Labor is the coordinated sequence of involuntary uterine contractions.

Understanding the stages of labor would allow the mother and the health care team facilitate a less stressful and safe childbirth. The four stages of labor are based on the changes that the uterus and cervix undergo as labor progresses. First Stage of Labor The first stage of labor usually have 20 t0 40 contractions. Three Phases of the First Stage of Labor Latent Phase. The mother is excited. This lasts from the beginning of labor until 3 cm of cervical dilatation. Active Phase. The mother is anxious. The cervix dilates from 4-7 cm and dilates in a more rapid rate. Transition Phase. The mother is irritable. The cervix dilates from 8-10 cm and the fetus descends further into the pelvis. Second Stage of Labor This is where the vulva is stretching. Contractions are at 40-60. This begins with complete dilatation and full effacement of the cervix and end with the birth of the baby. Third Stage of Labor This begins with the birth of the baby and ends with the expulsion of the placenta. The placenta is formed by the union of the chorionic villi and decidua basalis. Types of Placental Separation Schultz. The presenting part is the fetal side which is shiny. Duncan. The presenting part is the maternal side which is called dirty because it is raw and red. Nursing Care During the Third Stage of Labor Do not hurry the expulsion of the placenta. This usually takes around 20 minutes. Tract cord slowly. Inspect for missing cotyledons. There should be 30. Palpate the uterus. Inject oxytocin. Inspect the perineum. Put down the legs of the mother together to prevent injury. The mother should be flat on bed without pillows for 6 hours. If the client is experiencing chills, provide her with a blanket and NOT soup. Provide additional nourishment.

Allow the mother to sleep to regain her strength. Fourth Stage of Labor The fourth stage of labor is the most critical stage. This lasts from the delivery of the placenta through the first 1-4 hours after birth. The nurse should assess the fundus, blood pressure and pulse rate, the lochia which should be moderate in flow, and the perineum. If the flow of the lochia is heavy the mother should be checked for lacerations and rechecked for retained placental fragments. Nursing Care During Labor Monitoring the fetus. Monitoring the laboring woman. Helping the woman cope with labor. Condition Assessment with Fetal Compromise Fetal Heart Rate. Lower limit is 110-120 bpm and the upper limit is 150-160 bpm. No variability in the electronic monitoring. Slowing of the fetal heart rate. This persists or preceeds after contraction. Meconium stained. The amniotic fluid is green.. If the amniotic fluid is yellow, cloudy, or has a foul odor, it may indcate infection. Contractions that last for 90 secs. Incomplete uterine relaxation. Maternal hypotension. Maternal hypertension. Maternal fever. Evaluate Fetal Heart Rate Baseline Rate. The range of contractions and its changes and fluctuations. This should be constant. Variability. The decreases and fluctuations. Periodic changes. The changes in baseline rate. Classified as acceleration and deceleration. Types: Early decelerations. The rate of decrease during contraction but return to baseline by end of contraction. Variable decelerations. 70 bpm or less for longer than 60 seconds. This may suggest fetal cord compression around the neck or inadequate amniotic fluid. Late deceleration. This is similar to early deceleration except it does not return to baseline until contractions end. Inspection of Amniotic Fluid Normal color is clear with flecks of vernix caseosa.

Green stained fluid indicates the amniotic fluid is meconium stained. Cloudy or yellow amniotic fluid is infected.

Stage 1 Latent Phase Beginning with stage 1 of the stages of labor, stage 1 has 3 distinct phases. Dont confuse stages with phases. During phase 1 (latent phase) the cervix is at a dilation of around 1 4 cm. Contractions occur every 15 30 minutes with duration of 15 30 seconds and are of mild intensity. In phase 1 the mother is very chatty and excited to be in labor. Burn off that extra fat that baby left behind!!! The mother and father should be an active part of the care in this phase. Comfort is of the utmost importance, mother should seek assistance with changes in position and walking. Mother should also drink lots of fluids or ice chips. Voiding every 1 2 hours is important at this point. Stages of labor Stage 1 Active Phase In the active phase of stage 1 the cervix is dilated to 4 7 cm. Contractions take place every 3 5 minutes with duration of 30 60 seconds and are of moderate intensity. The mother becomes restless and anxious and because of this may have feelings of helplessness. For this reason it is important to keep the mothersbreathing pattern effective, keep the room as quiet as possible. Mother and father should be kept informed of the progress. Comfort measures used in this phase include back rubs, sacral pressure, support with pillows, and changes in position. Effleurage or Swedish massage should be done by the husband; medical staff can show him what to do. Mother can use ointment for dry lips and continue to drink fluids or ice chips and should void every 1 2 hours. Transition phase The transition phase of the stages of labor is normally the hardest phase to have to go through. This picture shows the end of the transition phase of stage 1 and the beginning of stage 2 (birth of the baby). Stage 1 Transition Phase During the transition phase of stage 1 the cervix is dilated to 8 10 cm. Contractions are occurring every 2 3 minutes with duration

