labor

labor:

see birthbirth
or labor,
delivery of the fetus by the viviparous mammal. Birth is also known as parturition. Human birth normally occurs about 280 days after onset of the last menstrual period before conception.
..... Click the link for more information. .

labor,

term used both for the effort of performing a task and for the workers engaged in the activity. In ancient times much of the work was done by slaves (see slaveryslavery,
historicially, an institution based on a relationship of dominance and submission, whereby one person owns another and can exact from that person labor or other services.
..... Click the link for more information. ). In the feudal period agricultural labor was in the main performed by the serfserf,
under feudalism, peasant laborer who can be generally characterized as hereditarily attached to the manor in a state of semibondage, performing the servile duties of the lord (see also manorial system).
..... Click the link for more information. . In medieval towns, however, the skilled artisans of the craft guildsguilds
or gilds,
economic and social associations of persons engaging in the same business or craft, typical of Western Europe in the Middle Ages. Membership was by profession or craft, and the primary function was to establish local control over that profession or
..... Click the link for more information. became influential citizens. Many manual labor jobs were eliminated with the introduction of machinery (mid-18th cent.), thus creating a labor surplus (see Industrial RevolutionIndustrial Revolution,
term usually applied to the social and economic changes that mark the transition from a stable agricultural and commercial society to a modern industrial society relying on complex machinery rather than tools.
..... Click the link for more information. ). With increased competition for jobs and consequent decreasing wages, a form of labor contract came into use in Great Britain and its colonies, called indenture, by which people could hire themselves out for a certain number of years either for a lump sum of money or to pay off a debt. This practice disappeared by the end of the 19th cent. From the last quarter of the 19th cent. the condition of most manual labor has improved slowly in industrial countries through organization (see union, laborunion, labor,
association of workers for the purpose of improving their economic status and working conditions through collective bargaining with employers. Historically there have been two chief types of unions: the horizontal, or craft, union, in which all the members are
..... Click the link for more information. ), permitting collective bargaining with employers and successful pressure on governments for protective legislation. In fact, the term labor is today most frequently used to signify organized labor. For labor disputes, see strikestrike,
concentrated work stoppage by a group of employees, the chief weapon of organized labor. A suspension of work on the employer's part is called a lockout. Strikes usually result from conflicts of interest between the employer, who seeks to reduce costs, and employees, who
..... Click the link for more information. . See also child laborchild labor,
use of the young as workers in factories, farms, and mines. Child labor was first recognized as a social problem with the introduction of the factory system in late 18th-century Great Britain.
..... Click the link for more information. ; migrant labormigrant labor,
term applied in the United States to laborers who travel from place to place harvesting crops that must be picked as soon as they ripen. Although migrant labor patterns exist in other parts of the world (e.g.
..... Click the link for more information. ; peonagepeonage
, system of involuntary servitude based on the indebtedness of the laborer (the peon) to his creditor. It was prevalent in Spanish America, especially in Mexico, Guatemala, Ecuador, and Peru.
..... Click the link for more information. .

Bibliography

See J. R. Commons et al., History of Labour in the United States (4 vol., 1918–35, repr. 1966); G. D. H. Cole, A Short History of the British Working-Class Movement (new ed. 1960); N. J. Ware, Labor in Modern Industrial Society (1935, repr. 1968); A. Kuhn, Labor: Institutions and Economics (rev. ed. 1967); A. A. Paradis, The Labor Reference Book (1972); R. Fantasia, Cultures of Solidarity: Consciousness, Action, and Contemporary American Workers (1989); T. Roof, American Labor, Congress and the Welfare State, 1935–2010 (2011).

Labor

the complex physiological process that consummates pregnancy. Labor is the function by which the fetus, placenta, and fetal membranes are passed through the birth canal and expelled from the mother’s body.

In humans, a distinction is made between full-term labor, resulting in the birth of a mature fetus at the end of a 40-week pregnancy, and premature labor, resulting in the birth of an immature but viable fetus between the 28th and 39th week of pregnancy. Many systems of the body participate in the preparation for and realization of labor. The central and peripheral nervous systems are involved, as are the endocrine glands, the hormones and other biologically active substances formed in the fetus and placenta, and the neuromuscular apparatus of the uterus.

Labor involves the interaction of three components: the birth canal, the fetus with the placenta and membranes, and the expulsive contractions. The birth canal consists of the bony ring of the true pelvis, whose dimensions during childbirth are almost unchanged. It also includes the soft tissues of the uterine cervix—the vagina and the muscles of the pelvic floor, which upon stretching are capable of enlarging. A narrow pelvis often makes passage of the fetus through the birth canal impossible, and delivery by surgery is necessary (for example, Caesarean section).

The fetus is able to pass through the birth canal only when its long axis is parallel to that of the uterus (longitudinal presentation). The part of the fetus that passes through the birth canal with the most difficulty is the head—the largest and most solid part of the fetus. However, the sutures and fontanels between the bones of the fetal skull enable the head to change somewhat in shape to conform with the features of the birth canal. In 96 percent of all births the head of the fetus is directed downward (cephalic presentation), and in 3.5 percent the presenting part of the fetus is the buttocks or legs (breech presentation). Breech delivery presents some danger, mainly for the fetus. In one out of 200 deliveries the axis of the fetus is perpendicular to that of the uterus (transverse presentation, or transverse lie). In such a case the obstetrician corrects the position of the fetus by means of version or delivers the baby surgically.

There are expulsive contractions of the smooth musculature of the uterus (labor pains) and of the transverse striated muscles of the abdominal wall and diaphragm (bearing-down efforts). The uterine contractions play the major role. The rhythmic contractions of increasing frequency and severity are most intense at the moment of birth. The average duration of a uterine contraction is one to 1½ minutes; the pauses between contractions are ten to 15 minutes at the beginning of labor and two to three minutes toward the end. The uterine contractions are involuntary, whereas the abdominal contractions are to some degree voluntary—the woman can inhibit or intensify them.

Labor is divided into three stages: (1) dilatation of the cervix, (2) expulsion of the infant, and (3) expulsion of the placenta and membranes (the afterbirth).

During the period of dilatation, the cervix gradually becomes smooth, the birth canal enlarges, and the amnion enters the birth canal. After complete dilatation of the mouth of the cervix, the amnion ruptures. Sometimes the amnion ruptures earlier, resulting in a dry labor. With good contractile activity of the uterus such a complication need not interrupt a normal delivery. In rare cases, the amnion does not rupture, and the infant is “born in a nightshirt.” The amnion is quickly ruptured, so that with the start of respiration the infant does not choke on the amniotic fluid.

During the stage of expulsion of the fetus the uterine contractions are joined by the abdominal ones, which the woman perceives as downward thrusts. Passage of the fetus through the birth canal involves a number of movements. With each uterine contraction that is accompanied by an abdominal one, more and more of the head appears outside the vulvovaginal orifice. After the head is born, the shoulders, trunk, arms, and legs are expelled without any special difficulty. During the birth of the head, the tissues of the perineum stretch and may rupture. The physician or midwife attending the birth regulates the movement of the head and, so as not to damage the perineum, does not allow the head to be expelled too rapidly.

