Stages of Labor:

Stage 1

Onset of labor Full dilation of the cervix

o Latent Phase

Onset of labor 4 cm dilation

o Active Phase

4 cm dilation full dilation

Monitor the following:

o Maternal blood pressure and pulse
o Electronic fetal monitor: fetal heart rate and uterine contractions
o Examine cervix to monitor the progression of labor for:

Cervical Dilation

Cervical Effacement

Station

Where the fetus is located in relationship to the pelvis

Measured -3 to +3
Stage 2

Begins following full dilation and mothers urge to push

Rate of fetal head descent determines the progression of this stage of labor
1. Engagement

Fetal head enters the pelvis occiput first

Increases PGE2 leads to breakage of disulfide bonds infusion of water and

cervical ripening
2. Descent

Progresses as uterine contractions and maternal pushing occur

Descent continues until the fetus is delivered

3. Flexion

The fetal head undergoes flexion

4. Internal Rotation

When the fetal head reaches the ischial spine, the fetus starts to rotate

Rotation moves the sagittal sutures into the forward position

5. Extension

Occurs so that the head can pass through the vagina

Occurs as babys head passes the pubic symphysis

Baby becomes oriented forward and upward

6. External Rotation

External rotation creates room for the shoulders to descend

Anterior shoulder goes under the pubic symphysis first

7. Anterior Shoulder Delivery

Gentle downward pressure on the fetal head will aid in the delivery of the anterior
shoulder
8. Posterior Shoulder Delivery

Gentle upward pressure on the fetal head will aid in delivery of the posterior
shoulder

The rest of the fetus will follow

Stage 3

Immediately after delivery, inspect and repair lacerations of the vagina while waiting for placental
separation
o Signs of placental separation include:

Fresh bleeding from vagina

Umbilical cord lengthening

Uterine fundus rising

Uterus becomes firm

Stage 4

Time after delivery of the placenta

Table 1: Stages of Labor

Stages

Beginning to End

Duration

Stage 1

Onset of labor full

dilation of cervix
Onset of labor 4
cm dilation
4 cm dilation full
dilation
Full dilation of cervix
delivery of
neonate

Primi: 6-18 hrs

Multi: 2-10 hrs
Primi: 6-7 hrs
Multi: 4-5 hrs
Primi: 1 cm /hrs
Multi: 1.2 cm /hr
Primi: 30 min 3 hrs
Multi: 5-30 min

Delivery of neonate
delivery of
placenta

30 minutes

Latent Phase
Active Phase
Stage 2

Stage 3

Figure 1: Graphical Representation of Stages of Labor

Figure 1: Cardinal Movements of Labor