Kate Audi S.

Aclan, RN
MN- 1

STAGES OF LABOR

Divided into three stages:

1. First Stage of Dilatation
- Which begins with the initiation of true labor contractions and ends when the cervix
is fully dilatated.
2. Second Stage
- Extending from the time of full dilatation until the infant is born.
3. Third Stage
- Also known as Placental Stage.
- Lasting from the time the infant is born until after the delivery of the placenta.
4. Fourth Stage
- The first 1 to 4 hours after birth of the placenta.

FIRST STAGE
1. LATENT PHASE ( Preparatory Phase)
- Begins at the onset of regularly perceived uterine contractions and ends when rapid
cervical dilatation begins.
- Contractions during this phase are mild and short, lasting 20 to 40 seconds.
- Cervical effacement occurs, and the cervix dilatates from 0 to 3cm.
- The phase lasts approximately 6 hours in a nullipara and 4.5 hours in a multipara.
- Cephalopelvic Disproportion a disproportion between the fetal head and pelvis.
Another reason for prolonged latent phase.
2. ACTIVE PHASE
- During this phase of labor, cervical dilatation occurs more rapidly increasing from 47cm.
- Contractions grow stronger, lasting 40-60seconds and occur approximately every 3
to 5 minutes.
- This phase last approximately 3 hours in nullipara and 2 hours for multipara.
- Show (increased vaginal secretions) and perhaps spontaneous rupture of
membranes may occur during this time.
3. TRANSITION PHASE
- Contractions reach their peak of intensity, occurring every 2 to 3 minutes with
duration of 60-90 seconds and causing maximum dilatation of 8-10cm.
- During this phase, a woman may experience intense discomfort, so strong that it is
accompanied by nausea and vomiting. Because of the intensity and intensity of the
contractions.
- May also experience a feeling of loss of control, anxiety, panic or irritability.

The peak of the transition phase can be identified by a slight slowing in the rate of
cervical dilatation when 9cm is reached (termed deceleration on a labor graph).
As woman reaches the end of this stage at 10cm of dilatation, a new sensation
occurs (i.e. an irresistible to push).

SECOND STAGE
-

Dilatation and effacement to birth of the infant.

With uncomplicated birth, this stage takes about 1hour.

THIRD STAGE
-

The placental stage, begin with the birth of the infant and ends with the delivery of
the placenta.

Two separate phases are involved:

1. PLACENTAL SEPARATION
Signs indicate that the 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

Types of Placenta
Schultze Placenta
-

Appearing shiny and glistening from the fetal membranes

Duncan Placenta
-

Looks raw, red and irregular with the ridges or cotyledons that separate blood
collection spaces showing.

Brandt- Andrews Manuever

-

push and pulling of the umbilical cord.

Up and down manuever

2. PLACENTAL EXPULSION
- After separation, the placenta is delivered either by the natural bearing down effort
of the mother or by the gentle pressure on the contracted uterine fundus by the
physician or nurse-midwife (Credes Manuever).

INTRAPARTUM PAIN EXPERIENCE

A. Overview of Pain
1. Intrapartum pain is a subjective experience of physical sensations associated with
uterine contractions, cervical dilatations and effacements, and fetal descent during
labor and birth.
2. Physiologic responses to pain may include increased blood pressure, pulse,
respirations, perspirations, pupil diameter, muscle tension (such as facial tension or
fisted hands) or muscle activity (sush as pacing, turning, or twisting)
3. Nonverbal expressions of pain may include withdrawal, hostility, fear depression.
4. 4. Verbal expressions of pain may include statement of pain, moaning and groaning.
B. Factors affecting perception of Intrapartum pain.
1. Previous experience with painful stimuli and personal expectations of the birth
experience.
2. Cultural concept of pain, specifically during childbirth, and how one should respond.
3. Rapidly progressive uterine contractions.
4. Fear, anxiety, and fatigue.
C. Physiologic causes of Intrapartum pain
1. Uterine anoxia due to compressed muscle cells during the contraction.
2. Compression of the nerve ganglia in the cervix and lower uterine segment during the
contraction.
3. Stretching of the cervix during dilation and effacement
4. Traction on, and stretching and displacement of the perineum
5. Pressure on the urethra, bladder and rectum during fetal descent
6. Distention of the lower uterine segment
7. Stretching of the uterine ligaments