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First Stage

The first stage of labor is divided into three phases: the latent, the active, and the transition phase.

This stage starts at the onset of regularly perceived uterine contractions and ends when rapid cervical dilation begins. This is also called the preparatory phase.
Contractions Duration of Contractions Cervical Dilation Duration

Mild and short 20 to 40 seconds

0-3 cm

Nullipara: 6 hours

Multipara: 4.5 hours

Woman with a non-ripe cervix will have a longer than usual latent phase Analgesia given too early during this period may prolong this phase Woman who is psychologically prepared for labor only have minimal discomfort Best time to reinforce health teachings

Active Phase
During the active phase, cervical dilatation occurs more rapidly and contractions grow stronger.
Contractions Duration of Contractions Cervical Dilation Duration

Stronger, longer and causestrue 40 to 60 seconds every 3 to 5 4 to 7 cm minutes discomfort

Nullipara: hours

Multipara: hours

It is an exciting time because a woman realizes something dramatic is happening Administration of analgesic at this point has little effect on the progress of labor Show and spontaneous rupture of membranes occur during this time

Transition Phase
During this phase, the contractions reach their peak intensity, cervix to maximum dilatation and to full effacement.
Contractions Duration of Contractions Cervical Dilation Duration

At peak intensity 60 to 90 seconds every 2-3 minutes 8 to 10 cm

Until full cervical dilation

If membranes have not previously ruptured or been ruptured by amniotomy, they will rupture as a rule at full dilation. Both full dilation and cervical effacement have occurred at this stage Woman may have intense discomfort and may be accompanied by nausea and vomiting. Woman may experience a feeling of loss of control, anxiety, panic or irritability. Her focus is on the entirety of delivering her baby. This stage ends at 10 cm of dilatation and feels a new sensation (i.e., irresistible urge to push).

Second Stage
The second stage starts from full dilatation and cervical effacement to birth of the infant; with uncomplicated birth, this stage takes about 1 hour.Contractions change to an overwhelming, uncontrollable urge to push or bear down with each contraction as if to move her bowels. Patient may experience nausea and vomiting at this point. The fetal head touches the internal side of the perineum; the perineum begins to bulge and appears tense. The anus may become everted and stool may be expelled. As the fetal head pushes against the perineum, the vaginal introitus opens and the fetal scalp appears at the opening to the vagina. At first, it appears slit-like then becomes oval and then circular. This is called crowning. All of her energy and her thoughts are being directed towards giving birth. As she pushes, using her abdominal muscles to aid the involuntary uterine contractions, the fetus is pushed out of the birth canal.

Third Stage
The third stage is called the placental stage. It begins with the birth of the infant and ends with the delivery of the placenta. Two separate phases are involved: placental separation and placental expulsion. After birth, the uterus can be palpated as a firm round mass just inferior to the level of the umbilicus. After a few minutes, the uterus begins to contract again and assumes a discoid shape. It retains this shape until placenta is separated, approximately 5 minutes after birth of the infant.

Placental Separation
As the uterus further contracts down on an almost empty interior causing disproportion between the placenta and the contracting wall of the uterus ultimately causing separation of the placenta. The following are the signs indicating that placenta has loosened and is ready to deliver:

Lengthening of the umbilical cord Sudden gush of vaginal blood Change in the shape of the uterus Firm contraction of the uterus Appearance of the placenta at the vaginal opening

Bleeding occurs as a normal consequence of placental separation. The normal blood loss is 500 mL.

Placental Expulsion
After separation, the placenta is delivered either by the natural bearing-down effort of the mother or by gentle pressure on the contracted uterine fundus by the physician or nurse-midwife (Credes maneuver). Pressure must never be applied to post-partal uterus in a non-contracted state, because doing so would cause uterus to evert and maternal blood sinuses are open and gross hemorrhage could occur. If the placenta does not deliver spontaneously, I t can be removed manually. References: Piliteri (2008)