Duration

Stages of
Start End
Labor
Nullipara Multipara

10-12 hr 6-8 hrs

Full but 6-20 but 2-12
First True labor
cervical hrs is the hrs is the
Stage contractions
dilatation normal normal
limit limit
Onset of
regularly
perceived
3 cm
Latent uterine
cervical 6 hrs 4.5 hrs
phase contractions
dilatation
(mild
contractions
lasting 20-40 sec)
Stronger uterine 7 cm
Active
contractions cervical 3 hrs 2 hrs
phase
lasting 40-60secs dilatation

Uterine
contractions
10 cm
Transition reaching their
cervical 3 hrs 1.5-2 hrs
al phase peak, occurring
dilatation
every 2-3 minutes
for 60-90 s

<2 hrs 0.5-1 hrs

Second Full cervical
Infant birth
Stage dilatation 3 hrs with 2 hrs with
epidurals epidurals

Third Placental
Infant birth Maximum of 30 min.
Stage delivery

NURSING RESPONSIBILITIES
First Stage of Labor
Latent Phase
- if patient received anesthesia because it can prolong latent phase.
- Allow patient to be continually active.
- Upright maternal positions are recommended for women on the first stage of labor.
- Conduct interviews and filling in of forms
- Educate patient on different relaxation techniques.
- Ensure that the total number of internal examinations the woman receives in the
entire course of labor is limited to 5 only.
 Active Phase
starts from 4 cm cervical dilatation to 7 cm cervical dilatation. During this phase,
contraction intensity is stronger, interval shortens, and duration lengthens. This is
where true discomfort is first felt by the patient so she is dependent and her focus is
on herself
- Inform patient on the progress of her labor
- Encourage patient to be continually active to maximize the effect of uterine
contractions.
- Assist patient in assuming her position of comfort.
- Monitor maternal vital signs and fetal heart rate every 2 hours
- Determine when patient last voided because a full bladder can hinder fast labor
progress.
Transitional Phase
starts from 8 cm cervical dilatation to 10 cm (full) cervical dilatation and full cervical
effacement. During this time, patient may be exhausted and withdrawn or
aggressive and restless. Patient’s urge to push is noticeable.
- Inform patient on progress of her labor.
- Assist patient with pant-blow breathing.
- Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or
depending on the doctor’s order. Contraction monitoring is also continued.
- When perineal bulging is noticeable, prepare for delivery.
Second Stage of Labor
starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. At this
stage, the patient feels an uncontrollable urge to push. The patient may also experience
temporary nausea together with increased restlessness and shaking of extremities. The nurse at
this stage must coach quality pushing and support delivery.
- Instruct patient on quality pushing. The abdominal muscles must aid the involuntary uterine
contractions to deliver the baby out.
-Provide a quiet environment for the patient to concentrate on bearing down.
- Provide positive feedback as the patient pushes.
-Repeat doctor’s instructions. the patient barely hears the conversation around
- Take note of the time of delivery and proceed to initiate essential newborn care. Delayed
cord clamping is recommended
Third Stage of Labor
Placental stage starts from birth of infant to delivery of placenta. It is divided into two
separate phases: placental separation and placental expulsion. Five minutes after
delivery of baby, the uterus begins to contract again, and placenta starts to separate
from the contracting wall. Blood loss of 300-500 mL occurs as a normal consequence of
placental separation. Placenta sinks to the lower uterine segment or upper vagina. The
placenta is then expelled using gentle traction on the cord.
Here are the signs of placental separation:
- Lengthening of umbilical cord
- Sudden gush of vaginal blood
- Change in the shape of uterus (globular in shape)
- Firm uterine contractions
- Appearance of placenta in vaginal opening
At this stage, here are the nursing care tips:
- Coach in relaxation for delivery of placenta.
- Congratulate on delivery of baby.
- Encourage skin-to-skin contact to facilitate bonding and early breastfeeding.
- Ask patient whether placenta is important to them before it is destroyed.
- Administer prophylactic oxytocin as ordered.
- Utilize controlled cord traction technique for placental expulsion.
 MECHANISMS OF LABOR
- Labor and birth are affected by the five Ps: passenger, passageway, powers, position
of the woman, and psychologic responses.
