Stages of Labor

FIRST STAGE (STAGE OF DILATATION)

Latent
• from onset of uterine contraction to
rapid cervical dilation.

• contractions are mild and short

• 20-40 seconds

• 0-3 cm

• 6 hours – Nullipara

• 4.5 hours – multipara

• Woman can(and should) continue to walk and make preparations for

birth.
Active Phase
• more rapidly cervical dilatation

• 4-7 cm
• 40-60 seconds approximately every 3 to 5 minutes

• 3 hours – nullipara
• 2 hours – multipara

• Show and spontaneous rupture of membrane may occur.

 Transition Phase

• Contraction reach the peak of intensity.

• 60-90 seconds
• 2-3 minutes
• 8-10 cm
• When she reach 10 cm-irresistible urge to
push.
SECOND STAGE (BIRTH)

• From full dilatation and cervical effacement to

birth of the baby.

• Contraction – crescendo-decrecsendo.

• Crowning
THIRD STAGE (PLACENTAL STAGE)

• From the birth of infant to the delivery of the

placenta.
• Placental separation
• Placental Expulsion
• Uterus – firm, round mass inferior to the level
of the umbilicus.
• After few minutes contraction begins again
 Signs of Placental Separation

• Lengthening of the umbilical cord

• Sudden gush of vaginal blood
• Change in the shape of the uterus
• Firm contraction of the uterus
• Appearance of the placenta at the vaginal
opening
 Placental Presentation
1.) Schultze
– Separates in the center
– Shiny and glistening
2.) Duncan
– Separates at its edges
– Raw, red, irregular, with ridges or cotyledons
 Placental Expulsion

• Bearing-down effort of the mother

• Or by gentle pressure on the contracted
uterine fundus (crede’s maneuver

NORMAL BLOOD LOSS:

300 – 500 ml
 Maternal and Fetal Response to Labor

Cardiovascular system
– contraction greatly decreases blood flow to the uterus.
– Average weight loss : 300-500 ml

Blood Pressure:
 increased cardiac output caused by contractions,
systolic Blood pressure rises an average of
15mmhgwith each contraction.
 Supine and pushes-hypotension
 Upright or side lying position.
 Respiratory System

• Increase cardiovascular parameters – increase

additional oxygen supply.
• Appropriate breathing pattern
 Urinary system

• Specific gravity may rise to high normal level:

1.020-1.030
• 1+ protein in the urine
 Musculoskeletal System

• Relaxin- acts to soften cartilage between

bones.
• A woman may report increased flexibility as
increased back pain or irrigating, nagging pain
at the pubis as she walks or turn in labor.
 Gastrointestinal System

• Becomes fairly inactive

• Eating during labor is usually restricted.
 Psychological Responses
Fatigue
• A woman is generally tired from burden of
carrying so much extra weight with her.
• Backache: side lying
• difficulty of adjusting to the situation.
Fear

• Explain what to experience during labor.

 Danger Signs of Labor
Fetal danger signs
– High or low fetal heart Rate
 More than 160 or less thatn 110 bpm
– Meconium staning
- Green color amniotic Fluid
- Hyperactivity
- Fetal Acidosis (pH <7.2
 Maternal Danger Sign
• Rising or Falling Blood Pressure systolic
Pressure > 140 mmhg and Diastolic Blood
Pressure < 90mmhg
• Abnormal Pulse
- 70-80bpm- normal
- > 100 bpm
• Inadequate or Prolonged Contraction
• Abnormal Lower Abdominal Contour
- Full bladder