With the birth of the infant, the afterbirth period begins. Owing to the contraction of the uterine musculature along its entire length, including the site of placental attachment, the placenta separates from the uterine wall. The separation is accompanied by brief, insignificant bleeding (150–300 ml). Intense and prolonged hemorrhaging requires prompt intervention of the physician. With the expulsion of the afterbirth, labor is considered complete. The postnatal period begins, and the woman from that moment is called a puerpera.

The total duration of labor averages 15 to 20 hours in women giving birth for the first time (primiparas) and ten to 12 hours in women who have previously given birth (multiparas). The period of dilatation is longer: 13 to 18 hours for primíparas and six to nine hours for multiparas. The period of expulsion lasts one or two hours in primiparas and from five minutes to one hour in multiparas. The afterbirth period is 15 to 60 minutes (average 30).

In modern times, a decrease in the average duration of labor has been observed. This decrease is apparently due to improved health and physical stamina of women, better socioeconomic and hygienic conditions, and the improvement of obstetric care. Physiopsychological preparation for childbirth is also responsible for the decrease in labor duration. In addition, many medicinal agents and therapeutic methods (electroanalgesia) are used that promote painless childbirth, accelerate dilatation of the cervix, and intensify uterine contractions. The network of institutions in the health care system for mothers and children furnishes the Soviet woman qualified care in all stages of pregnancy and makes it possible for all women to have their babies in maternity hospitals or the maternity departments of hospitals.

Pathology. The normal course of labor may be disrupted if there are anomalies of the birth canal, such as the presence of a narrow pelvis and cicatricial stenoses of the soft tissues. Complications may also result from the defective development of the female reproductive organs or from the existence of neoplasms, such as a fibromyoma of the uterus or an ovarian cyst.

Other possible complications include improper presentation of the fetus, disturbance of uterine contractions, anomalies of the fetal head (hydrocephalus), tumors of the fetus, untimely rupturing of the amnion, abnormal structure or position of the umbilical cord (improper attachment, winding around the fetus), and improper attachment or early sloughing off of the placenta.

Various therapeutic measures are taken to protect the life and health of the mother and the infant.

REFERENCES

Bodiazhina, V. I., and K. N. Zhmakin. Akusherstvo. Moscow, 1970.
Rodovaia deiatel’nost’ i ee reguliatsiia (collection of works by L. S. Persianinov). Moscow, 1972.

L. S. PERSIANINOV

In domestic animals, the course of labor is determined by the physiological state of the female, which in turn is determined by the animal’s feeding, maintenance, use, and species characteristics. Labor usually occurs at night or in the early morning. One to five days before an animal goes into labor, relaxation of the pelvic ligaments, edema of the external genitalia, discharge of mucus, and the appearance of colostrum are observed. Small domestic animals and wild animals prepare a birthing area.

There are three stages of labor: (1) preparation, (2) expulsion of the fetus, and (3) expulsion of the afterbirth. In the first stage, contractions of the uterine musculature result in complete dilatation of the cervical canal and a change in the position and limb arrangement of the fetus. The stage ends with the rupture of the allantois and discharge of the first waters. Expulsion of the fetus involves active uterine contractions and bearing down of the abdominal muscles. This stage lasts 15 to 30 minutes in mares, up to four hours in cows, 15 to 30 minutes in ewes and nanny goats, two to 20 hours in sows, and ten minutes to 12 hours in female dogs. In multiple births the offspring are born at intervals of 5 minutes to 15 hours. Expulsion of the afterbirth takes 30 minutes in mares, five or six hours in cows, two hours in ewes, and ten to 20 minutes in sows. In dogs and often sows the fetus and the afterbirth are expelled together.

On animal-raising farms, pregnant animals are placed in a special area (staffed by personnel trained in veterinary hygiene) several days before the expected date of labor. In a normal delivery, the fetus is expelled from the birth canal in a longitudinal position, with head and feet extended. Small animals are expelled with folded limbs. A fetus having breech presentation is delivered by carefully pulling the limbs.

The newborn animal is received on clean, dry litter, and its respiratory tract is freed from mucus and amniotic fluid. The mother should be allowed to lick the young’s body. The umbilical cord is tied and cut after pulsations cease in the vessels; the stub of the cord is treated with a disinfectant.

The normal course of labor may be disrupted if the fetus is not properly positioned in the uterus or if it is underdeveloped or deformed. Complications may also arise with the birth of twins and if the mother has a narrow pelvis. In difficult deliveries the veterinarian renders obstetric aid to the animal to conduct the fetus through the birth canal. If it is impossible to extract the fetus in this manner, a special surgical operation must be conducted.

REFERENCE

Studentsov, A. P. Veterinarnoe akusherstvo i ginekologiia. [4th ed.] Moscow, 1970.

V. S. SHIPILOV

Labor

the purposeful activity of a human being, in the process of which tools are used to act on nature and create use values in order to satisfy needs. When considered in such a general aspect, labor is, as K. Marx wrote, “the everlasting nature-imposed condition of human existence, and therefore is independent of every social phase of that existence, or rather, is common to every such phase” (K. Marx and F. Engels, Soch., 2nd ed., vol. 23, p. 195).

Labor has played a decisive role in man’s “coming-to-be.” Analyzing this role, F. Engels emphasized that man owes to labor the division of functions between arms and legs, the development of speech organs, the gradual transformation of the animal brain into a developed, human brain, and the perfection of his sense organs. Engaged in labor, man expanded his circle of perceptions and ideas; his acts of labor came to have a conscious character. The classics of Marxism point out that all history is nothing else but the formation of man through labor.

As a purposeful human activity, labor began with the fashioning of tools. Gradually, the quality of work improved, and labor became more diverse, multifaceted, and complex. In its simplest form, labor requires, aside from its purposeful activity, objects of labor and implements of labor.

Labor involves more than an interaction with nature. In order to produce material wealth, people enter into certain relationships, that is, production relations, with one another. The nature of these relations determines the social character of labor, for with a change in the forms of ownership there is a change in the way labor power is combined with the means of production.

Under the primitive communal system, communal ownership of the means of production determined the production relations. There was no exploitation of man by man. The level of development of the productive forces was so low that the labor expended in the production process was barely sufficient to ensure the reproduction of the labor power. Production relations in slavehold-ing societies were based on the slaveholder’s ownership of the means of production and of the workers themselves. Using ex-traeconomic constraints, the slaveholder was able to appropriate all of the surplus product and part of the necessary product created by the slave. Under feudalism, the basis of the production relations of the society was the feudal lord’s ownership of the land and his partial ownership of the workers (serfs). The principal form of constraint continued to be extraeconomic; the serf, because of his personal dependence on the feudal lord, was forced to labor in the lord’s behalf. Although the serf was able to benefit economically from labor on his own farm, the harshness of the system’s exploitation and the forced character of the labor retarded the development of productive forces.

