OBSTETRIC

NURSING

LABOR PROCESS
 FIRST STAGE OF LABOR
(Stage of Dilatation)

Begins with the true contractions and ends

with complete dilatation of the cervix.
 Duration of Normal Labor

STAGE PRIMI MULTI

First Stage 12 ½ hrs 8 hrs
Second Stage 80 mins 30 mins
Third Stage 10 mins 10 mins
TOTAL 14 hrs 8 hrs
 STAGE DILATION DURATION INTERVAL INTENSITY
LATENT 0-3 cm 10-30 sec 5-30 mins Mild
ACTIVE 4-7 cm 30-40 sec 3-5 mins Moderate
TRANSITION 8-10 cm 45-90 sec 2-3 mins Severe
Primi-gravida - effacement then dilate
Multi-gravida - dilate then effacement
 Nursing Intervention
 Administer perineal prep/enema if ordered.
 Assess vital sign as base line data, FHT and
contractions.
 Maintain bed rest if indicated or required.
 Position patient for maximum comfort.
 Reinforced breathing technique as needed.
 Have patients attempt to void every 1-2 hrs.
 Apply external fetal monitoring as ordered.
 Administer analgesia if ordered for pain.
 Give patient positive support during labor.
 SECOND STAGE OF LABOR
(Stage of Expulsion)

Begins with the complete dilatation and ends

with the delivery of the infant.
Mechanisms of Labor:

1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Extension
6. External Rotation
7. Expulsion
PHASES STATION CONTRACTION
1 0 to +2 2 to 3 mins apart
2 +2 to +4 2 to 2.5 mins apart
3 +4 to birth 1 to 2 mins apart
 Nursing Intervention
 Transfer mother carefully to delivery table,
support legs equally to prevent strain.
 Clean vulva and perineum to prepare for
delivery.
 Continue observation of maternal and fetal
vital sign.
 Encourage mother in sustained pushes
with each contraction.
 THIRD STAGE OF LABOR
(Stage of Placental Delivery)
Begins with the delivery of the baby and
ends with the delivery of the placenta.
The placenta deliver in the period of 5 to 10
mins ( max of 30 mins)
The nurse should assess the placenta on
the number of 30 cotyledons, weights of 400
to 600 grms ( 1lbs, 1/6 of fetal size)
Signs of Placental Separation:

1. Sudden gush of blood

2. Lengthening of the cord
3. Change in shape of uterus
or Calkin’s sign
Types of Placental Delivery:

1. Duncan
2. Schultz
 Degree of Laceration of Perineum

1st degree – involves the vaginal mucous

membranes and perineal skin.
2nd degree – plus the muscle
3rd degree – plus the external sphincter of
the rectum
4th degree – plus the mucous membranes of
the rectum
Degrees of Laceration
 Nursing Intervention
 Palpate fundus immediately after delivery of
placenta, massage gently if not firm.
 Palpate fundus at least 15 minute for first hour.
 Observe lochia for color and amount.
 Inspect perineum for bleeding.
 Offer fluid as indicated.
 Promote beginning relationship with the baby
and parents through touch and privacy.
 Administer medication as ordered
 FOURTH STAGE OF LABOR
(Stage of Recovery)

First 2 hours to 4 hours postpartum is the

most crucial stage for the mother due to
unstable vital sign, unexpected bleeding and
pain.
Endometrial Surface / Lochia’s

Lochia Color Days Release Consistency

Blood and cellular
Rubra Dark red 1-3 days
debris
Serosa Pinkish brown 4-10 days Serum, blood tissue
Decidua, epithelial cell,
Alba Yellowish white 11-21 days
mucus
 Rubin’s Postpartum Phases

1. Taking-in Phase
- 1-3 days after delivery
- the mother is self-centered
1. Taking hold Phase
- 3 days to 2 weeks
- the mother strives for independence
1. Letting go Phase
- 10 days or 2 weeks to 6 weeks
- the mother integrates her new role
 Nursing Intervention
 Palpate fundus every 15 minutes for first 1-2
hours, massage gently if not firm.
 Check mothers vital sign.
 Check lochia for color and amount, every 15
minutes for the first 1-2 hours.
 Inspect perineum every 15 minutes for first 1-2
hours.
 Apply ice to perineum if swollen.
 Encourage mother to void particularly if fundus is
not firm or displaced.
 THE END….

HERALD CLARENCE M.
AMBAYEC, RN