Process and Stages of Labor and
Birth
Sarah Alkhaifi
Nursing/ Midwifery intervention during
Second stage of labor
Nursing management
• Second stage of labor
• Provide privacy (curtain, draping, information)
• Encourage woman to share her feeling.
• Teach woman prenatally about benefits of upright
positions
• During labor, encourage woman to change positions
frequently; suggested positions include squatting,
semi-recumbent, standing, and upright kneeling
Positioning During labor
Nursing management
• Allow woman to rest until she feels an urge to push
• Encourage spontaneous bearing down
• Support, rather than direct, the woman’s involuntary
pushing efforts
• Discourage prolonged maternal breath holding
• Monitor fetal heart (base line, variability, aceleration,
deceleration)
• Monitor the uterine contractions (intensity, duration)
instruct the woman to push in according to the uterine
contraction.
Interpret the following CTG
Nursing management
• Assess the effectively of maternal pushing through
comparing the bearing down with the fetal head
descending.
• place one hand (non dominant) on the fetal head to
avoid rapid extension.
• Support perineum during crowning with sterile pad.
• Assess if there is indication for Episiotomy.
Perennial support and control head extension
As the fetal head pushes down, the perineum bulges. This sign
indicates that birth is imminent. (Copyright © Barbara Proud.)
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The
fetal head is face down, in normal occiput anterior position. C,
D: Extension of the fetal head (right occiput anterior position). E: Birth of
the shoulders. F: Emergence of the rest of the fetal body, including the
umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The
fetal head is face down, in normal occiput anterior position. C,
D: Extension of the fetal head (right occiput anterior position). E: Birth of
the shoulders. F: Emergence of the rest of the fetal body, including the
umbilical cord.
Episiotomy.
Nursing management
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Check if umbilical cord present around the neck of baby. (loss, tight).
Loss the umbilical cord in case the umbilical cord around the fetal neck.
Let the fetus’s head to rotate (external rotation)
Place your hand in each said of baby’s head and pull the fetal head
downward to deliver the anterior shoulder ,then apply upward traction to
deliver posterior shoulder.
Deliver the rest of the newborn body, and place the fetal on the
mother’s ABD.
Inject 5 U of oxytocin IM after delivery of anterior shoulder.
Cut and clamp umbilical cord. (technique).
Perform APGAR assessment for the newborn.
Perform immediate newborn care (see the lab) 
Collect umbilical cord blood (bilirubin ,blood culture, Blood gases, carbon dioxide, and pH levels,
Blood sugar level, Blood type and Rh, CBC, Platelet count)
What do you know about late VS early umbilical cord clamping?
Normal vaginal birth sequence. A: Early crowning. B: Late crowning.
The fetal head is face down, in normal occiput anterior position. C,
D: Extension of the fetal head (right occiput anterior
position). E: Birth of the shoulders. F: Emergence of the rest of the
fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head
is face down, in normal occiput anterior position. C, D: Extension of the fetal head
(right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest
of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal
head is face down, in normal occiput anterior position. C, D: Extension of the
fetal head (right occiput anterior position). E: Birth of the
shoulders. F: Emergence of the rest of the fetal body, including the umbilical
cord
Normal vaginal birth sequence. A: Early crowning. B: Late crowning.
The fetal head is face down, in normal occiput anterior position. C,
D: Extension of the fetal head (right occiput anterior position). E: Birth
of the shoulders. F: Emergence of the rest of the fetal body, including
the umbilical cord
EBP
APGAR Assessment
Third stage of labor
Third stage of labor
• From complete fetal delivery till complete separation
of the placenta.
• Up to 30 minutes for placental separation
• Mechanism of separation
Firm uterine contraction
Deceasing in the uterine surface area
Bleeding and hematomah
Third stage of labor
• Signs of placental
separation
1.Globular shaped uterus
2. Rise of fundus
3. Gush of blood
4. Lengthening of cord
• Do not pull on
cord !.... Why?
Placental Delivery
Placenta Delivery
• After signs of placenta separation
signs the mother may bear down.
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• Controlled Cord Traction(CCT).
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3
Placenta (fetal side)
Placenta (Maternal side)
Nursing Intervention During
Third Stgae of Labor
Fourth Stage of Labor
Fourth Stage of Labor
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1- 4 hrs after delivery
Time of recovery
After pains
Hunger and thirst
At risk for atony and hemorrhage
Promote bonding and attachment
Nursing Intervention During
Fourth Stage of Labor
References
http://www.uptodate.com/contents/managementof-normal-labor-anddelivery?source=search_result&search=manageme
nt+normal+labor&selectedTitle=1~150#H28