STAGES OF

LABOR
Dr. Shirley May de Gracia
 Signs of Labor
 Preliminary signs of Labor
1. Lightening- descent of the fetal presenting part into the pelvis (10-14 days)
2. Increase in Level of Activity – due to an increase in epinephrine release
initiated by a decrease in progesterone produced by the placenta
3. Braxton Hicks Contractions – may be misinterpreted as true labor
contractions
4. Ripening of the Cervix (Goodel’s sign) – “butter-soft” & it tips forward
Difference between True &
False Labor Contractions
FALSE CONTRACTIONS
Begin & remain irregular
Felt first abdominally &
remain confined to the
abdomen & groin
Often disappear with
ambulation & sleep
Do not increase in duration,
frequency, or intensity
Do not achieve cervical
dilatation
TRUE CONTRACTIONS
Begin irregularly but become
regular & predictable
Felt first in lower back &
sweep around to the
abdomen in a wave
Continue no matter what the
woman’s level of activity
Increase in duration,
frequency, and intensity
Achieve cervical dilatation
Signs of True Labor

 Involve uterine & cervical changes

1. Uterine contractions – effective, productive,
involuntary
2. Show
3. Rupture of the Membranes- a sudden gush or scanty,
slow seeping of clear fluid from the vagina
 FIRST STAGE

❑ The first stage of labor is

divided into three phases:
the latent, the active, and
the transition phases.
 LATENT ACTIVE TRANSITION

DILATION 0 - 3 cm 4 - 7 cm 8 – 10 cm

FREQUENCY 5 – 10 minutes* 3 – 5 minutes 2 – 3 minutes

DURATION 20-40 seconds 40-60 seconds 60-90 seconds

INTENSITY mild stronger peak of intensity

MOTHER’S ▪Psychologically ▪Excited because she ▪Intense discomfort, so

BEHAVIOR prepared for labor. realizes that something strong it accompanied by
▪Does not tense at each dramatic is happening. nausea and vomiting.
tightening sensation in ▪Frightened because ▪Feeling of loss of
her abdomen. she realizes that labor is control, anxiety, panic,
truly progressing and her and irritability.
life is about to change.

NURSING CARE ▪Encourage woman to ▪Administration of an ▪Inform on progress*

continue walking. analgesic at this point ▪Restless mother;
▪ Encourage to void has little effect on the encourage controlled
every 2-3 hours because progress of labor. chest breathing.*
a full bladder inhibits ▪Assess: VS, cervical ▪Encourage and praise*
uterine contractions.* dilation & effacement, ▪Discomfort: apply sacral
▪ Chest breathing* fetal monitor, etc.* pressure to suppress
▪ Abdominal breathing* pain transmission to the
brain.*
Parts of Contractions
 Increment or crescendo – beginning of contractions until it
increases
 Acme or apex – height of contraction
 Decrement or decrescendo – from height of contractions until it
decreases
 Duration – beginning of contractions to end of same contraction
 Interval – end of 1 contraction to beginning of next contraction
 Frequency – beginning of 1 contraction to beginning of next
contraction
 Intensity – strength of contraction
Health Teachings:
 It’s ok to shower!
 NPO – GIT stops function during labor if with food
(aspiration)
 Enema – administer during labor
 To cleanse bowel
 Prevent infection
 Sim’s position/side lying – 12 to 18 inches-
height of enema tubing
 Check FHT after administering enema
 Normal = 120 - 160
 SECOND STAGE

❑The period from full

dilatation and cervical
effacement to birth of the
infant.
 MOTHER’S BEHAVIOR

❑ The woman may experience

momentary nausea or vomiting
because pressure is no longer
exerted on her stomach as the
fetus descends in the pelvis. She
pushes with such force that she
perspires and the blood vessels in
her neck may become distended.
❑ Ittakes a few contractions of this
new type for the woman to realize
that everything is still all right, just
different, and to appreciate that it
feels good, not frightening, to push
with contractions.
❑ The need to push becomes so
intense that she cannot stop herself.
She barely hears the conversation in
the room around her. All of her
energy, her thoughts, her being are
directed toward giving birth. As she
pushes, using her abdominal muscles
and the involuntary uterine
contractions, the fetus is pushed out
of the birth canal.
Mechanisms of Labor
(Cardinal Movements)
 Descent – downward movement of the biparietal
diameter of the fetal head to within the pelvic inlet
 Flexion – head bends forward onto the chest, making
the smallest AP diameter present to the birth canal
 Internal rotation
 Extension
 External rotation
 Expulsion (Video)
Nursing care:
 Lithotomy position – put legs up
at the same time
 Breathing – panting (teach
mom)
 Assist doctor performing
episiotomy – to prevent
laceration, widen vaginal
canal, shorten 2nd stage of
labor
 THIRD STAGE

❑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

❑ Separation occurs automatically as the

uterus resumes contractions.

❑ Active bleeding on the maternal surface

of the placenta begins with separation;
bleeding helps to separate the placenta
still further by pushing it away from its
attachment site.
❑ As separation is completed, the placenta
sinks to the lower uterine segment or the
upper vagina.

❑ The following signs indicate that the

placenta has loosened and is ready to
deliver:

❑Lengthening of the umbilical cord

❑Sudden gush of vaginal blood
❑Change in the shape of the uterus –
fundus rises, becomes firm & globular
❑ Ifplacenta separates first at its center
and last at its edges, it tends to fold
on itself like an umbrella and will
present at the vaginal opening with
the fetal surface evident. Appearing
shiny and glistening from the fetal
membranes, it is called a Schultze’s
placenta. Approximately 80% of placentas
separate and present in this way.
❑ If , however, 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, and is called a Duncan
placenta.
❑ Bleeding occurs as part of the
normal consequence of
placental separation, before the
uterus contracts sufficiently to
seal maternal sinuses. The
normal blood loss is 300-500ml.
 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 the physician or
nurse-midwife ( Crede’s maneuver).
❑ Pressure must never be applied to a uterus in
a noncontracted state or the uterus may evert
and hemorrhage. This is a grave
complication of birth, because the maternal
blood sinuses are open and gross hemorrhage
occurs.
❑ Ifthe placenta does not deliver
spontaneously, it can be
removed manually. With
delivery of the placenta, the
third stage of labor is over.
Nursing
1.
care:
Check for completeness of placenta
2. Check fundus – if relaxed, massage uterus
3. Check bp
4. Administer methergine IM
5. Monitor hpn (or give oxytocin IV)
6. Check perineum for lacerations
7. Assist MD for episioraphy
8. Flat on bed
9. Chills due to dehydration-give blanket, clear liquid (tea, clear gelatin)
10. Let mother sleep to regain energy
 FOURTH STAGE
❑ The first 1-2 hours after placental delivery also known
as the “Recovery Stage”.
❑ Monitor VS q15 for 1 hr; 2nd hr q 30 mins; 3rd hr q
1hr
❑ Check placement of fundus at level of umbilicus
❑ Iffundus above level of umbilicus – deviation of
fundus
❑Empty bladder to prevent uterine atony
❑Check lochia
❑Maternal observations – body system
stabilizes