Under capitalism, where the basis of production relations is formed by the capitalist’s ownership of the means of production, the workers are free citizens enjoying equality under the law. However, lacking the means of production, they are compelled, under the threat of hunger, to sell their labor power to the capitalist. This economic form of constraint guarantees the capitalist a massive and “voluntary” supply of sellers of labor power, power that in turn becomes a commodity. Labor power is sold for specified periods of time for a specified price. On the surface, it appears that the wages received by the worker constitute “payment for labor”; that is, that the worker is being compensated in full for his labor by the capitalist. The way in which wages are paid, that is, so much per hour or per unit of output, as well as the movement of wages, reinforces the mistaken notion that the full value of the functions of labor power—the worker’s labor—is being paid for. Marx showed the actual principle at work behind the outward appearance; he demonstrated that the value of labor power, like the value of any commodity, is determined by the labor that is socially necessary to reproduce the labor power, while wages, being a monetary expression of the value of the commodity known as labor power, usually lag behind the value of this commodity. Over and above the value of the labor power, the worker’s labor creates a surplus value, which is appropriated by the owner of the means of production, that is, the capitalist.

Under the conditions of commodity production, labor has a dual nature. On the one hand, it is concrete, as seen in, for example, the labor of a mechanic or tailor; concrete labor creates the use value of a commodity. At the same time, however, each commodity embodies human labor in a more general sense, labor that is independent of qualitative distinctions. Labor of this type, referred to as abstract labor, forms the value of a commodity. The dual nature of labor reflects the objective contradiction between private and social labor. Under capitalism, labor, in an immediate sense, is private; here, its social character is hidden. Private, capitalist ownership of the means of production serves to separate people from one another. The labor of each individual producer is his private affair. Hence, under capitalism, the labor of individual commodity producers cannot be coordinated on a societal scale. At the same time, the level of the social division of labor that has been reached objectively requires a comprehensive range of relations between commodity producers, and it creates interdependence among producers. Nevertheless, the social character of labor under capitalism manifests itself only in the marketplace, and herein lies one of the profound, antagonistic contradictions of capitalist society. As capitalism develops, the exploitation of hired labor increases, and the class struggle between labor and capital becomes more intense; this is the basic contradiction of capitalism.

Under socialism, the basis of production relations is the public ownership of the means of production. Socialist production relations give rise to new economic laws defining the character, nature, and organization of labor, among them the fundamental economic law of socialism, the law of planned proportionate development of the national economy, and the law of distribution according to labor. In the first phase of communism, labor ceases to be a burden that the individual is forced to bear; labor for one’s self and labor for the society are harmoniously combined; and labor becomes a creative activity performed in the context of socialist cooperation. Socialism guarantees full employment, a combination of material and moral stimulation in labor, an increase in the standard of living of workers and of the people as a whole based on a steady and rapid growth in labor productivity, and a gradual overcoming and resolution of nonantagonistic social distinctions and contradictions in social labor.

V. I. Lenin considered the absence of exploitation of man by man to be one of the most important features of labor under socialism. “For the first time after centuries of working for others, of forced labor for the exploiter, ” wrote Lenin, “it has become possible to work for oneself and moreover to employ all the achievements of modern technology and culture in one’s work” (Poln. sobr. soch., 5th ed., vol. 35, p. 196). The socialist state determines, in planned fashion, the best combination of labor for oneself and labor for the society, establishing the relative amounts of necessary and surplus labor and of consumption and accumulation. Socialist labor cooperation becomes a feature of the economy; it is based on the widespread socialization of production and the use of science and technology to increase labor productivity, improve working conditions, and make work easier. The principal characteristic of labor cooperation under socialism is the development of worker initiative, which manifests itself in various forms of socialist competition. With socialist cooperation, labor is voluntary in nature; labor discipline comes primarily from conviction, and workers are highly conscientious. Socialist labor cooperation harmoniously reconciles the interests of the individual with the interests of society; it also fosters the development of a new and conscientious attitude toward labor.

Under socialism, labor gradually becomes direct social labor. However, for two reasons, direct social labor is still in its first stage of development. In the first place, direct social labor does not include the labor of craftsmen, small tradesmen, and peasants having their own farms; nor does it include the labor of kolkhoz members and industrial and nonindustrial workers performing work on household plots, in markets outside the commercial network of the state, and at home. In the second place, social labor during the first phase of communism is characterized by social heterogeneity. Hence here, as Marx noted, “a given amount of labor in one form is exchanged for an equal amount of labor in another form” (K. Marx and F. Engels, Soch., 2nd ed., vol. 19, p. 19); that is, an exchange of the products of labor is made in accordance with the principle of equivalency.

Under socialism, all members of society who are physically able to work do so. A socialist society has no classes, strata, or social groups that would not take part in socially useful labor or that would live at someone else’s expense. The system of socialist production relations ensures to all a genuine right to labor, that is, a right enjoyed equally by all members of society to have a job and to receive payment for labor in accordance with the labor’s quantity and quality. The right to work is set forth in the constitutions of socialist countries. This right also means that there are opportunities for every worker to acquire a profession and improve his skills. These opportunities are provided by the state, which has organized a vast network of training programs at educational institutions and at the workplace. The industrialization of the country and the collectivization of agriculture have led to the elimination of unemployment.

The social organization and successful development of labor in a socialist economy are possible only when centralization is judiciously combined with the development of democracy and democratic forms and methods of managing social labor. In order to make fuller use of the capacities, talents, and initiative of those taking part in social production, the rights of collectives of enterprises and organizations are being expanded, and the personal, collective, and social interests of the workers are being harmoniously combined. An extremely important feature of the socialist organization of labor is the use of material and moral stimulation. The personal material interests of workers under socialism are conditioned by the social division of labor that has taken shape and by the retention of certain socioeconomic distinctions between various kinds of labor. Among the distinctions are those between rural and urban, mental and physical, skilled and unskilled, heavy and light, and mechanized and manual types of work, as well as between work performed under safe conditions and that performed under hazardous conditions. Society benefits from all types of labor, and it is in society’s interest to see that workers receive general and specialized training, that individual and social labor productivity are increased, and that product quality be at the highest level possible. These goals are achieved through the distribution of wealth according to the quantity and quality of labor and through the use of moral incentives.

Under socialism, labor typically experiences a rapid growth in productivity, making possible an increase in the standard of living of the workers and of the people as a whole. The growth in labor productivity in the national economy has been based on technological advances, changes in the structure of production, and improvements in the organization of both production and labor. The USSR and other socialist countries have achieved great success in increasing labor productivity and in raising the material and cultural level of workers and of the people as a whole.

Under developed socialism, the socioeconomic distinctions (nonantagonistic contradictions) inherent in social labor in the first phase of communism are gradually resolved and overcome (mental and physical, rural and urban). However, so long as the social division and social heterogeneity of labor exist, socioeconomic distinctions will be drawn not only between the labor of workers, peasants, and members of the intelligentsia but also between the different types of labor performed by members of the principal classes of society (workers and peasants) and between different types of labor performed by the intelligentsia. The different types of labor performed by workers in a socialist society are differentiated by the skills required, the physical difficulty, the working conditions, and the tediousness. Inequality in social labor underlies the contradictions associated with a distribution of wealth on the basis of the quantity and quality of labor. On this point, Lenin wrote that the “first phase of communism, therefore, cannot yet provide justice and equality: differences, and unjust differences, in wealth will still persist, but the exploitation of man by man will have become impossible ... the mere conversion of the means of production into the common property of the whole of society (commonly called ’socialism’) does not remove the defects of distribution and the inequality of ’bourgeois law, ’ which continues to prevail so long as products are divided ’according to the amount of labor performed’” (Poln. sobr. soch., 5th ed., vol. 33, pp. 93–94). The socioeconomic distinctions between various types of labor manifest themselves in various aspects of life, and the effects are felt by workers of all classes and groups of a socialist society. Only communism, wrote Marx and Engels, ensures that higher degree of equality within which “a different form of activity, of labor, does not justify inequality, confers no privileges in respect of possession or enjoyment” (K. Marx and F. Engels, Soch., 2nd ed., vol. 3, p. 542).