of 45 90 seconds and are of strong intensity. At this point the mother has become exhausted, is edgy and irritable, and feels out of control. The mother should rest between contractions to conserve energy. Mother should be awakened at beginning of a contraction so she can begin her breathing pattern. Continuing fluid intake or ice chips and voiding every 1 2 hours is important. Stages of Labor: Stage 2 Finally we move on to stage 2, of thestages of labor. During stage 2 dilation of the cervix is complete. The progress of this stage of labor is measured by the changes in fetal station, which means the descent of the babys head through the birth canal. Contractions occur every 2 3 minutes with duration of 60 75 seconds and the intensity continues to be strong. The mother will feel and urge to bear down and the medical staff will assist the mother in her efforts to push. An increase in bloody show will occur. The vital signs of the mother are important to monitor at this point. The babys heart rate will be monitored before, during, and after a contraction. The normal heart rate of a baby is 120 160 beats a minute. Mother should be helped into positions of comfort and that assist in her efforts to push such as side-lying, squatting, kneeling, or lithotomy. The bulging of the mothers perinea area or seeing the babys head are signs the birth is about to occur. Third Stage of Labor Stage 3 is the expulsion of the placenta.Stages of Labor: Stage 3 At stage 3 of the stages of labor the baby has already been born. Stage 3 is the delivery of the placenta. Contractions will continue until the placenta is born. The placenta separates from the wall and natural removal occurs by uterinecontractions. The birth of the placenta takes place 5 30 minutes after the birth of the baby. There are two different mechanisms of birth of the placenta that can happen; they are Dirty Duncan or Shiny Schulzes. For Duncans mechanism the margin of the placenta separates, and the dull, red, and rough maternal surface emerges from the vagina first. For Schulzes mechanism the center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina. The mother has her vital signs and uterine fundus location checked. The fundus, at this point, is located 2

fingerbreadths below the umbilicus (belly button). The placenta will be checked for the presence of cotyledons (lobes of placenta), to make sure none of the placenta is missing, including making sure that the placenta membranes are intact. Mother may begin to shiver do to a decrease in body core temperature, provide blankets to warm up. Medical staff should promote baby-mother attachment. Stage 4 Stage 4 of labor is a peroid time 1 - 4 hours after delivery. Stages of Labor: Stage 4 Stage 4 extends 1 to 4 hours after delivery. During this time the mothers blood pressure will return to pre-labor level, pulse is decrease than that of the labor pulse. The fundus remains contracted; this is normal and essential. Fundus is midline 1 2 fingerbreadths below the umbilicus (belly button). Lochia is scant and red. (Lochia is a discharge from the vagina after birth to 6 weeks and progresses as follows: mostly blood, followed by a more mucous fluid that contains dried blood, and later a clear-to-yellow discharge.) Checking the mother frequently after birth is important. She is checked first every 15 minutes for 1 hour, then every 30 minutes for an hour, and lastly every hour for 2 hours. Comfort is important at this stage of labor. Give the mother warmed blankets if possible, ice to the perinea area to decrease swelling, teach the mother to massage her uterus to prevent a boggy uterus, the uterus should stay firm. Teach the mother how to breast feed and ask open ended questions to promote conversation about breast feeding. The Stages of Labor are: 1. First Stage - onset of regular contraction to full dilation Phase One (LATENT) - dilatation is 0 - 3 cm; duration is 10 - 30 sec; interval is 5 - 30 mins; intensity ismild to moderate Phase Two (ACTIVE) - dilatation is 4 - 7 cm; duration is 30 - 40 sec; interval is 3 -5 mins; intensity ismoderate to strong Phase Three (TRANSITION) - dilatation is 8 10 cm; duration is 45 - 90 sec; interval is 2 - 3 mins; intensity is strong

