LABOR NORMAL

LABOR NORMALA. DEFINITIONSChildbirth is the process whereby the baby , placenta and amniotic membranes out of the mother's uterus . Childbirth is considered normal if the process occurs in pregnancy is at term ( after 37-40 weeks ) without any complications ( JNPK - KN , 2008) .B. Types of delivery1 . Normal delivery ( spontaneous ) , is a process where the birth of a baby in the back of the head ( LBK ) with maternal power alone, without the aid of tools and not to injure the mother and baby were generally lasts less than 24 hours . Normal delivery is the process of spending that occurs in pregnancy fetus at term ( 37-42 weeks ) , birth spontaneously back of the head with a presentation that lasted no more than 18 hours without complications for both mother and fetus .2 . Artificial labor is labor with the help of external force .3 . Delivery is recommended when the power required for the delivery caused by the road outside stimuli .C. delivery mechanisms1 . falling headThe entry of the head to the PAP in primigravida occurred in the last month of pregnancy but in multipara usually occur until the beginning of labor . Advances the head in primigravida occurring after head into the pelvic cavity and usually just starting on the second stage . On the contrary multiparous advance head and head entry into the pelvic cavity occur together .Which led to the rapid advancement of the head are :- Pressure intrauterine fluid- Pressure directly by fundus buttocks- The power push- Melurusnya the child by Rahim deformation2 . flexionWith the rapid advancement of the head usually grow up to Labor Law jugafleksi clearly lower than Uub . Flexion is because the child is driven forward and instead got custody of fringe PAP , cervical , pelvic wall or pelvic floor .3 . Rotation axis inReferred to as the pivot round are :Playback from the front so that the lowest part of the front of the fore turning down sympisis .Rotation axis in the absolute need for the birth of the head due to rotation axis is an attempt to adjust the position of the head with the shape of the birth canal .4 . Extension or deflectionOccurs due to the birth canal axis PBP forward and upward , so head through it must hold for the extension . After subocciput sympisis stuck on the bottom edge to advance because of the strength of the above section dealing with subocciput , it gives birth in a row on the edge of the perineum Labor Law , uub , forehead , nose , mouth and chin with the birth of the extension movement .5 . Pivot round the outsideAfter the head is born, the child's head will roll back towards the back of the neck of the child to menghilangkantorsi happens because the rotation axis , proceed to the next round the back of the head to deal with unilateral tuberischiadikum .6 . expulsionOnce outside the pivot round the shoulders to below sympisis and became the center of rotation to the birth of the shoulders . Shoulders back and then subsequently the whole body after the child was born outside the direction of the axis .D. Kala - kala in laborDuring delivery in time for the 4 are:1 . 1 Kala : Kala opening ( Mochtar , R , 2001)Time for the opening of the cervix to be a complete opening ( 10 cm ) . In the opening stage is divided into 2 phases :a) . latent phase- Starting from the beginning of the contraction that causes thinning and opening of the cervix is gradually- The opening of less than 4 cm- It usually takes less than 8 hoursb ) . active phase- The frequency and duration of uterine contractions generally increased ( contraction inadequate / 3 times or more in 10 minutes and lasts for 40 seconds or more )- Cervical open from 4 to 10 , typically at speeds up to hourly 1cm/lebih complete opening ( 10 )- A decrease in the lowest part of the fetus- Lasts for 6 hours and on for over 3 phases , namely :By friedman curve : acceleration period , lasting for 2 hours opening into 4cm maximum dilatation period , lasting for 2 hours rapid opening of 4 to 9cm diselerasi Period , lasted 2 hours later than the opening of 9cm to 10cm / complete2 . Kala II : Kala spending fetus ( JNPKR and MOH , 2002)Uterine time with his strength plus strength straining to push the fetus out .At this second stage is characterized by :- His coordinated , stronger , faster and longer roughly 2 - 3menit once- The head of the fetus has entered the room down the flanks and push reflektoris raises curiosity- Pressure on the rectum , the mother felt like BAB- Anus openAt the time of his fetal head begin to appear , open the vulva and perineum stretch , with his head and straining are guided to be born , and followed the whole body of the fetus .Long on the second stage at different primi and multipara namely : primiparous second stage lasted 1.5 hours - 2 hours multiparous second stage lasted 0.5 hours - 1 hourlabor leadersThere are 2 ways to push mothers to the second stage according to the lying position , embracing her legs with both arms until elbows bounds , head raised slightly so that the chin on the chest , mouth dikatup ; manner as above , but the body tilted back towards where the fetus is and just one leg who embraced the upper3 . Third stage : Kala uriIe the release time and expenses uri ( placenta ) . After the baby is born pause uterine contractions , uterine fundus palpable hard with center height and contains a thick placenta 2 times before . Moments later his expenses arise and release uri , within 1-5 minutes placenta separates pushed into the vagina and is born spontaneously or with little encouragement ( androw brand , the whole process usually takes 5-30 minutes after the baby is born . And the expulsion of the placenta usually accompanied by a bloodletting about - about 100 - 200cc . Signs third stage consists of two phases :1 ) Phase uri releaseUri release mechanism comprising:a. Schultze• Data is as much as 80 % off the first that ensued amid the refuse uri reteroplasenterhematoma first - first in the middle and then entirely , according to this way of bleeding is usually no prior uri uri born and a lot after birth .b . Dunchan• The loss of uri starting from the edges , so the first born of the edge ( 20 % )• Blood will flow all the amniotic membranesc . Simultaneously from the center and edge of the placenta2 ) Phase spending uri maneuver - uri maneuvers to find out the release are:1 ) KustnerPutting pressure on the hand with / above the symphysis , the cord stretched , when the log is not yet off the placenta , umbilical cord still and when forward ( longitudinal ) means the placenta has detached .2 ) ClientsWhen we push a little there his womb , when the umbilical cord is not yet off the back , if silent / down means it is off .3 ) StrastmanFlex cord and tap on the fundus , when the umbilical cord is not yet off the vibrate , vibrate when it does not mean it is off .4 ) Rahim stands out above symfisis5 ) The umbilical cord length increases6 ) Rahim round and hard7 ) Exit blood suddenly4 . Kala IV : Kala supervisionIe the time after the baby is born and the placenta for 1-2 hours and the time in which to determine the state of the mother , especially against the dangers of postpartum hemorrhage .