A socialist society must also resolve the contradictions relating to the social organization and remuneration of labor. Certain contradictions between personal and social interests are inherent in the very relations of socialist distribution: while each participant in production seeks to obtain the maximum payment for his own labor, the interests of the society as a whole demand that the principle of awarding payment on the basis of the quantity and quality of labor be strictly adhered to and that provision be made for ensuring the socialist accumulation necessary for expanded reproduction. Lenin accorded great importance to resolving this contradiction; he linked the very existence of the state under socialism with the need to ensure control over the measure of labor and the measure of consumption: “To this extent, therefore, there still remains the need for a state, which, while safeguarding the common ownership of the means of production, would safeguard equality in labor and in the distribution of products” (Poln. sobr. soch., 5th ed., vol. 33, p. 95).

Contradictions between personal and social interests are also engendered by violations of such economic laws as the law of distribution according to labor, of the replacement of labor expenditures, of the planned development of the national economy, and of value.

The social organization of labor under developed socialism reflects the contradictions arising between rapidly developing productive forces and obsolescent production relations. The scientific and technological revolution, which has been accompanied by an enormous growth in the cultural and educational level and level of skills of workers, is constantly improving society’s productive forces. Production relations do not always keep pace with changes in productive forces. As a result, certain forms and methods used in the social organization of labor and in management, which were once justifiable, occasionally become a force restraining the initiative of workers in social production. The resolution of these contradictions is one of the most important aspects of the economic policies of the CPSU and the state; it is being pursued through a judicious combination of centralized control, on the one hand, and independent action and initiative on the part of enterprises (associations), on the other, through a broadening of the rights of the enterprises, and through an increase in material incentives to workers.

In the higher phase of communism, labor will be considerably different from labor under socialism: “the distinction between the first, or lower, and the higher phase of communism will in time, probably, be tremendous” (V. I. Lenin, ibid., p. 98). The transformation of socialist labor into communist labor presupposes the creation of the material and technical basis for communism, the development of productive forces sufficient to ensure an enormous growth in the productivity of social labor, and the occurrence of profound changes in the nature of labor. These changes will include the emergence and development of a communist division of labor, the elimination of the nonantagonistic contradictions between mental and physical and between rural and urban labor, and, as a consequence, the overcoming of socioeconomic distinctions in labor and of the one-sided nature of labor. The worker will no longer be the direct agent of production; labor will undergo further socialization, and the private household plots of kolkhoz members and industrial and nonindustrial workers will thereby be phased out. Changes in the nature of labor will also affect the household, with women enjoying equality of rights in both society and the family. Labor will be transformed into the most vital human need; the principle “from each according to his ability” will be followed to the fullest possible extent; and there will be a gradual transition to the communist principle of distribution: “to each according to his needs.”

REFERENCES

Marx, K. Kapital, vol. 1. In K. Marx and F. Engels, Soch., 2nd ed., vol. 23.
Marx, K. Naemnyi trud i kapital. Ibid., vol. 6.
Marx, K. K kritikepoliticheskoi ekonomii. Ibid., vol. 13.
Marx, K. Kritika Gotskoiprogrammy. Ibid., vol. 19.
Engels, F. Printsipy kommunizma. Ibid., vol. 4.
Engels, F. Anti-Dühring. Ibid., vol. 20.
Marx, K., and F. Engels. Manifest Kommunisticheskoipartii. Ibid., vol. 4.
Lenin, V. I. Gosudarstvo i revoliutsiia. In Poln. sobr. soch., 5th ed., vol. 33.
Lenin, V. I. “Ocherednye zadachi Sovetskoi vlasti.” Ibid., vol. 36.
Lenin, V. I. “Velikii pochin.” Ibid., vol. 39.
Lenin, V. I. “Kak organizovat’ sorevnovanie?” Ibid., vol. 35.
Lenin, V. I. “Ocherednye zadachi Sovetskoi vlasti.” Ibid., vol. 36. (Original version.)
Lenin, V. I. Rech’ na III Vserossiiskom s”ezde professional’nykh soiuzov, 7 aprelia 1920 g. Ibid., vol. 40.
Lenin, V. I. K chetyrekhletnei godovshchine Oktiabr’skoi revoliutsii. Ibid., vol. 44.
Konstitutsüa (Osnovnoi zakon) SSSR. Moscow, 1975.
Programma KPSS. Moscow, 1976.
Materialy XXV s”ezda KPSS. Moscow, 1976.
Strumilin, S. G. Problemy ekonomiki truda. Moscow, 1957.
Manevich, E. L. Problemy obshchestvennogo truda v SSSR. Moscow, 1966.
Manevich, E. L. V. I. Lenin o trude pri sotsializme i kommunizme. Moscow, 1969.
Podmarkov, V. G. Sotsial’nye problemy organizatsii truda. Moscow, 1969.
Sotsial’no-ekonomicheskie voprosy organizatsii truda. Moscow, 1974.
Trud i zarabotnaiaplata v SSSR, 2nd ed. Moscow, 1974.

E. L. MANEVICH

Labor

A.F.L.-C.I.O.(American Federation of Labor—Congress of Industrial Organizations) federation of autonomous labor unions in North America. [Am. Hist.: NCE, 84]Gompers, Samuel(1850–1924) labor leader; organizer of American Federation of Labor. [Am. Hist.: Jameson, 203]I.W.W.Industrial Workers of the World [Am. Hist.: Hart, 400]International Labor Organization(I.L.O.) agency of the United Nations; aim is to improve labor and living conditions. [World Hist.: EB, V: 389–390]Meany, George (1894–1980)former president of the A.F.L.-C.I.O. [Am. Hist.: NCE, 1733]Marx, Karl (1818–1883)chief theorist of modem socialism stimulated working class’s consciousness. [Ger. Hist.: NCE, 1708]National Labor Relations Boardindependent agency of U.S. government, supporting labor’s right to organize. [Am. Hist.: NCE, 1887]Solidarity(Solidarnosc) Polish labor union movement of the 1980s. [Pol. Hist.: WB, P:541]Teamsterslarge, powerful union of U. S. truckers. [Am. Hist.: NCE, 2703]U.A.W.large American auto workers union. [Am. Hist.: WB, U:21]Wobbliesnickname for I.W.W. members. [Am. Hist.: Hart, 400]

