Stages of normal labor

LABOR is a process , or sequence of events, that begins with uterine

contractions and ends1 hour after delivery of the placenta. The labor
process is described in four stages.
 THE FIRST STAGE OF LABOR: DILATION AND EFFACEMENT

The first stage of labor, also known as the dilation stage, begins with regular
contractions and ends with complete effacement and dilation of cervix. This is
usually the longest stage and divided into three phases: latent, active and
transition.

 Latent Phase
The latent phase of the stage of labor is from the onset of contractions until the
cervix is dilated 4 centimeters. Contractions usually occur 10 to 15 minutes and
gradually increase 5 minutes apart. Each contractions lasts 30 to 40 seconds and
is of mild to moderate intensity. In the Latent Phase, the client is away from
contractions but is relatively comfortable. She is excited that the labor has
begun, and is often anxious about what lies ahead. If the membrane have not
ruptured, the woman is encouraged to walk as long as she does not become tired.
This is a good time to reinforce to both mother and partner, especially relaxation
method. The latent phase usually last 8 to 10 hours with the first pregnancy.
With subsequent pregnancies, it usually lasts about 5 hours.
 Active Phase
The active phase of the first stage of labor begins when the cervix is dilated 4 centimeters
and ends with 8 centimeters dilation. Contractions occur every 3 to 5 minutes. They last 60
to 90 seconds and are moderate to strong intensity. Clients perceive an increased amount
of discomfort as the fetus descends through the pelvis, stretching muscles and ligaments.
During the phase of stage 1, clients seek a position to reduce discomfort. They may need
assistance to change position. The clients focus now on relaxation and breathing
techniques. The average length of labor is 4 to 6 hours for the primigravida client and 3 to
4 hours for the multipara client.

 Transition Phase
The transition phase of the first stage of labor is the period during which the cervix widens
from 8 to 10 centimeters. The contractions are strong, occurring every 2 to 3 minutes and
lasting 90 seconds as the fetus descends deeper into the pelvis and Ferguson’s reflex is
triggered, there is a strong urge to push. The client may need reminding to focus on
relaxation and breathing techniques. As mentioned previously, it is important for the client
not to push actively until the cervix is completely dilated. If the client pushes to early the
cervix can tear. Some behaviors are common during the transition phase of labor, the client
becomes restless, irritable and sometimes angry. Statements such as “I can’t take anymore
and don’t touch me!” are common, it is important to help the support persons that this
behavior is part of the labor process. The average length of the transition phase of stage
one labor is 1 to 2 hours.
 THE SECOND STAGE OF LABOR: BIRTH

The second stage of labor begins when the cervix is completely dilated and ends with
the birth of the baby. Contractions continuous every 2 to 3 minutes, lasting 60 to 90
seconds, the client is encouraged to use her abdominal muscle to bear down actively
with each contraction. The second stage of labor could take 1 to 3 hours for the
primigravida client. If often take 15 to 30 minutes for the multipara client. As the
fetal head pushes on the perineum and the client pushes, the tissue of the perineum
thin and bulge. The labia open. The fetal head can be seen with contractions, but it
recedes into the vagina between contractions. Gradually, more and more of the fetal
head appears with contractions. When the largest part of the fetal head is past the
vulva remains visible between contractions. Crowning is occurred a few more pushes
and the fetus will be born.
 Episiotomy
In many births, an episiotomy, or surgical cutting of the perineal tissue, is performed
at this time. An episiotomy may aid birth and prevent tearing of perineal and anal
tissue.
 Ritgen’s Maneuver is done by covering the anus with a sterile towel and exert
upward and forward pressure on the fetal chin while exerting gentle pressure
with two fingers on the head to control the emerging head. This will not only
support the perineum, thus also favor flexion so that the smallest
suboccipitobregmatic diameter of the fetal head is presented.
 MECHANISM OF LABOR

The fetus changes position as it moves through the pelvis. These movements are
called the mechanism of labor or cardinal movements. The first three
movements may occur before the first contractions of during the first stage of
labor.

 Engagement is the point at which the presenting part enters the true pelvis.
The presenting part is even with or below the ischial spines. The fetus is no
longer ballotable.
 Descent begins with engagements and continuous as the contractions push the
fetus through the pelvis.
 Flexion describes the attitude the fetus assumes. Ideal flexion is positive,
with head flexed onto the chest, the arms flexed across the chest, and the
legs flexed across the abdomen.
 Internal Rotation may take place prior to labor, but it most commonly occurs
during the first or second stages. The fetus turns to an anterior position (OA).
The fetal occiput is next to the maternal symphysis pubis.
 Extension occurs when the fetus extend’s its head, pushing its occiput against the
maternal symphysis pubis. This movement causes the fetal head to emerge
through the vaginal opening. The health care provider may assist with the birth
by applying pressure on the mother’s lower perineum, helping the fetus extend
its neck by lifting the fetal chin.
 Restitution is the turning of the fetal head to be in normal alignment with the
shoulders. The fetus then rotates until the shoulders are in anterior/posterior
position (external rotation).
 Expulsion is the birth of the rest of the fetus after restitution. The assisting
health care provider apllies gentle, downward pressure on the fetal head,
allowing the anterior shoulder to emerge under the maternal symphysis pubis.
The is then raised to allow the posterior shoulder to emerge. The rest of the fetus
then slides out the vagina.
 THIRD STAGE OF LABOR: PLACENTA EXPULSION

The third stage of labor begins with birth of the fetus and ends with the
expulsion of the placenta. The placenta should be delivered within 30 minutes of
birth. Continuous contractions following birth causes the placenta to separate
from the wall of the uterus. As is separates, there is some bleeding. The
membrane are peeled from the uterus as the placenta slides into the vagina.
Signs that the placenta is ready to be expelled are a gush of blood from the
vagina, a lengthening of the umbilical cord, and a globular shape of the uterus.
The client pushes one last time and the placenta is expelled. The placenta may
separate in different ways. Expulsion of the placenta with the fetal side out is
termed the Schultze mechanism. If the maternal side is out when the placenta is
expelled, it is called Duncan mechanism.
 FOURTH STAGE OF LABOR: RECOVERY

The fourth stage of labor is the first hour after birth. During this period, the
mother’s body begins to return to a nonpregnant state. Blood pressure has a
moderate decline. The pulse increase and gradually slows. Normal blood loss is
between 250 and 500 ml, mostly at the time of placental separation.
The fundus should be located below the umbilicus and in the midline. The uterus
should remain firm in order to control bleeding. Saturation of more than one
perineal pad with blood during the 1 hour recovery time is considered excessive.
The mother may experience uncontrolled shaking or chills (postpartal chills) as a
psychologic response to labor and as a result of rapid weight loss at birth.