Stages of Labor Labor is traditionally divided in three stages: 1. Dilatation a. Early labor (latent phase) b.

Active labor (active phase) c. Transition (transition phase) 2. Birth 3. Delivery of placenta a. Placental separation b. Placental expulsion **The first 1-4 hours after birth of the placenta is sometimes termed the fourth stage to emphasize the importance of the close maternal observation needed at this time. These designations are helpful in planning nursing interventions to ensure the safety of both mother and the newborn. Also called, recovery stage. First stage (Dilatation) - which begins with the initiation of true labor contractions and ends when the cervix is fully dilated (10cm). a. Latent phase - 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 20-40 seconds. - Cervical effacement occurs, and the cervix dilates from 0-3 cm. - Lasts approximately 6 hours in nullipara and 4.5 hours in a multipara. - Measuring the length of the latent phase is important because a reason for prolonged laten phase is cephalopelvic disproportion that could require a cesarean birt. b. Active phase - Cervical dilatation occurs more rapidly, increasing from 4-7cm. - Contractions grow stronger, lasting from 40-60 seconds, and occur approximately every 3-5 minutes. - Lasts approximately 3 hours in nullipara and 2 hours in multipara. - Show (increased vaginal secretions) and perhaps spontaneous rupture of the membranes may occur. c. Transition phase - Contractions reach their peak of intensity, occurring every 2-3 minutes with a duration of 60-90 seconds and causing maximum cervical dilatation of 8-10 cm. - If the membranes have not previously ruptured or been ruptured by amniotomy, they will rupture as a rule at full dilatation (10cm). - Show occurs as the last of the mucus plug from the cervix is released. - By the end of this phase, both full dilatation (1ocm) and complete cervical effacement (obliteration of the cervix) have occurred. - A woman may experience intense discomfort, accompanied by nausea and vomiting, feeling of loss of control, anxiety, panic or irritability. Her focus is entirely inward on the task of birthing her baby.

Second stage (birth) - Extending from the time of full dilatation and cervical effacement to birth of the infant; with uncomplicated birth, this stage takes about 1 hour. - A woman feels contractions change, uncontrollable urge to push or bear down with each contractions as if to move her bowels. - She may experienced momentary nausea and vomiting - 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 of the vagina. At first, the opening is slitlike, then becomes oval and then circular. The circle enlarges from the size of the dime, then a quarter, then a halfdollar. This is called Crowning. Third stage (placental stage) Lasting from the time the infant is born until after the delivery of the placenta. - After the birth of the infant, a uterus can be palpated as a firm, round mass just inferior to the level of the umbilicus. - After a few minutes of rest, uterine contractions begin again, and the organ assumes a discoid shape. It retains this new shape until the placenta has separated, approximately 5 minutes after the birth of the infant. - Two separate phases: placental separation and expulsion. a. Placental separation o As the uterus contracts down on an almost empty interior, there is such a disproportion between the placenta and the contracting wall of the uterus that folding and separation occur. o 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  Firm contractions of the uterus  Appearance of the placenta at the vaginal opening o Schultze presentation- if the placenta separates first at its center and last at its edges, it tends to fold onto itself like an umbrella ad presents at the vaginal opening with the fetal surface evident. Appearing shiny and glistening from the fetal membranes.(shiny; fetal membrane surface) o Duncan Presentation- 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.(dirty; irregular maternal surface) o Bleeding occurs as a part of the normal consequences of placental separation. Normal blood loss is 300-500 for NSVD, and 1000-1500 for C/S. b. Placental expulsion o 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 nurse-midwife (Crede s Maneuver). o If the placenta does not remove spontaneously, it can be removed manually. o With delivery of the placenta, the third stage of labor is complete.