What is Labor?

Labor is a physiologic process that starts with the rhythmic contractions coupled with cervical dilatation and effacement or thinning of the cervix. The presence of cervical dilatation without contractions is not at all a labor. It only could tell that there is a cervical incompetence and the patients should undergo procedures to help the baby remain within the womb till it is term.

According to the recent Clinical Practice Guidelines on Normal Labor and Delivery by the Philippine Obstetrics and gynecology Society, the following will suggest presence of labor:
1. Uterine contractions that was either observed by the examiner herself or by a cardiotocogram to be occurring at least once in ten minutes or four times in twenty minutes.
2.documented progressive cervical dilatation and effacement
3. Cervical dilatation of more than 3 centimeters
4.cervical effacement of 70 per cent

There are four stages of labor. The first stage occurs when there is the beginning of the regular contractions. It is divided into latent phase and the active phase. The latent phase occurs normally up to 14 hours for the multigravids or those who had delivered previously and 20 hours for first time parturients. Active phase starts when the cervix becomes 4-cm dilated.

Thus, in our institution, we admit patients who are at least with four centimeter-cervical dilatation.It means, the patient is already in her active labor. We do admitting cardiotocograph test for high risk patients and we monitor vital signs and fetal heart tones in accordance to the guidelines. Fetal heart tone was measured every thirty minutes during the first stage of labor. Then, every five minutes during the second stage. The latter is when the cervix becomes fully dilated. It ends with the delivery of the baby.

According to Cunningham et. al, labor is characterized by brevity and considerable biological changes. Once the threshold of 3 cm or more is reached, the patient enters active labor. Depending on the prior number of pregnancies and delivery she already had, delivery is expected within to 6 hours.
The third stage of labor begins after delivery of the baby until the placenta is delivered. The fourth stage encompasses the puerperal period of six weeks which included the return of the uterus to its previous nonpregnant state.

List of Sources:
Cunningham, et al. Williams Obstetrics,23rd ed.Chapter 17.new york, McGraw-Hill,2010.

Clinical Practice Guidelines, 2nd edition. Philippine Obstetrics and Gynecology Society(Foundation), Inc.