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BACHELOR OF SCIENCE IN MIDWIFERY

COURSE OUTLINE
MDPS 102 NORMAL OB, IMMEDIATE NEWBORN CARE

Stages of Labor
Labor is traditionally divided into three stages

First Stage
Three separate divisions mark the first stage of labor: the latent, the active, and the transition
phase.
a. Latent Phase
- The latent or preparatory phase begins at the onset of regularly perceived uterine
contractions and ends when rapid cervical dilatation begins.
- Contractions during this phase are mild and short, lasting 20 to 40 seconds.
- Cervical effacement occurs, and the cervix dilates from 0 to 3 cm.
- Encourage the mother to continue ambulation
- Encourage mother to empty bladder every 2 to 3 hours
b. Active Phase
- During the active phase of labor, cervical dilatation occurs more rapidly, increasing
from 4 to 7 cm.
- Contractions grow stronger, lasting 40 to 60 seconds, and occur approximately every 3
to 5 minutes.

During this stage; Health care provider needs to monitor and evaluate the
following
1. Uterine contractions
o Duration
 From the beginning of one contraction to the end of the same contraction.
o Interval
 From the end of one contraction to the beginning of the next contraction
o Intensity
 The strength of contraction
o Frequency
 From the beginning of one contraction to the beginning of the next
contraction.
2. Blood Pressure
o Must not be taken during contraction as it tends to increase.
o Should be taken at least every hour during active labor
o When a woman in labor complains of a headache, the first nursing action is to
take the BP.
3. Fetal Heart Rate
o Should not be mistaken with uterine souuffle
o Normally 120 – 160 per minute
o Should not be taken during a uterine contraction because it tends to decrease.
o Compression of the fetal head when the uterus contracts stimulate the vagal
reflex which, in turn, causes bradycardia.
o Should be taken every hour during the latent phase of labor, every half of an
hour during active phase, and 15 minutes during the transition phase.
o For any abnormality in FHR, the initial nursing action is to change the mothers
position
4. Signs of Fetal Distress
o Bradycardia (FHR less than 100/minute) or Tachycardia (FHR more than
180/minute)
o Meconium-stained amniotic fluid in nonbreech presentation
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 o Fetal – thrashing – hyperactivity of the fetus as it struggles for more oxygen
Health Teachings for a woman in labor:
 Bath - is advisable if contractions are tolerable or not too close to one another.
Will make the mother more comfortable
 Ambulation – helps shorten the first stage of labor
 Solid or liquid foods are to be avoided because:
o Digestion is delayed during labor
o A full stomach interferes with proper bearing down
o May vomit and cause aspiration
Enema
Purpose: A full bowel hinders the progress of labor
– Expulsion of feces during second stage of labor predisposes the
mother and baby to infection
– Full bowel predisposes to postpartum discomfort
Contraindications to enema in labor:
– Vaginal bleeding
– Premature labor
– Abnormal fetal presentation or position
– Ruptured membranes
– Crowning
 Encourage the mother to void every 3 hours by offering the bedpan because
o A full bladder retards fetal descent
o Urinary stasis can lead to urinary tract infection
o A full bladder can be traumatized during delivery

Perineal prep
 Done aseptically.
 Use no. 7 method, always from front to back
 Perineal shave – not a routine procedure; maybe done to provide a clean area
for delivery.
 Muscles at the symphysis pubis should be kept taut and razor moved along the
direction of hair growth

Sims Position
 Favors anterior rotation of the fetal head
 Promotes relaxation between contractions
 Prevents continual pressure of the gravid uterus on the inferior venacava
 Women in labor should not be allowed to push or bear down unnecessarily
during contractions of the first stage because it leads to unnecessary exhaustion

Abdominal Breathing
 Advised for contractions during the first stage in order to reduce tension and
prevent hyperventilation

c. Transition Phase
- Contractions reach their peak of intensity, occurring every 2 to 3 minutes with a
duration of 60 to 90 seconds
- Cervix dilates from 8 to 10 cm.
- If the membranes have not previously ruptured, they will rupture as a rule at full
dilatation (10 cm).
- By the end of this phase, both full dilatation(10cm) and complete cervical
effacement(100%) have occurred.
- As a woman reaches the end of this stage at 10 cm of dilatation, an irresistible urge to
push occurs.
Comfort measures
• Sacral pressure
• Proper bearing down techniques: push with contractions
• Controlled chest breathing during contractions
• Emotional support

2|P age
Second Stage
- The second stage of labor is the period from full dilatation and cervical effacement to birth
of the infant.
- With uncomplicated birth, this stage takes about 1 hour (Archie, 2007).
- As the fetal head touches the internal side of the perineum, the perineum begins to bulge
and appears tense.
- The anus may become everted, and stool may be expelled.
- As the fetal head pushes against the perineum, the vaginal introitus opens and the fetal
scalp appears at the opening to the vagina.
- At first, the opening is slitlike, then becomes oval, and then circular.
- The circle enlarges from the size of a dime, then a quarter, then a half-dollar. This is
called crowning.
- Mother barely hears the conversation in the room around her.
- All of her energy and her thoughts are directed toward giving birth.
- As she pushes, using her abdominal muscles to aid the involuntary uterine contractions,
the fetus is pushed out of the birth canal.

Third Stage
The third stage of labor, the placental stage, begins with the birth of the infant and ends with
the delivery of the placenta. Two separate phases are involved: placental separation and
placental expulsion.

Placental Separation
The following signs indicate that the placenta has loosened and is ready to deliver:
• Uterus becomes round and firm again, rising high to the level of umbilicus
or Calkin’s sign. This is the earliest sign of placental separation.
• Sudden gush of vaginal blood
• Lengthening of the umbilical cord

Types of Placental Separation

Schultze presentation (Shiny)
- If the placenta separates first at its center and last at
its edges, it tends to fold onto itself like an umbrella and
presents at the vaginal opening with the fetal surface
evident. Appearing shiny and glistening from the fetal
membranes. Approximately 80% of placentas separate
and present in this way.

Duncan presentation (Dirty)

- If the placenta separates first at its edges, it slides
along the uterine surface and presents at the vagina
with the maternal surface evident. It looks raw, red, and
irregular, with the ridges or cotyledons that separate
blood collection spaces showing.

References:

Pilliteri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family,
7th Ed. Philadelphia: Lippincott Williams & Wilkins, 2014

Levino, K., et al. Williams Obstetrics, 24th ed. New York: McGraw-Hill Medical, 2010

3|P age