Stages of Labor

Labor Stage

Primigravida 8-10 hours (Ave: 9 hours) 6 hours 2 hours 5 hours 4 hours 1 hour

Multigravida

FIRST STAGE: phases 1. Latent phase (0-4 cm cervix) 2. Active phase (4-8 cm cervix) 3. Transitional phase (8-10 cm cervix) the most difficult for the mother

SECOND STAGE the most difficult part for the fetus THIRD STAGE

Mean: 50 minutes/1 hours 5-15 minutes The average duration of the third stage is 5 minutes The period of recovery, usually 1-2 hours most u to 4

20 minutes (1/2 hour) 5-10 minutes

FOURTH STAGE MOST DANGEROUS for the mother. When the fundus fails to contract and remains atonic in spite of management, the woman can hemorrhage the leading cause of maternal mortality

Stabilization, or homeostasis, hours

First Stage of Labor

(Dilatation Stage)

Latent phase Nursing responsibility:

Proper positioning: side lying Provide backrub Support system: Husband may stay with the client.

Active phase
Nursing Responsibility:
Encourage woman to slow her breathing and take shallow breaths; Teach deep breathing exercises and relaxation techniques. If hyperventilation occur: Offer a paper bag where she can breath into or instruct her to breathe into her cupped hands until sighs abate Stay with the woman to keep her at ease.

First Stage of Labor

(Dilatation Stage)

Transition phase Nursing Responsibility:

Provide physical comfort with dry linens and cool clothes. Clean up vomitus. Provide backrub Coach on breathing techniques: pant-blow pattern of breathing in the transition phase Provide psychologic comfort: Dont leave client alone; help focus on task; inform of progress; be understanding of her irritability.

Second Stage of Labor

(Delivery Stage)
From fully dilated cervix to the Nursing delivery or expulsion of the Implementation: baby P- raise Maternal Behavior: R- eassurrance w/ need to bear down E- ncouragement Perineum bulges I- nform mother of Increase bloody show; w/ progress leg crams S- upport system Bag of water rapture T-ouch Assist/Coach: bear down only when needed; during contractions Monitor FHT: be alert for late decelerations

Cont. Nursing Intervention

Proper position: Lithotomy to consider: padded stirrups, no pressure on popliteal region, equal height of legs. Simultaneous placing of legs on the stirrups Perineal prep Provide assistance to the health provider in attendance, or assist with delivery as indicated.

Third Stage of Labor

(placental stage)

The placental stage is the period from the delivery of the baby to the delivery of the placenta.

Signs of placental separation:

Calkins sign is the first sign; uterus changes its shape (globular) Uterus becomes mobile Sudden gush of blood Lengthening of the cord most definitive sign that the placenta has detached.

Types of placental delivery

Schultze Mechanism:
More common Shiny clean bluish side is the first delivered Less external bleeding because blood is usually concealed behind the placenta The type where separation starts at the center, then to the edges causing inverted umbrella shape

Duncans Mechanism:
Less common Rough, dirty reddish maternal side out first More external bleeding so it appears bloody. Umbrella shaped placenta delivered sideways

Nursing Implementation
watchful waiting; dont pull the chord especially if the uterus is relaxed may cause uterine inversion. Gradual delivery of placenta Inspect for completeness:
Complete cotyledon: 30 Complete cord vessels: 1 vein 2 arteries Complete membrane

Feel the fundus for contraction or firmness. Massage uterus until firm; Ice ca may be applied to further contract the uterus; Never use hot water bag.

 Inject ordered oxytocin after placental delivery to increase uterine motor activity by direct stimulation to prevent postpartum bleeding. Assess V/S, presence of lacerations and bleeding. Lower legs slowly Allow mother to spend time with infant to promote bonding.

Fourth Stage of Labor

Period of recovery first 1-4 hours Nursing Interventions:
Monitor V/S q15 Palpate fundus q15 check height, position in relation to umbilicus and consistency of uterus Assess lochia Check for bladded distention Check the perineum Check episiotomy wound or lacerated wound for bleeding, hematoma or edema. Ice bag to perineum immediately after delivery (1st 24 hours) to reduce edema Promote sleep and comfort Provide nourishment as the woman may be thirst and hungry.