- Because of its size and relative rigidity, the fetal head is a major factor in determining
the course of birth.
- The diameters at the plane of the pelvic inlet, mid- pelvis, and outlet, plus the axis of
the birth canal, determine whether vaginal birth is possible and the manner in which
the fetus passes down the birth canal.
- Although the events precipitating the onset of labor are unknown, many factors,
including changes in the maternal uterus, cervix, and pituitary gland, are thought to
be involved.
- A healthy fetus with an adequate uterofetopla- cental circulation will be able to
compensate for the stress of uterine contractions.
CARDINAL MOVEMENTS OF MECHANISMS OF LABOR
1. Descent: The fetus descends into the pelvis.
Occurs due to: Uterine contractions, Amniotic fluid
pressure and abdominal muscle contraction.
Descent is encouraged by:
- Increased abdominal muscle tone
- Braxton hicks in late stages of pregnancy
- Increased frequency and strength of
contractions during labour
- As the head descends, it moves towards the
pelvic brim in either the left or right occipito-
transverse position (this means the occiput
can be facing the left side or right side of the
mother’s pelvis.
2. Engagement: This is when the largest diameter
of the fetal head descends into the maternal
pelvis.
The term engagement is referring to the widest
part of the fetal head successfully negotiating its
way down deep into the maternal pelvis.
Engagement is identified by abdominal palpation,
where the fetal head is 3/5th palpable or less.
3. Neck Flexion: As the fetus comes into contact
with the pelvic floor, cervical flexion occurs. This
allows the presenting part of the fetus to be sub-
occipito bregmatic.
In this position, the fetal skull has a smaller diameter
which assists passage through the pelvis
4. Internal Rotation: The pelvic floor has a gutter shape with a forward and downward slope,
encouraging the fetal head to rotate from the left or right occipito-transverse position a
total of 90-degrees, to an occipital-anterior (occiput facing forward) position, to lie under
the subpubic arch.
This rotation will occur during established labour and it is commonly completed by
the start of the second stage. Further descent leads to the fetus moving into the
vaginal canal and eventually, with each contraction, the vertex becomes
increasingly visible at the vulva.
5. Crowning: When the widest diameter of the fetal head successfully negotiates through
the narrowest part of the maternal bony pelvis, the fetal head is considered to be
‘crowning’. This is clinically evident when the head, visible at the vulva, no longer retreats
between contractions. Complete delivery of the head is now imminent.
6. Extension of presenting part: The occiput slips beneath the suprapubic arch as the head
extends and the nape of neck is pivoting against the arch
7. Restitution: the head externally rotate to face the right or left medial thigh of the mother.
8. Internal Rotation: the shoulders, having reached the pelvic floor, will complete their
rotation from a transverse position to an anterior-posterior position.
Placental Expulsion - After separation, the placenta is delivered either by the
natural bearing-down effort of the mother or by gentle pressure on the
contracted uterine fundus by a physician or nursemidwife (Credé’s maneuver).
Pressure must never be applied to a uterus in a noncontracted state, because
doing so may cause the uterus to evert and hemorrhage. This is a grave
complication of birth, because the maternal blood sinuses are open and gross
hemorrhage could occur (Poggi, 2007). If the placenta does not deliver
spontaneously, it can be removed manually. With delivery of the placenta, the
third stage of labor is complete.
Placental Previa
- is a condition of pregnancy in which the placenta is implanted
abnormally in the uterus. It is the most common cause of painless
bleeding in the third trimester of pregnancy.
- It occurs in four degrees: implantation in the lower rather than in
the upper portion of the uterus (low-lying placenta); marginal
implantation (the placenta edge approaches that of the cervical
os); implantation that occludes a portion of the cervical os (partial
placenta previa); and implantation that totally obstructs the
cervical os (total placenta previa).
Placental Abruption
- occurs when the placenta partially or completely separates from
the inner wall of the uterus before delivery. This can decrease or
block the baby's supply of oxygen and nutrients and cause heavy
bleeding in the mother.