labor

[la´ber] the physiologic process by which the uterus expels the products of conception (fetus or newborn and placenta), after 20 or more weeks of gestation. It may be divided into three stages: The first stage (dilatation) begins with the onset of regular uterine contractions and ends when the cervical os is completely dilated and flush with the vagina, thus completing the birth canal. The second stage (expulsion) extends from the end of the first stage until the expulsion of the infant is completed. The third stage (placental stage) extends from the expulsion of the child until the placenta and membrane are expelled and contraction of the uterus is completed. Called also accouchement and parturition.
Labor is believed to be triggered by the release of oxytocin and prostaglandins, after a fall in the levels of other hormones. Normally at the end of pregnancy oxytocin, which is stored in the posterior lobe of the pituitary gland, is released and stimulates contraction of the uterine muscles.
The progress and final outcome of labor are influenced by four factors: (1) the “passage” (the soft and bony tissues of the maternal pelvis); (2) the “powers” (the contractions or forces of the uterus); (3) the “passenger” (the fetus); and (4) the “psyche” (mother's emotional state, e.g., anxiety).
The mechanisms of labor (for a vertex presentation) consist of the following sequence of events: engagement (posterior occiput of fetus enters the pelvic outlet); flexion (of fetal head); descent (fetal head descends lower into the midpelvis); internal rotation (fetal head and body rotate so that the occiput is more anterior); extension (fetal head extends once the occiput is beneath the symphysis pubis); and external rotation (fetal head rotates back to position it had at engagement).First Stage of Labor. The beginning of labor is usually indicated by one or more of the following signs: (1) show (passage from the vagina of small quantities of blood-tinged mucus); (2) breaking the “bag of waters” (normal rupture of membranes, indicated by a gush or slow leakage of amniotic fluid from the vagina); and (3) true labor contractions. The first two of these signs are almost always unmistakable. The contractions, however, can be confusing. braxton-hicks contractions, or “false labor pains,” can be distinguished from true labor contractions by the irregular time intervals between them and by their tendency to disappear when the patient changes position or gets up and walks about. True labor contractions are regularly spaced and usually start in the small of the back, or as a feeling of tightness in the abdomen, or of pressure in the pelvis. The contractions recur at shorter and shorter intervals, every three to five minutes, and become progressively stronger and longer lasting. The increase in the strength of contractions usually is accompanied by an increase in the amount of show because of rupture of capillaries in the dilating cervix.
This first stage of childbirth is known as the dilatation period. The uterus is like a large rubber bottle with a half-inch long neck that is almost closed. As the uterine muscles contract, the cervix becomes thinner (effacement) and more open (dilated) so that the neck of the uterus eventually resembles that of a jar more than that of a bottle.
The length of the first stage of labor varies with each individual patient, with an average of 8 to 12 hours in primiparous and 6 to 8 hours in multiparous women. It is related to the strength and effectiveness of the contractions and is a period when the mother is instructed to relax as much as possible and let the uterus do the work. Pushing or bearing down is not effective during this stage and is harmful in that it may cause a tearing of the cervix and will only serve to exhaust the woman. She is encouraged to rest and possibly to nap between contractions.
The second stage of labor may be heralded by symptoms of nausea, vomiting, irritability, the urge to bear down, or periods of feeling hot and then cold, signs of the period of transition from the first to the second stage.Second Stage of Labor. This period, called the expulsion stage, usually is characterized by intense contractions that last for about one full minute and occur at 2 to 3 minute intervals. The cervix is fully dilated and the woman is able to help with this process by bearing down with each uterine contraction, using her abdominal muscles to help expel the infant. This stage varies from a few minutes to one to two hours.Third Stage of Labor. In this stage the placenta detaches itself from the uterine wall and is expelled. The process takes about 15 minutes, and is painless.Fourth Stage of Labor. This final stage is the stage of recovery and lasts 2 to 4 hours.Patient Care. Once labor has begun the patient should have someone in constant attendance. She will derive much emotional support from one who is warm, kind, and understanding, and displays a genuine interest in her welfare and that of her infant. It is best to have the same person care for her through the entire labor and birth process.
During labor the strength, frequency, and duration of contractions are noted and recorded. It is expected that the contractions will increase in all three characteristics, but a sudden change in any one should be reported to the health care provider immediately. The rate, regularity, and volume of the fetal heart tones are checked and recorded periodically. Some apprehensive patients may be helped by allowing them to listen to the infant's heartbeat.
Food and fluids are withheld during active labor, but thirst may cause some discomfort and may be lessened by allowing the patient to moisten her lips with a gauze sponge or to suck on ice chips. Intravenous fluids are usually given. Frequent bathing of the face with a cool washcloth often helps relieve the flushed feeling brought about by the actual hard work being done by the mother. Frequent changing of her gown and of the pad protecting the bed linens may be necessary to keep her clean, dry, and comfortable.
If there is a support person with the woman during labor, that person should be instructed in ways he or she can help the patient and at the same time feel that he or she is making some contribution in this very important event. The support person may wish to participate in keeping a record of the contractions, or might appreciate the opportunity to listen to the fetal heart tones occasionally. If the patient feels that sacral support during each contraction helps mitigate the pain, the support person can be shown how to do this. Some supporters have attended classes for expectant parents and are prepared for their role during labor and delivery. Both the patient and the support person should be informed of the progress during labor so they can feel that something is being accomplished by their efforts.
The patient is encouraged to rest and relax between contractions so as to conserve her strength. She should not bear down until the cervix is fully dilated, since this effort will only serve to exhaust her and may cause lacerations of the cervix. After the cervix is fully dilated she can speed the birth process by holding her breath and contracting her abdominal muscles. Controlled breathing exercises learned in classes for expectant parents promote relaxation and aid labor.
Although serious complications rarely develop during labor, they can occur and must be watched for. Observations to report immediately include hyperactivity of the fetus; vaginal bleeding in excess of a heavy show; a rapid and irregular pulse and drop in blood pressure; sudden rise in blood pressure; and headache, visual disturbances, extreme restlessness, or rapidly developing edema. A sudden cessation of contractions or a contraction that does not relax may indicate a serious disturbance in the labor process. The appearance of meconium in the vaginal discharge may indicate fetal distress unless the infant is in a breech position. (See also fetal monitoring.)

Schematic representation of factors believed to have a role in starting labor. From Gorrie et al., 1994.artificial labor induced labor.dry labor a lay term indicating that in which the amniotic fluid escapes before contraction of the uterus begins.false labor false pains.induced labor that which is brought on by extraneous means, e.g., by the use of drugs that cause uterine contractions; called also artificial labor.instrumental labor delivery facilitated by the use of instruments, particularly forceps.missed labor that in which contractions begin and then cease, the fetus being retained for weeks or months.precipitate labor delivery accomplished with undue speed.premature labor expulsion of a viable infant before the normal end of gestation; usually applied to interruption of pregnancy between the twenty-eighth and thirty-seventh weeks.preterm labor labor commencing before the end of 37 completed weeks of gestation; it can be arrested (see tocolysis) and does not necessarily lead to preterm delivery. Preterm labor can be treated by bed rest at home and use of a tokodynamometer with a recording unit that transmits data about uterine activity over the telephone to a monitoring station. Tocolytic drugs, including ritodrine hydrochloride and terbutaline, may be used to relax the uterine muscles.spontaneous labor delivery occurring without artificial aid.

la·bor

, stages of labor (lā'bŏr), The process of expulsion of the fetus and the placenta from the uterus. The stages of labor include: first stage, beginning with the onset of uterine contractions through the period of dilation of the os uteri; second stage, the period of expulsive effort, beginning with complete dilation of the cervix and ending with expulsion of the infant; third stage or placental stage, the period beginning at the expulsion of the infant and ending with the completed expulsion of the placenta and membranes. [L. toil, suffering]

labor

(lā′bər)n.1. Physical or mental exertion, especially when difficult or exhausting; work.2. The process by which childbirth occurs, beginning with contractions of the uterus and ending with the expulsion of the fetus or infant and the placenta.v. la·bored, la·boring, la·bors v.intr. To undergo the labor of childbirth.

