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 Revised Fall 09 Page 1 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 Revised Fall 09 Page 2 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 Revised Fall 09 Page 3 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 Revised Fall 09 Page 4