Stages

of
Labor
 LABOR
Labor is a series of rhythmic, progressive
contractions of the uterus that gradually move
the fetus through the lower part of the uterus
(cervix) and birth canal (vagina) to the outside
world.
Monitoring Techniques
During Labor
FHR auscultation
Fetoscope
Doppler
EFM
Uterine contraction
 3 phases of labor contraction
1. INCREMENT – building up of the contraction
(longest phase)
2. ACME – peak of the contraction
3. DECREMENT – letting up of the contraction
 Terms to describe uterine contractions
during labor
• DURATION from the beginning of a contraction to
the completion of the same contraction

• FREQUENCY- the beginning of one contraction and

the beginning of the next contraction

• INTERVAL- the end of one contraction to the

beginning of the next contraction

• INTENSITY – refers to the strength of the contraction

during acme (mild, moderate, strong)
 Difference between true and false labor
TRUE LABOR FALSE LABOR
Contraction Regular, increasing Irregular, no
frequency and change in
intensity, shortening of frequency,
interval duration and
intensity
Discomfort Radiates from back Pain at abdomen
around the abdomen
Rest/ Contraction does not Contraction may
decrease with rest or lessen with activity
Activity activity or rest.
Cervix Progressive Cervical changes
effacement and do not occur yet
dilatation of cervix
• Four Stages of Labor:

1. First Stage: Cervical Dilation

a. Early Labor (latent phase)
b. Active Labor (active phase)
c. Transition (Transition phase)
2. Second Stage: Expulsion
3. Third Stage: Placenta Stage
4. Fourth Stage: Recovery
 FIRST STAGE(Cervical Dilatation)
From the beginning of labor to the full opening (dilation)of the
cervix(about 4inches or 10cm).

a.) Latent Phase

-cervix dilates at 0-3cm
-mild contractions
-duration of 20-40sec
-frequency of every 5-10min

-breathing technique: slow, deep

breathing
b.) Active Phase
-cervical dilatation reaches
4-7cm
-moderate contractions
-duration of 40-60sec
-frequency of 3-5min
-breathing technique: rapid,
shallow breathing
c.)Transition Phase
-cervix at 8-10cm
-strong contractions
-duration of 60-90sec
-frequency of 2-3min
-breathing technique: pant-blow
pattern
Nursing Interventions:
1. Hospital admission
a. personal data
b. obstetrical data
2. Vital Signs
3. FHR- normally 120-160/min
4. Laboratory routine: CBC, Hgb, Hct
5. Enema
6. Perineal Shaving
7. Provide emotional and psychological support
8. Timing of uterine contractions
9. Assisting the doctor in giving meds or analgesia
10. Giving local anesthesia (lidocaine) when in DR table
SECOND STAGE(Expulsion)

-From the complete dilatation of the cervix to delivery of the baby.

- CROWNING –hallmark of 2nd stage
-PRIMI—50 minutes
-MULTIGRAVID-20minutes
Mechanisms of Labor
• Engagement
• Descent
• Flexion
• Internal Rotation
• Extension
• External Rotation
• Expulsion
Nursing Interventions:
1.Position legs into stirrups at the same
time

2.When the head crowns, instruct mother

not to push but to pant.

3.Assist in episiotomy
 THIRD STAGE (Placental stage)
From delivery of the baby to delivery of the placenta.
• Made up of 15-20 lobes
called cotyledons

Types of Placental Delivery

1. SCHULTZ – fetal surface,
bluish and shiny

2. DUNCAN-uterine
surface, reddish and
rough
Signs of Placental Separation
• Lengthening of the cord
• Sudden gush if blood
• Change in the shape of the uterus of Calkin’s
sign
• Firm contraction of uterus
• Appearance of placenta at the vaginal opening
Nursing Interventions:
1. Just watch for the signs of placental separation
2. Take note of the time of placental delivery
3. Inspect for the completeness of the cotyledons
4. Check for the condition of the fundus
-massage carefully
-apply ice cap over abdomen to help contract the uterus
-injection of Methergin or Syntocinon (IM) to maintain uterine contraction
and prevents hemorrhage.
5. Inspect the perineum for laceration
6. Make mother comfortable
7. Position the newly delivered mother flat on her back without pillows
8. Give initial nourishment (milk, soup, tea)
9. Allow patient to sleep
 Fourth Stage
-critical period for the mother on the 1st 1-2hrs after delivery

Nursing Interventions:
• Monitor VS every 15 minutes
• Fundus should be checked every 15 minutes x
1 hr then every 30 minutes for the next 4
hours
• Check for the amount of bleeding
• Check for bladder distention
• Encourage rooming-in