la′bor·er n.

labor

Parturition Obstetrics The physiologic process that results in the expulsion of a conceptus and placenta from the uterus via the cervix and vagina. See Back labor, False labor, Prechaotic labor, Precipitate labor, Prolonged labor Vox populi Work. See Child labor.

la·bor

, stages of labor (lā'bŏr, stājĕz) The process of expulsion of the fetus and the placenta from the uterus. The stages of labor are: first stage, beginning with the onset of uterine contractions through the period of dilation of the os uteri; second stage, the period of expulsive effort, beginning with complete dilation of the cervix and ending with expulsion of the infant; third stage, or placental stage, the period beginning at the expulsion of the infant and ending with the completed expulsion of the placenta and membranes.
Synonym(s): labour. [L. toil, suffering]

labor

(la'bor) [L., labor, hard work]

SEQUENCE OF LABOR AND CHILDBIRTHIn pregnancy, the process that begins with the onset of repetitive and forceful uterine contractions sufficient to cause dilation of the cervix and ends with delivery of the placenta. Synonym: childbirth; parturition See: illustration

Traditionally, labor is divided into three stages. The first stage of labor, progressive cervical dilation and effacement, is completed when the cervix is fully dilated, usually 10 cm. This stage is subdivided into the latent phase and the active phase.

First stage (stage of dilation): This is the period from the onset of regular uterine contractions to full dilation and effacement of the cervix. This stage averages 12 hr in primigravidas and 8 hr in multiparas.

The identification of this stage is particularly important to women having their first baby. Its diagnosis is complicated by the fact that many women experience false labor pains, which may begin as early as 3 to 4 weeks before the onset of true labor. False labor pains are quite irregular, are usually confined to the lower part of the abdomen and groin, and do not extend from the back around the abdomen as in true labor. False labor pains do not increase in frequency and duration with time and are not made more intense by walking. The conclusive distinction is made by determining the effect of the pains on the cervix. False labor pains do not cause effacement and dilation of the cervix as do true labor pains. See: Braxton Hicks contractions

A reliable sign of impending labor is show. The appearance of a slight amount of vaginal blood-tinged mucus is a good indication that labor will begin within the next 24 hours. The loss of more than a few milliliters of blood at this time, however, must be regarded as being due to a pathological process. See: placenta previa

Second stage (stage of expulsion): This period lasts from complete dilatation of the cervix through the birth of the fetus, averaging 50 min in primigravidas and 20 min in multiparas. Labor pains are severe, occur at 2- or 3-min intervals, and last from a little less than 1 min to a little more than 112 min.

Rupture of the membranes (bag of water) usually occurs during the early part of this stage, accompanied by a gush of amniotic fluid from the vagina. The muscles of the abdomen contract involuntarily during this portion of labor. The patient directs all her strength to bearing down during the contractions. She may be quite flushed and perspire. As labor continues the perineum bulges and, in a head presentation, the scalp of the fetus appears through the vulvar opening. With cessation of each contraction, the fetus recedes from its position and then advances a little more when another contraction occurs. This continues until more of the head is visible and the vulvar ring encircles the head like a crown (therefore often called crowning).

At this time the decision is made concerning an incision in the perineum (episiotomy) to facilitate delivery. If done, it is most commonly a midline posterior episiotomy. When the head is completely removed out of the vagina it falls posteriorly; later the head rotates as the shoulders turn to come through the pelvis. There is usually a gush of amniotic fluid as the shoulders are delivered.

Third stage (placental stage): This is the period following the birth of the fetus through expulsion of the placenta and membranes. As soon as the fetus is delivered, the remainder of the amniotic fluid escapes. It will contain a small amount of blood. Uterine contractions return, and usually within 8 to 10 min the placenta and membranes are delivered. After this, there is some bleeding from the uterus. The amount may vary from 100 to 500 ml.

The amount of blood loss will vary with the size of the fetus, but the average is 200 ml. The probability that blood loss will exceed 500 ml is increased with a large fetus or multiple fetuses, as the placental attachment area on the uterine wall is larger and the uterus is more distended, meaning it does not contract as well after delivery of the fetus, placenta, and membranes. The above probability is less than 5% if the fetus weighs 5 lb (2268 g) or less. Other factors such as episiotomy or perineal laceration will also affect the amount of blood loss. See: birthing chair; Credé method for assisting with the expulsion of the placenta

Patient care

Often pregnant women and their partners or a labor coach who will be with them attend prenatal classes taught by obstetrical nurses to prepare the patient and family for labor, delivery, and care of the newborn. Such classes include exercises; breathing techniques; supportive care measures for labor, delivery, and the postpartum period; and neonatal care and feeding techniques. Expectant couples (or the pregnant woman and a support person) should attend classes together. The goals of expectant parent education are the birth of a healthy infant and a positive experience for the woman/couple. Labor and delivery may take place in a hospital, birthing center, or at home. Hospitals offer care in traditional labor and delivery rooms and, increasingly, in birthing rooms that simulate a homelike environment. Prenatal records are made available in order to review medical, surgical, and gynecological history; blood type and Rh; and esp. any prenatal problems in the pregnancy. If the mother is Rh negative and if the Rh status of the fetus is unknown or positive, the nurse will administer Rh immune globulin to the mother within 72 hr after delivery.

As part of the admission workup of the laboring woman, the nurse assesses vital signs, height and weight, fetal heart tone and activity, and labor status, i.e., condition of membranes, show, onset time of regular contractions, contraction frequency and duration, and patient anxiety, pain, or discomfort). Initial laboratory studies are carried out according to protocol. The obstetrician, resident physician or other house staff, nurse-midwife, lay midwife, or obstetrical nurse examines the patient, depending on the site and policy. The abdomen is palpated to determine fetal position and presentation (Leopold maneuvers), and a sterile vaginal examination determines cervical dilatation and effacement, fetal station, and position of the presenting part. The attending nurse or midwife monitors and assesses fetal heart rate and the frequency and duration of contractions, using palpation and a fetoscope or electronic monitoring. The frequency of assessment and repetition of vaginal examination are determined by the patient's labor stage and activity and by fetal response. In the past, admission to a labor suite usually included a perineal shave and enema in preparation for delivery, but these procedures have been largely discontinued and are currently done only if prescribed for a particular patient. The patient should urinate and have a bowel movement, if possible. Bladder distention is to be avoided, but catheterization is carried out only if all other efforts to encourage voiding in a patient with a distended bladder fail. The perineum is cleansed (protecting the vaginal introitus from entry of cleansing solutions) and kept as clean as possible during labor. Special cleansing is performed before vaginal examination and delivery, as well as after expulsion of urine or feces.

