CHILDBIRTH

Mechanism, Stage, and Factors

Nurragoa
Nurul Amaliah Abbas
Nurul Annisani
Nurul Huda
Nurul Huda Al Amin
 Mechanism Of Labour
The mechanism of labor is a fetal movement that
accommodates itself against the mother's pelvis.
The main movements of the delivery mechanism are:
1. Engagement
2. Flexion
3. Desensus
4. Internal Rotation
5. Extension.
6. External Rotation
7. Expulsion
1. Engagement
In primigravida, the entry of the head into
the pelvic door is generally in the last month of
pregnancy, but in multigravida it usually occurs
at the onset of labor
Engagement occurred at the first and
second stage of labor. This is due to the
contraction and retraction of the upper segment
of the uterus, which causes direct pressure of
the fundus on the fetal buttocks.
2. Flexion
At the beginning of labor, the baby's head is
in a mild flexion. With the progression of the
head usually flexion also increases. In this
movement the chin is brought closer to the fetal
chest so that the small fontanum is lower than the
large crown, this is due to the resistance of the
cervical, and pelvic
3. Desensus
In nullipara, engagemen occurred before my father and did
not continue until the beginning of stage II; in multiparous
desensus takes place along with cervical dilatation.
Causes of desensus:
1. Amnionic fluid pressure
2. Direct pressure by the uterine fundus on the buttocks
3. Mother's power
4. Extension of fetal body movements (fetal body becomes straight)
Another factor that determines the occurrence of desensus is:
1. Size and shape of the pelvis
2. Position of the lowest part of the fetus
3. The greater the resistance of the pelvic bone or the presence of
pelvic narrowing will cause a slow desensus.
4. Internal Rotation
The inner rotation is rotated from the front
in such a way that the lowest part of the front of
the fetus rotates forward downwards simpisis. At
the lowest presentation the back of the head is the
small fontanel area and this part will rotate
forward towards simpisis
5. Extension.
After the fetal head reaches the base of
the pelvis and the small fontanum under
symisis, extension of the fetal head occurs.
This is caused because the birth canal on the
bottom of the pelvis points forward and
upwards so the head must hold flexion to
pass through it.
6. External Rotation
The head that has been born then it will
restitution, which is the baby's head rolling back
so that the shoulder can be born
7. Expulsion
After the External Rotation, the front
shoulder is below the symphysis and
becomes the hipomochlion for the back
shoulder birth
The Stage Of Labour

The stage Of Labour devided in 4 stages are :

1. First Stage of Labour ( Contractions and
cervical dilatation)
2. Second Stage of labour ( Childbirth )
3. Third Stage of Labour ( Delivery Placenta )
4. Fourth Stage of Labour ( Observation of
Mother’s vital signs )
First Stage of labour
1. Begins with regular uterine contractions and
ends with complete cervical dilatation at 10 cm
2. Contractions become progressively more
rhythmic and stronger
3. Divided into a latent phase and an active phase
a. Latent Phase : 1- 3 cm of cervical dilatation about 8
hours
b. The active phase usually begins at about 4 cm of
cervical dilation and is characterized by rapid
cervical dilation and descent of the presenting fetal
part about 6 hours
Second stage Of Labour
1. Begins with complete cervical dilatation and ends with the
delivery of the fetus
2. At the second stage of labour the contraction, more
frequent, and longer. The amniotic membrane may also
have ruptured / just broke spontaneously at the beginning
of this 2nd stage. The average time for the entire process of
phase 2 is primigravida ± 1.5 hours, and multipara ± 0.5
hours.
Third Stage Of Labour
1. The period begin when the fetus is born and the
delivery of the placenta and fetal membranes
2. Delivery of the placenta often takes less than 10
minutes, but the third stage may last as long as 30
minutes
3. The third stage of labor is considered prolonged after
30 minutes and need immediate action
4. Active management involves oxytocin or other
uterotonics (prostaglandins or ergot alkaloids), cord
clamping/cutting, and controlled traction of the
umbilical cord
Fourth Stage Of Labour
1. Begin When the placenta is born complete, until two hours
after that.
2. Important things that must be considered in the 4th stage of
labor:
a. Uterine contraction must be good
b. There is no vaginal bleeding or other genitals
c. The placenta and membranes must be born completely
d. Bladder must be empty
e. Injuries to the perineum must be treated and there is no
hematoma
f. Resume the general condition of mother and baby.( Vital
Signs)
Fourth Stage Of Labour
1. Begin When the placenta is born complete, until two hours
after that.
2. Important things that must be considered in the 4th stage of
labor:
a. Uterine contraction must be good
b. There is no vaginal bleeding or other genitals
c. The placenta and membranes must be born completely
d. Bladder must be empty
e. Injuries to the perineum must be treated and there is no
hematoma
f. Resume the general condition of mother and baby.( Vital
Signs)
Factors that affect Labour
1. Passage
2. Power
3. Passanger
4. Psychology
1. Passage
 The birth canal that must be passed by the fetus consisting of
the pelvic cavity, pelvic floor, cervix and vagina.
 The normal pelvic cavities are: the upper calling door is
almost round, sacrum wide and curved, promontorium does
not protrude forward, both spinal ischiadica do not protrude
into, the angle of the pubus arc is quite wide (90-100), the
size of conjugata vera (face size the back of the pelvic top
door is from the bottom of the sympathetic to the
promontorium) is 10-11 cm, the size of the transverse
diameter (the size of the transverse upper pelvis) 12-14 cm,
oblique diameter (sserong size of the pelvic top door) 12-14
cm, lower pelvis size transverse face 10-10.5 cm.
2. Power
 Power is the energy to give birth which consists of his or
uterine contractions and energy from the mother
 Power is the primary or primary force produced by the
contraction and retraction of the uterine muscles
 His is the contraction of the uterine muscles in labor
 Contraction is a shortening and thickening of the
muscles of the uterus that occur outside of consciousness
(involuter) and under the control of sympathetic nerves
 Retraction is a shortening of the uterine muscles that are
permanent after contractions
3. Passanger
 Passenger consists of the fetus and placenta
 The fetus is the main passanger, and the most important
part of the fetus is the head, because the fetal head has
the largest size, 90% of babies are born with the head
 The abnormalities that often inhibit the passanger are
abnormalities in the size and shape of the child's head
such as hydrocephalus or anencephalus, abnormalities in
location such as the location of the face or the location of
the forehead, abnormalities in the position of the child
such as latitude or breech position
4. Psychology
• Psychological factors of fear and anxiety are often
the cause of the length of labor, his condition is
not good, the opening becomes less smooth
• According to Pritchard, the feeling of fear and
anxiety is the main factor that causes pain in labor
and affects the uterine contractions and dilation
of the cervix so that labor becomes prolonged.