Defined as the first onset of contractions through the complete dilation of the cervix, with 3 separate phases. Stage 1 is the longest phase. Throughout this phase, keep in mind the following interventions:
- Monitor maternal and fetal vital signs.
- Continually assess FHR before, during, and after contractions.
- Assess fetal descent, cervical dilation, and effacement.
- Assess fetal station presentation and position.
- Encourage frequent position changes and/or ambulation if not contraindicated.
- Involve patient and support person in labor process and what to expect.
To start, I will add another definition here, prodromal labor. This is latent phase labor that has lasted several days.
The latent phase is usually defined by:
- Cervical dilation is 1 to 4 cm.
- Uterine contractions occur q15-30 mins and last 15-30 sec.
- Lasts an average length of 5-8 hrs
- Contractions are of mild intensity
In this stage, mom’s will most likely be feeling a variety of emotions. They are also usually able to participate in their own care and may not quite ask for pain control interventions at this time. Keep in mind that each mom is unique and requires individual assessment!
This phase consists of:
- Cervical dilation of 4 to 7 cm.
- Uterine contractions q3-5 min and last 30-60 sec.
- Lasts an average length of 2-5 hrs.
- Some fetal descent.
- Contractions are moderate-strong intensity.
During this phase of labor, mom’s behavior will start to shift. She will start breathing heavier and may not be able to talk through contractions. She will benefit from a quiet environment and pain control interventions. Pain interventions do not have to be medication, as promoting comfort with back rubs, sacral pressure, and position changes can be effective and beneficial.
This phase is arguably the “most difficult” phase of labor.
- Cervical dilation is 8 to 10 cm.
- Uterine contractions occur q2-3 min and last 45-90 sec in duration.
- The contractions are of strong intensity.
- Fetal descent.
During this phase, mom may have increased anxiety, apprehension, and discomfort. She will experience increased pressure, bloody show, and may verbalize the urge to push. Contrary to the active phase of labor, she may not want to be touched. Rest is encouraged between contractions.
Stage 2 is defined as the period from complete cervical dilation and effacement to the delivery of the fetus, or “Expulsive” phase.
- Contractions continue to occur q2-3 min lasting 60-75 sec.
- Increase in bloody show occurs.
- Mom will experience voluntary or involuntary urge to “bear down.”
- This stage can last minutes to 4 hours.
Sources of pain during the 2nd stage of labor change from pain in a more generalized area to localized to the distention of the vagina and perineum and pressure on adjacent structures.
It is important to complete assessments every 5 minutes. Normal FHR is 110-160 bpm before, during, and after contractions.
Cardinal movements of labor:
- Internal Rotation
- External Rotation
The process of labor does not stop once the baby has been born! This 3rd stage is from the delivery of the infant to the expulsion of the placenta. Contractions continue to occur until this is completed.
Image source: https://www.newlifeblessings.com/blog/category/placenta
- Schultze Mechanism: “Shiny shultze” – center of the placenta separates first, and the shiny portion of the placenta emerges first.
- Duncan Mechanism: “Dirty duncan” – the margin of the placenta separates first and the dull, rough, red portion of the placenta emerges first.
Signs of placental separation:
- Uterus becomes globular shaped
- Rise of the fundus in the abdomen
- Sudden gush or trickle of blood
- Further protrusion of the umbilical cord out of the vagina
Be sure to continue involving the mother and support person in this stage about the steps of delivering the placenta while also promoting parental-neonatal attachment. The uterine fundus should be firm and should be located 2 fingerbreadths below the umbilicus.
A placenta is considered retained if more than 30 minutes has elapsed since the birth of the infant.
Stage 4 is known as the Recovery Stage. This stage is defined from the delivery of the placenta to the immediate recovery of the mother.
It is important to perform maternal assessments q15min for 1 hour, q30min for 1 hour, and hourly for 2 hours, or according to facility policy. Apply ice packs to the perineum, and massage the uterus as needed to keep it firm.
The mother may also experience chills, a hypotonic bladder, and a variety of emotions related to the birth process. Encourage continued bonding between the infant and parents, and provide breast-feeding support as needed.
References and Additional Resources
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Continue your NCLEX Review Journey by checking out some of my other NCLEX Review posts!
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