First stage: The patient may be alert and ambulating, depending on membrane status, fetal position, and labor activity. Electrolyte-rich oral liquids may be prescribed, or intravenous therapy initiated. The nurse supports the patient and her partner or other support person and monitors the progress of the labor and the response of the fetus, notifying the obstetrician or midwife of any abnormal findings. When membranes rupture spontaneously or are ruptured artificially by the midwife or obstetrician, the color and volume of the fluid and the presence of meconium staining or unusual odor are noted. To distinguish it from a sudden spurt of urine having a slightly acid pH, the fluid may be tested for alkaline pH using nitrazine paper. The fetal heart rate, an indicator of fetal response to the membrane's rupture, is noted. Noninvasive pain relief measures are provided, prescribed analgesia is administered as required by the individual patient, and regional anesthetic use is monitored. Patient-controlled epidural anesthesia (PCEA) or continuous epidural anesthesia is frequently employed, based on patient satisfaction regarding its timeliness and effectiveness, and the patient's preference for having pain management under her control.

Second stage: The patient may deliver in any agreed-on position, including lithotomy or modified lithotomy, sitting, or side lying, in a birthing chair, in a birthing bed, or on a delivery table. The nurse, midwife, or physician continues to monitor the patient and fetus; prepares the patient for delivery (cleansing and draping); sets up delivery equipment; and supports the father or support person (positioned near the patient's head), positioning the mirror or TV monitor to permit viewing of delivery by the couple. The nurse also notes and documents the time of delivery, determines the infant’s Apgar score, and provides initial infant care after delivery, including further suctioning of the nasopharynx and oropharynx as necessary (initial suctioning is done by the deliverer before delivering the infant's shoulders), drying and warming the infant (head covering, blanket wrap, or thermal warmer), application of cord clamp (after the deliverer double-clamps the cord and cuts between the clamps), and positive identification (footprints of infant and thumb prints or fingerprints of mother, and application of numbered ankle and wrist band to the infant and wrist band to the mother). Eye prophylaxis for gonorrhea and Chlamydia may be delayed up to 2 hr to facilitate eye contact and to enhance maternal-infant bonding, or may be refused by the parents, on signing of an informed consent. An Apgar score of the infant's overall condition is obtained at 1 min and 5 min after the birth. The infant in good condition is placed on the mother's chest or abdomen for skin to skin contact. This position enhances bonding and maintains infant warmth. Alternately, the infant is put to the breast, and the woman/couple is encouraged to inspect and interact with the infant. An infant in distress is hurried to the nursery, usually with the father or support person attending, so that specialized care can be provided by nursery and neonatal-nurse specialists, and a pediatrician. If the infant is critically ill, its birth may be attended by a chaplain, and photographs may be taken to assist the parents in dealing with the life, critical time, and possible death of the infant.

Third stage: The nurse continues to monitor the status of the patient and the fundus through delivery of the placenta and membranes (documenting the time), examination of the vagina and uterus for trauma or retained products, and repair of any laceration or surgical episiotomy. The placenta is examined to ascertain that no fragments remain in the uterus. The perineal area is cleansed and the mother is assisted to a comfortable position and covered with a warm blanket.

Fourth stage: The nurse continues to observe the patient closely and is alert for hemorrhage or other complications through frequent assessment, including monitoring vital signs, palpating the fundus for firmness and position in relation to the umbilicus at intervals (determined by agency policy or patient condition), and massaging the fundus gently or administering prescribed oxytocic drugs to maintain or assist uterine contraction and to limit bleeding. The character (including presence, size, and number of clots) and volume of vaginal discharge or lochia are assessed periodically; the perineum is inspected and ice applied as prescribed, and the bladder is inspected, palpated, and percussed for distention. The patient is encouraged to void, and catheterization is performed only if absolutely necessary. The nurse notifies the obstetrician or midwife if any problems occur or persist. This period also is used for parent-infant bonding, because the infant is usually awake for the first hour or so after delivery. The mother can breast-feed if she wants to, and the immediate family couple can inspect the infant. The nurse supports the family's responses to the newborn, as well as to the labor and delivery experience. The infant is then taken to the nursery for initial infant care.

Early postpartum period: Once the infant's temperature has stabilized, measurements have been taken (length, head and chest circumference, weight), and other prescribed care carried out, the infant may be returned to the mother's side (in its crib carrier). The nurse continues to assess the mother's physical and psychological status after delivery, checking the fundus, vulva, and perineum according to policy; inspects the mother's breasts and assists her with feeding (whether by breast or bottle) and with measures to prevent lactation as desired; helps the mother to deal with other responsibilities of motherhood; and carries out the mandated maternal teaching program, including providing written information for later review by the patient. In hospitals or birthing centers, the nurse prepares the mother for early discharge to the home setting and arranges for follow-up care as needed and available. In many settings, the nurse makes follow-up calls or visits to the mother during the early postpartum period or encourages her to call in with concerns, or she may receive follow-up visits by a caregiver from her health maintenance organization. The mother may also be referred to support groups, such as the La Leche League, Nursing Mothers' Club, and others as available in the particular community.

active labor

Regular uterine contractions that result in increasing cervical dilation and descent of the presenting part. This encompasses the active phase of stage 1, as well as stages 2 and 3 of labor.

arrested labor

Failure of labor to proceed through the normal stages. This may be due to uterine inertia, obstruction of the pelvis, or systemic disease.

artificial labor

Induction of labor.

augmented labor

Induction of labor.

back labor

Labor involving malposition of the fetal head with the occiput opposing the mother's sacrum. The laboring woman experiences severe back pain. See: persistent occiput posterior

complicated labor

Labor occurring with an accompanying abnormal condition such as hemorrhage or inertia.

dry labor

A colloquial, imprecise term for labor associated with extensive loss of amniotic fluid related to premature rupture of membranes.

dysfunctional labor

Abnormal progress of dilation and/or descent of the presenting part.

false labor

Uterine contractions that occur before the onset of labor. The contractions do not result in dilation of the cervix. They may resolve spontaneously or continue until effective contractions occur and labor begins. Synonym: missed labor (1) See: Braxton Hicks contractions

hypertonic labor

A condition in which frequent, painful, but poor-quality contractions fail to accomplish effective cervical effacement and dilation. Hypertonicity usually occurs in the latent phase of labor and most often is related to fetal malpresentation and cephalopelvic disproportion.

hypotonic labor

A condition during the active phase of labor in which contractions are inadequate in frequency, intensity, and duration and are ineffective in causing cervical dilation, effacement, or fetal descent. Hypotonicity usually occurs after the woman has entered the active phase of labor and most often is related to uterine overdistention, fetal macrosomia, multiple pregnancy, or grand multiparity.

instrumental labor

Labor completed by mechanical means, e.g., the use of forceps or vacuum assist.

missed labor

1. False labor.2. Labor in which true labor pains begin but subside. This may be a sign of a dead fetus or extrauterine pregnancy.

normal labor

Progressive dilation and effacement of the cervix with descent of the presenting part.

obstructed labor

Interference with fetal descent related to malposition, malpresentation, and cephalopelvic disproportion.

precipitate labor

Labor marked by sudden onset, rapid cervical effacement and dilation, and delivery within 3 hr of onset.

premature labor

Preterm labor

preterm labor

Labor that begins before completion of 37 weeks from the last menstrual period. The condition affects 7% to 10% of all live births and is one of the most important risk factors for preterm birth, the primary cause of perinatal and neonatal mortality. Although associated risk factors do exist, in most cases the cause is unknown. Synonym: premature laborpremature rupture of membranes; prematurity;

Note: Treatment for active premature labor is best managed in a regional perinatal intensive care center, where staff members are prepared to handle the required care and treatment, and so that the neonate can remain in the same setting as the mother, rather than being transferred alone for neonatal intensive care after delivery.