Nursing Care for First Stage of Labor monitor V/S and FHR every 15 mins bed rest for ruptured membrane empty the bladder pain relief teach breathing techniques maintain safety 2. Second Stage of Labor - from full dilation to delivery of the fetus (30-60 mins for primigravida and 20 mins for multipara) Phase One - station is 0 to +2; contraction is 2 to 3 mins apart Phase Two - station is +2 to +4; contraction is 2 to 2.5 mins apart with urgency to bear down Phase Three - station is +4 to birth; contraction is 1 to 2 mins apart;fetal head visible, increased urgency to bear down Nursing Care for Second Stage of Labor transfer to delivery room for 8-9 cm dilation for multigravidas and full dilation for primiparas monitor V/S and FHR prepare perineal area encourage pushing with contractions immediate newborn care

The stages of labor are often thought to be a mystery. In all honesty it is a mystery in many ways. Each woman will have a different labor and yet many parts are the same. Below you will find a crash course in the stages of labor, what each does, the parameters, and some average events of that stage. Remember, however, that very few women will follow this to the letter, there will be some variation. First Stage First stage of labor is usually the longest part of labor. This is where you are having contractions and your cervix is dilating. This stage is broken down into three phases: Early Phase "Yippy! I'm in labor!" The early phase of labor may be spent wondering "Is this really labor?" The contractions are usually very light and may be

20 minutes or more apart in the beginning, gradually becoming closer, possibly up to five minutes apart. The key to this stage is to go about your normal schedule or if it's the middle of the night go back to bed! Most women will be very comfortable during this stage and with a few exceptions those having a hospital birth will not be in the hospital at this point. Active Phase "This is hard work." The active phase of labor is where many women are getting serious and withdrawing to do the hard work of labor. Contractions generally are four or five minutes apart and may last up to 60 seconds long. Remember this still gives you a big break in between. Use this break to relax, go to the bathroom, and drink something. For woman who desire medications in labor they will usually go to the hospital in this stage of labor, while those desiring little or no medications will go towards the end of this stage or the beginning of transition, again, with a few exceptions. Mobility and relaxation are the key to getting through active labor. Remember to use the skills you learned in childbirth class and call your doula if you haven't yet. Transition Phase "Okay, I'll go home and come back tomorrow!" This is one of the shortest parts of labor, but definitely one of the hardest. Your contractions may be two or three minutes apart, lasting up to a minute and a half. Some women will shake and may vomit during this stage. This is normal. Remember that this stage usually doesn't last more than an hour or two. Partners, your support is crucial here. Remind her how well she is doing, and help her find a comfortable position, use cold rags for her face, and give her sips of water or ice in between contractions. This is hard work. When this phase is done you will be completely dilated! Some women will have a small break of no contractions after becoming fully dilated, and yet not feeling the need to push yet. Sheila Kitzinger calls this the "rest and be thankful" phase. Second Stage "I can push?" Pushing usually feels better for most women. They have spent the first stage of labor relaxing and letting their body do all the work, now they can actually do something to help. This stage

can last three or more hours, but for many women will not. The length of this stage is dependent upon the positioning of the mother (upright = faster), the positioning of the baby, whether medications have been used, etc. The contractions will usually space out a bit, going back to about four minutes apart. This stage ends with the birth of your baby! Third stage "I forgot the placenta!" After you are holding your beautiful baby, you may be asked to push again after some point, and you might be puzzled. Oh yes, the placenta! Don't worry this one has no bones and is much easier to push out. Nursing your baby after he or she is born will help the uterus to contract and expel the placenta, but most come within an hour after birth, usually within a few minutes. Don't worry about it, spend the time bonding with your new little one. Fourth Stage "I asked for this?" No real contractions to speak of, but postpartum is generally accepted as the fourth stage of labor. Your body is going through many changes now that the baby has been born. Not to mention the large changes your family is going through adding a new person to your family. Be sure to ask for help. Your body will slowly change and become more like your prepregnancy self, but not exactly. Hang in there, babies grow way to fast. I've often said that we need to save postpartum for when our children are about three years old so that we can enjoy the tiny newborns. Enjoy your labor, believe it or not it's the hardest work you'll do, but it yields the most rewards.