STAGES OF LABOR

STAGES OF LABOR
Firts Stage
Second Stage
Third Stage
Fourth
FIRST STAGE  begins with the initiation of true labor
contractions and ends when the cervix is
fully dilated.
 cervix - 0-10 cm

SECOND STAGE  extending from the time of full dilatation until

the infant is born

THIRD STAGE  lasting from the time the infant is born until
after the delivery of the placenta

FOURTH STAGE  the first 1 to 4 hours after birth of the placenta

 THE FIRST STAGE
 takes place about 12 hours to complete
 divided into three segments:
(1) Latent Phase
(2) Active Phase
(3) Transition Phase
Latent Phase (Early Phase)
 begins atthe onset of regularly perceived uterine contractions and ends
when rapid cervical dilatation begins
 contractions are mild and short, lasting 20-40 seconds
 cervical effacement occurs, and the cervix dilates minimally
 multiparous usually progresses more quickly than a nullipara
 a woman who enters labor with a “nonripe” cervix will probably have a longer
than average latent phase.
 analgesia can be given (may prolong this phase)
 cause only minimal discomfort and can be manage by controlled breathing.
 encourage women to continue to walk about and make preparations for birth
such as doing last-minute packing
Active Phase
 cervical dilatation occurs more rapidly
 contractions grom stronger, lasting 40 to 60 seconds
 occur approximately every 3 to 5minutes
 show increase vaginal secretions
 spontaneous rupture of the membranes may occur
 encourage women to be active participants in labor by
keeping active and assuming whatever position is most
comfortable for them (except flat on their back)
Transition Phase
 contraction reach their peak of intensity, occurring every 2 to 3 minutes with a
duration of 60 to 70 seconds.
 maximum cervical dilatation of 8-10 cm
 show will occur
 if the membranes have not previously rupture, they will usually rupture at full
dilatation. (10 cm)
 complete effacement
 may experience intense discomfort that is so strong (may be accompanied
by nausea and vomiting)
 THE SECOND STAGE
 is the time span from full dilatation and cervical effacement to birth of
the infant.
 uncontrollable urge to push or bear down with each contraction as if to
move her bowels
 may experience momentary nausea or vomiting because pressure is
no longer exerted on her stomach as the fetus descends into the pelvis
 the fetus begins descent and, as the fetal head touches the internal
perineum to begin internal rotation
 perineum begins to bulge and appear tense.
 anus may become everted, and stool may be expelled
 as the fetal head pushes against the vaginal introitus, this opens and
the fetal scalp appears at the opening to the vagina and enlarges -
CROWNING
 as the fetal head is pushed out of the birth canal, it extends and then
rotates to bring the shoulders into the best line with the pelvis.
 the body of the baby is then born
 THE THIRD STAGE
 placental stage
 begins with the birth of the infant and ends with the delivery of the placenta
 two separate phases:
(1) placental separation
(2) placental expulsion
 after the birth of the infant, the uterus can be palpated as a firm, round mass
just below the level of the umbilicus
 after a few minutes of rest, uterine contraction begin again, and the organ
assumes a discoid shape.
 it retains this new shape unitl the placenta has separated, approximately 5
minutes after the birth of the infant.
PLACENTAL SEPARATION
The placenta has loosened nd is ready to deliver when:
 there is lengthening of the umbilical cord
 a sudden gush of blood
 The placenta is visible at the vaginal opening
 the uterus contracts and feels firm again
 can anywhere from 1 to 30 minutes
 blood loss of about 300 to 500 ml.
PLACENTAL EXPULSION
 once separationhas occurred, the placenta delivers either
by the natural bearing-down effort of the mother or by
gentle pressure on the contracted uterine fundus by the
primary lthcare provider - Crede maneuver
Note:
pressure should never be applied to a uterus in a non-
contracted state because doing so could cause the uterus
to evert (turn inside out) accompanied by massive
hemorrhage.