital signs be monitored during the fourth stage of labor? 🅰️ Every 5 minutes 🅱️ Every 10 minutes ✅ 🅲️ Every 15 minutes 🅳️ Every 30 minutes
Which of the following is the best immediate nursing action after placental expulsion? 🅰️ Provide oral fluids 🅱️ Encourage ambulation ✅ 🅲️ Assess uterine contraction and bleeding 🅳️ Give iron supplements
📚🩺 Partograph
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
A Partograph is a graphical tool used to monitor the progress of labor and assess maternal and fetal well-being during childbirth.
It helps in the early identification of abnormal labor, ensuring timely intervention to prevent complications.
✅ “The Partograph is a simple, effective, and essential tool for monitoring the progress of labor and preventing prolonged and obstructed labor.”
📖 II. Purpose of Using a Partograph
To monitor the progress of labor systematically.
To assess fetal condition and detect fetal distress early.
To evaluate maternal condition and prevent complications.
To identify cases requiring timely referral or interventions.
To reduce maternal and neonatal morbidity and mortality.
📖 III. Components of the Partograph
🟢 1. Fetal Condition Monitoring
Fetal Heart Rate (FHR): Recorded every 30 minutes.
Amniotic Fluid (Membranes): Intact or ruptured, color of liquor (clear, meconium-stained, blood-stained).
Molding of Fetal Skull Bones: Assessed during vaginal examinations.
🟢 2. Progress of Labor
Cervical Dilatation: Plotted against time on the graph.
Descent of the Fetal Head: Assessed using abdominal palpation.
Alert Line: Indicates expected progress of labor (1 cm dilatation per hour).
Action Line: Located 4 hours to the right of the alert line; crossing this line indicates need for clinical action.
🟢 3. Maternal Condition
Pulse: Recorded every 30 minutes.
Blood Pressure (BP): Recorded every 4 hours.
Temperature: Recorded every 4 hours.
Urine Output: Monitored for volume, protein, and ketones.
Contractions: Frequency, duration, and intensity recorded every 30 minutes.
📖 IV. How to Use a Partograph (Stepwise)
Start plotting when the woman is in active labor (cervical dilatation ≥ 4 cm).
Record maternal vitals and fetal parameters regularly.
Plot cervical dilatation against time to observe labor progress.
Take appropriate action if the plot crosses the alert or action lines.
Ensure timely referrals or interventions when necessary.
📚 Golden One-Liners for Quick Revision:
Partograph helps prevent prolonged and obstructed labor.
The alert line represents normal labor progress.
Crossing the action line requires immediate intervention.
Cervical dilatation is ideally 1 cm per hour during active labor.
Partograph is started at 4 cm cervical dilatation.
✅ Top 5 MCQs for Practice
At what cervical dilatation should the partograph be started? 🅰️ 2 cm 🅱️ 3 cm ✅ 🅲️ 4 cm 🅳️ 5 cm
What does crossing the action line on the partograph indicate? 🅰️ Normal labor progress ✅ 🅱️ Immediate need for intervention 🅲️ Start fetal monitoring 🅳️ Prepare for discharge
How often should fetal heart rate be recorded on the partograph? 🅰️ Every hour 🅱️ Every 15 minutes ✅ 🅲️ Every 30 minutes 🅳️ Every 2 hours
Which parameter is plotted to assess labor progress? 🅰️ Maternal BP ✅ 🅱️ Cervical dilatation 🅲️ Pulse rate 🅳️ Uterine tone
Which of the following is NOT a component of the partograph? 🅰️ Fetal heart rate 🅱️ Maternal BP 🅲️ Cervical dilatation ✅ 🅳️ Apgar Score