Patient care

In-hospital management: The patient is prepared for the use of cardiac, uterine, and fetal monitors along with intravenous therapy. Maternal vital signs and fetal heart rate (FHR) are monitored. If prescribed a tocolytic agent (beta-adrenergic drug) is administered intravenously; the infusion rate is increased every 10 to 30 min, depending on uterine response, but never exceeds a rate of 125 ml/hr. Uterine activity is monitored continuously; vital signs and FHR are checked every 15 min. Maternal pulse should not exceed 140/min; FHR should not exceed 180 bpm. When counting respiratory rate, breath sounds are noted, and the lungs are auscultated at least every 8 hr. The patient is assessed for desired response and adverse effects to treatment and is taught about symptoms she may expect and should report. If signs of drug toxicity occur, the medication is stopped. The intravenous line is kept open with a maintenance solution, and the prescribed beta-blocker as an antidote is prepared and administered. The patient is placed in high Fowler's position, and oxygen is administered. Cardiac rate and rhythm, blood pressure, respiratory rate, auscultatory sounds, and FHRs are closely monitored to evaluate the patient's response to the antidote. If no complications are present, absolute bed rest is maintained throughout the infusion, with the patient in a left-lateral position or supine with a wedge under the right hip to prevent hypotension. Antiembolism stockings are applied, and passive leg exercises are performed. A daily fluid intake of 2 to 3 L is encouraged to maintain adequate hydration, and fluid intake and output are measured. The patient is weighed daily to assess for overhydration. The patient is instructed in methods to deal with stress. Health care providers should respond to parental concern for the fetus with empathy, but never with false reassurance. Fetal fibronectin enzyme immunoassay may be carried out on a sample of vaginal secretions taken from the posterior vaginal fornix; the patient should understand that this test can help assess the risk of preterm delivery within 7 days from the sampling date. As prescribed, a glucocorticoid is administered to stimulate fetal pulmonary surfactant production.

Patients who undergo in-house therapy often receive magnesium sulfate, which helps restore the patient's beta-2 receptor sensitivity (thus improving the effectiveness of terbutaline) and decrease uterine contractions. The patient may be discharged on oral or subcutaneous tocolytic therapy. Intravenous therapy may be employed using a portable micropump that can deliver a basal rate or programmed intermittent bolus doses at predetermined times when the patient's circadian rhythms are known to increase uterine activity.

Home management: The plan for at-home care must target individuals whom the woman can call upon to help with home management. A social service referral can help the family access available community and financial assistance. Home health care nurses assist the patient to carry out the plan, provide ongoing emotional support, and evaluate fetal and patient response to therapy.

The treatment regimen is reviewed with the family, and written instructions are provided to help those involved to cooperate. The patient is maintained on bed rest (left-side, supine, with head on small pillow, feet flat or elevated) to increase uterine perfusion and to keep fetal pressure off the cervix. The patient usually is allowed out of bed only to go to the bathroom. The women's physical and psychological rest are the highest priority, as anxiety is known to compromise uterine blood flow. Paid or voluntary helpers must care for other children and all household chores. The patient's tocolytic therapy (most frequently using terbutaline) is scheduled around the clock (with food if desired), and the patient is taught about its action and adverse effects. The patient must be able to count her pulse, and is instructed to report a rate above 120/min. The patient also is taught about symptoms to report (palpations, tremors, agitation, nervousness) and how to palpate for contractions twice each day. Home uterine activity monitoring may be employed, with the patient or home health care provider recording uterine activity for an hour twice daily. The perinatal nurse analyzes the results. If contractions exceed a predetermined threshold, the patient is advised to drink 8 to 12 ounces of water, rest, then empty her bladder and monitor uterine activity for another hour. The process can reduce unnecessary visits to the medical setting, and increase the patient's peace of mind. The patient is encouraged to drink water throughout the day to prevent dehydration and reduce related uterine irritability. She also is warned not to take over the counter drugs without her obstetrician's approval. The patient is taught how to use sedation, if prescribed. Avoidance of activities that could stimulate labor is emphasized; these include sexual and nipple stimulation. Personal hygiene is reviewed, and the patient is made aware of signs of infection to report. A nonstress test may be performed weekly at home or in a medical setting, depending on the acuity of the situation and on maternal health factors (diabetes, pregnancy-induced hypertension [PIH]). The patient usually is provided with a 24-hr phone link to perinatal nurses in the health care system, who may contact her twice daily to discuss her situation. She is taught what to do in an emergency (bright red bleeding, membrane rupture, persisting contractions, decreased or absent fetal activity). If an incompetent cervix has been diagnosed based on the patient’s history, insertion of a purse-string suture (cerclage) as reinforcement at 14 to 18 weeks gestation may prevent premature labor. If labor is inevitable, it is carried out as for a low-birth-weight, readily compromised fetus. During the postpartum period, care focuses on helping the family to understand their infant's special needs, and to participate as fully as possible in care, or, in a worst-case scenario, to come to terms with the baby's death. In such a case, the family is assisted in their grieving, with encouragement to hold the swaddled infant, and look at pictures of the child if they are able. Psychological counseling may be required.

primary dysfunctional labor

protracted labor.

prodromal labor

The initial changes that precede actual labor, usually occurring 24 to 48 hr before the onset of labor. Some women report a surge of energy. Findings include lightening, excessive mucoid vaginal discharge, softening and beginning effacement of the ripe cervix, scant bloody show associated with expulsion of the mucus plug, and diarrhea.

prolonged labor

Abnormally slow progress of labor, lasting more than 20 hr. See: dystocia

prolonged latent phase labor

Abnormally slow progress of the latent phase, lasting more than 20 hr in a nullipara or 14 hr in a multipara. See: dystocia

protracted labor

Abnormally slow dilation of the cervix in the active phase of labor; defined as less than 1.2 cm/hr in a nullipara and 1.5 cm/hr in a multipara. Synonym: protraction disorder, protracted labor, primary dysfunctional labor.
See: arrested labor; precipitate labor

spontaneous labor

Labor that begins and progresses without pharmacological, mechanical, or operative intervention.

stage I labor

labor;

stage II labor

labor;

trial of labor

Permitting labor to continue long enough to determine if normal vaginal birth appears to be possible, e.g., in vaginal birth after cesarean delivery.

Labor

The process during which the uterus contracts, and the cervix opens to allow the passage of a baby into the vagina.Mentioned in: Placenta Previa, Placental Abruption

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Bibliography

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REFERENCES

REFERENCE

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REFERENCES

Labor

labor

labor

la·bor

labor

labor

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Patient care

active labor

arrested labor

artificial labor

augmented labor

back labor

complicated labor

dry labor

dysfunctional labor

false labor

hypertonic labor

hypotonic labor

instrumental labor

missed labor

normal labor

obstructed labor

precipitate labor

premature labor

preterm labor

Patient care

primary dysfunctional labor

prodromal labor

prolonged labor

prolonged latent phase labor

protracted labor