STAGE First Stage

SIGNS AND SYMPTOMS Latent Phase Regular perceived uterine contraction Rapid cervical dilatation begins Tightening sensation in the womans abdomen Active Phase Cervical dilatation occurs more rapidly Contractions are stronger Increased vaginal secretions Spontaneous rupture of the membrane Transition Phase Contractions reach their peak of intensity,occurring every 2 to 3 minutes with a duration of 60 to 90 seconds. Dilatation continues at a rapid rate Rupture of the membrane at full dilatation Mucus plug from cervix is released Nausea and vomiting A feeling of loss of control, anxiety, panic and irritability Intense sensation in the abdomen

EXPECTED BEHAVIOR OF THE MOTHER Feeling of excitement and fear Feeling of loss of control Anxiety Irritability Powerlessness Tensed Panic

NURSING INTERVENTIONS Assess couple for contributing factors related to feelings of loss of control Assist couple with using controlled breathing exercises and position changes. Reinforce information learned in childbirth education classes. Slowly and clearly explain the events and changes occurring with the active stage of labor. Inform the couple of things that can and cannot be controlled. Reassure, as appropriate, that labor is proceeding without problems. Allow opportunities for the couple to manipulate the environment. Offer couple options from which they can choose. Emphasize positive aspects of situation and what can be controlled Provide continued emotional support throughout labor and provide privacy as appropriate. Encourage the husband to continue actively support the wife. Respect contraction time Promote change of positions Promote voiding and provide bladder care Offer Support Respect and promote the support persons activities Support the womans pain management efforts

Second Stage

Full dilatation Cervical effacement Overwhelming, uncontrollable urge to push Momentary nausea or vomiting Perineum begins to bulge and appear tense Stool might also expelled Vaginal introitus opens Fetal scalp becomes visible at the opening of the vagina Crowning Involuntary uterine contraction

Feeling to push becomes strong Argumentative Angry Crying or screaming Focus on the babies birth

Assess and record the temperature, pulse, respirations, blood pressure, FHR, Contractions Provide Support Prepare the place of Birth Convert the room to a birth room by opening the sterile packs of supplies on waiting tables. Open the partition at the end of the room to reveal the baby island or newborn care area. Turn on the radiant heat warmer in advance. Place sterile towels and a blanket on the warmer. Position the woman into the stirrup Raise both legs at the same time. Secure straps holding the legs in the stirrup Pad stirrup with abdominal pads if woman has ankle edema Top portion of the table is raised to 3060 degrees angle. Place womans leg in a lithotomy position only at the last moment. Make sure that there is always someone at the foot of the broken delivery room table. Promote effective second stage pushing Do perineal cleaning At birth, place a sterile towel over the rectum and press forward on the fetal chin while the other hand is pressed downward on the occiput. Aspirate the newborns mouth and nose. Cut the cord and place infant to a sterile basket with the radiant heat warmer Cover the infants head with a wrapped towel or cap Take infant to the parents Apply prophylactic eye ointment. Allow mother to breastfeed baby if she wishes.

Third and Fourth Stage

Uterus resumes contraction Active bleeding on the maternal surface of the placenta Placenta sinks to the lower uterine segment or the upper vagina Lengthening of the umbilical cord Sudden gush of vaginal blood Change in the shape of the uterus Bleeding occurs

Excited Feeling anticlimactic

Inspect the placenta to ensure that it is intact and without gross abnormalities and check the number of cotyledons. Obtain a baseline blood pressure before handling oxytocic to the patient. Document the administration of oxytocics given in delivery or birthing room on the maternal record. Perform perineal stitching. Be certain to include her in explanations and appreciate how anticlimactic she may feel. Obtain vital signs every 15 minutes for 1 hour and according to the agencys policy. Palpate fundus for size, consistency, and position and observe the amount and characteristics of the lochia. Perform perineal care Offer a clean gown and a warmed blanket..