Stages of labor:
Stage 1 its important to monitor fetal heart rate, contractions and cervical changes
2 phases:
Latent phase:
o begins when women feel regular frequent contractions
o cervix dilates 0 to 4-6 cm in a woman who has never had babies be4, this might take
up to 20hrs + in a woman who has had babies be4, it should take up to 14 hrs.
o in cervical dilation when a woman begins to feel regular cintractio, the cervix thins
out cervical effacement ( thinning and stretching from disulfide bonds breaking)
near complete.
Active phase:
o cervix dilates in a faster rate from 6 to 10 cm (1.2 cm/hr for a woman who has never
had babies be4and 1.5cm/hr for a woman who has had babies be4)
o the cervix reaches its maximum dilation of 10 cm
o length of active phase is determined by the frequency/amplitude of the contractions,
size/position of baby, woman’s pelvis and nulli/multi.
o Dilation ends when 6cm dilation + rupture of membranes + no cervical changes after
4 hrs of continues contractions OR 6 hrs of being on Oxytocin.  3 criteria to complete
this stage.
Stage 2:
Complete dilation to the delivery.  Up to 3 hrs in nulli and 2 hrs in multi.
Monitor fetal heart rate and position through birth canal. How to measure position through
the birth canal? Fetal station : top of fetus’ head from horizontal line(0.4 fetal satge btw
ischial spines in cm.
Sth I miss
There are 4 sub-stages of stage 2:
1. presentation of head
2. rotation and delivery of the anterior shoulder
3. delivery of P shoulder
4. delivery of lwer body and umbilical cord.
Stage 3:
The point of infant delivery to placenta delivery.
Takes up to 30 mins
Management during this stage:
Active management uterotonic drug “oxytocin” control traction of umbilical cord, fundal
massage.
How to know placenta separated from uterus wall?
Fundal height increases, cord lengthens, lots of blood.
Postnatal/postpartum stage:
Monitor mother for signs of bleeding for hemodynamic stabilization.
Repair episiotomy or perineal tears with stitches.
Skin to skin contact after baby assessment to achieve the normal skin flora from the mother
Expecting mothers to get afterpains ( cramps) for days and vaginal discharge for weeks.
Screen for postpartum blues and depression due to hormonal changes.