Labor 

is defined as a series of rhythmic, involuntary, progressive uterine

contraction that causes effacement and dilation of the uterine cervix. It is a
physiologic process during which the fetus, membranes, umbilical cord,
and placenta are expelled from the uterus (Milton & Isaacs, 2019). The process of
labor and birth is divided into three stages.

The first stage of dilatation begins with the initiation of true labor contractions
and ends when the cervix is fully dilated. The first stage may take about 12 hours
to complete and is divided into three phases: latent, active, and transition.
The latent or early phase begins with regular uterine contractions until cervical
dilatation. Contractions during this phase are mild and short, lasting 20 to 40
seconds. Cervical effacement occurs, and the cervix dilates minimally.

The active phase occurs when cervical dilatation is at 6 to 7 cm and contractions

last from 40 to 60 seconds with 3 to 5 minutes intervals. Bloody show or
increased vaginal secretions and perhaps spontaneous rupture of membranes
may occur at this time. 

The last phase, the transition phase, occurs when contractions peak at 2 to 3-

minute intervals and dilatation of 8 to 10 cm. If it has not previously occurred,
the show will occur as the last mucus plug from the cervix is released. By the end
of this phase, full dilatation (10 cm) and complete cervical effacement have
occurred.

The second stage of labor starts when cervical dilatation reaches 10 cm and

ends when the baby is delivered. The fetus begins the descent, and as the fetal
head touches the internal perineum to begin internal rotation, the client’s
perineum begins to bulge and appear tense. As the fetal head pushes against the
vaginal introitus, crowning begins, and the fetal scalp appears at the opening to
the vagina.

Lastly, the third stage, or the placental stage, begins right after the baby’s birth
and ends with the delivery of the placenta. Two separate phases are
involved: placental separation and placental expulsion. Active bleeding on the
maternal surface of the placenta begins with separation, which helps to separate
the placenta further by pushing it away from its attachment site. Once separation
has occurred, the placenta delivers either by natural bearing down the client’s
effort or gentle pressure on the contracted uterine fundus.

There are instances where labor does not start on its own, so when the risks of
waiting for labor to start are higher than the risks of having a procedure to get
labor going, inducing labor may be necessary to keep the client and
the newborn healthy. This may be the case when certain situations such as
premature rupture of the membranes, post-term
pregnancy, hypertension, preeclampsia, heart disease, gestational diabetes, or
bleeding during pregnancy are present.

Nursing Care Plans

The nursing care plan for a client in labor includes providing information
regarding labor and birth, providing comfort and pain relief measures,
monitoring the client’s vital signs and fetal heart rate,
facilitating postpartum care, and preventing complications after birth.

Here are 45 nursing care plans (NCP) and nursing diagnoses for the
different stages of labor, including care plans for labor induction, labor
augmentation, and dysfunctional labor:

 Labor Stage IA: Latent Phase

1. Deficient Knowledge
2. Risk for Fluid Volume Deficit
3. Risk For Fetal Injury
4. Risk For Maternal Infection
5. Risk For Ineffective Coping
6. Risk For Anxiety
 Labor Stage IB: Active Phase
1. Acute Pain
2. Impaired Urinary Elimination
3. Risk For Impaired Fetal Gas Exchange
4. Risk For Maternal Injury
5. Risk For Ineffective Individual/Couple Coping
 Labor Stage IC: Transition Phase
 1. Acute Pain
2. Fatigue
3. Risk For Decreased Cardiac Output
4. Risk for Fluid Volume Deficit/Excess
5. Risk for Ineffective Coping
 Labor Stage II: Expulsion
1. Acute Pain
2. Altered Cardiac Output
3. Risk For Impaired Fetal Gas Exchange
4. Risk For Fluid Volume Deficit
5. Risk For Fetal Injury
6. Risk For Maternal Infection
7. Risk For Impaired Skin Integrity
8. Risk For Ineffective Individual Coping
9. Risk For Fatigue
 Labor Stage III: Placental Expulsion
1. Acute Pain
2. Knowledge Deficit
3. Risk For Fluid Volume Deficit
4. Risk For Maternal Injury
5. Risk For Altered Family Process
 Labor Induced: Augmented
1. Acute Pain
2. Knowledge Deficit
3. Anxiety
4. Risk For Impaired Fetal Gas Exchange
5. Risk For Maternal Injury
 Dysfunctional Labor: Dystocia
1. Risk for Maternal Injury
2. Risk for Fetal Injury
3. Risk for Fluid Volume Deficit
4. Ineffective Individual Coping
5. Acute Pain
 Precipitous Labor
1. Risk for Deficient Fluid Volume
2. Anxiety
3. Risk for Infection
 4. Risk for Injury
1. Labor Stage IA: Latent Phase

Labor Stage IA: Latent Phase

The latent phase of labor starts during the onset of true labor contractions until
cervical dilatation. The latent phase is considerably longer and less predictable
concerning the rate of cervical change than is observed in the active phase
(Hutchison et al., 2021). A birthing parent who is multiparous progresses more
quickly than a nullipara. Nursing care plans and diagnoses in this phase include:

1. Deficient Knowledge
2. Risk for Fluid Volume Deficit
3. Risk For Fetal Injury
4. Risk For Maternal Infection
5. Risk For Ineffective Coping
6. Risk For Anxiety