STAGES OF LABOR
FIRST STAGE – THE DILATATION STAGE
This is the longest phase and it varies from patient to patient. This period
begins with the onset of true labor contractions and ends when complete
dilatation of the cervix. It can last from 2 to 16 hrs or longer depending on
the individual. There are three phase to this stage.
The Latent phase is the first phase which begins with true contractions, cervical effacement
and dilatation. This phase ends when the patient reaches 3cm. The uterine contractions are
mild occurring about every 5 minutes lasting for 30-45 seconds. She will describe the
contractions as painful menstrual cramps with low back pain. During this time the female
usually stays at home and is sociable and active. She may pass her mucus plug during this
time period. This phase can last as long as 14 hrs.
The Active phase of labor becomes more intense for the female. She will dilate from 3 to 7cm
and cervical effacement will take place. The contractions are stronger occurring every 3-5
minutes lasting for 60 seconds and are moderate to strong in intensity. This phase advances at
a pace 1cm/hr dilatation for a nulliparous and 1.5cm/hr for a multip. The female is now more
focused and drawn inward so she can cope with the demands of labor. This is when you may
need to provide support by coaching her through each contraction.
The Transition phase is extremely intense period. The contractions are strong occurring every
2-3 minutes lasting 60-90 seconds. She will completely dilate and efface during this period. She
will complain of rectal pressure and the urge to push as the baby progresses forward in the
birth canal. You will notice an increase in bloody show and SROM if her membranes have not
already ruptured. The female often has difficultly coping and can become very emotional and
tired.
Nursing support during this stage will depend on the female and her needs
Nursing interventions
Labor support
Promotion of comfort through position changes, personal hygiene, utilization of
relaxation techniques
Administration of medications as needed
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SECOND STAGE
This stage begins with complete dilatation of the cervix and ends with the birth of the infant.
Duration can be as short as a few minutes and as long as 2 hours. She will experience strong
intense contractions lasting 60 sec. every 1 to 2 minutes. The intense contractions in
combination with the pushing will move the newborn through the birth canal. Rectal bulging with
flattening of perineum will occur as the newborn begins to crown.
HOW SHE MAY FEEL
Increasingly involved in the birth process.
Relief because second stage has begun
Desire to bear down or push
Tremendous satisfaction with each push or, conversely, acute pain with each push
Desire to move bowels
Complete exhaustion after each expulsive contraction
Unable to follow directions readily
Desire to participate fully in birth process or, conversely, to be “put to sleep”
A splitting or burning sensation due to extreme vaginal stretching as baby is born
WHAT SHE MAY DO
Notify nurse of desire to bear down
Spontaneously respond to the urge to push
Rest between contractions
Request pain meds
If scared may refuse to push
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THIRD STAGE
This stage begins with the birth of the infant and ends with the delivery of the placenta.
Duration is usually takes 5-10 minutes, but it can take as long as 30 minutes. As the placenta
begins to separate the uterus should be firm, globelike in shape and rising upward in the
abdomen. You should notice a gush of blood and a visible lengthening of the umbilical cord as
the placenta moves into vagina
HOW SHE MAY FEEL
Exhausted
Elated and proud of achievement
Focused on newborn
Delight that abdomen is flat
Ravenously hungry Thirsty
WHAT SHE MAY DO
Bond with newborn
Attempt to breastfeed
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FOURTH STAGE – THE RECOVERY STAGE
This period begins with the expulsion of the placenta and ends 2 hours post-delivery
NURSING ASSESSMENT
Perform overall general physical assessment of client
fundal height, consistency, and location every 15 minutes during first hour
Assess lochia with the client supine and in lateral position
Episiotomy for swelling / bleeding
Perineum for integrity and amount of swelling
BP and pulse every 15 minutes for 1 hour, or until stable, then every 30 minutes
times two
Bladder for distention – encourage to void
Amount of discomfort and medicate as needed
IV site and rate
NURSING INTERVENTIONS
Comfort measure- warm blanket, pillows, light snack, fluids
Share in the excitement and joy of the birth
Facilitate bonding and breastfeeding
Provide ice packs / peri care
Encourage voiding; if unable catheterize and record amount
Educate patient regarding after pains, lochia, fundal checks and massaging
Transfer client to post-delivery unit when her condition stabilizes
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