The Stages of Labor are: 1.

First Stage - onset of regular contraction to full dilation

Phase One (LATENT) - dilatation is 0 - 3 cm; duration is 10 - 30 sec; interval is 5 - 30 mins; intensity is mild to moderate Phase Two (ACTIVE) - dilatation is 4 - 7 cm; duration is 30 - 40 sec; interval is 3 -5 mins; intensity ismoderate to strong Phase Three (TRANSITION) - dilatation is 8 - 10 cm; duration is 45 - 90 sec; interval is 2 - 3 mins; intensity is strong

Nursing Care for First Stage of Labor 1. 2. 3. 4. 5. 6. monitor V/S and FHR every 15 mins bed rest for ruptured membrane empty the bladder pain relief teach breathing techniques maintain safety

2. Second Stage of Labor - from full dilation to delivery of the fetus (30-60 mins for primigravida and 20 mins for multipara)

Phase One - station is 0 to +2; contraction is 2 to 3 mins apart Phase Two - station is +2 to +4; contraction is 2 to 2.5 mins apart with urgency to bear down Phase Three - station is +4 to birth; contraction is 1 to 2 mins apart;fetal head visible, increased urgency to bear down

Nursing Care for Second Stage of Labor 1. 2. 3. 4. 5. transfer to delivery room for 8-9 cm dilation for multigravidas and full dilation for primiparas monitor V/S and FHR prepare perineal area encourage pushing with contractions immediate newborn care

3. Third Stage of Labor - from delivery of infant to delivery of placenta

5 - 30 mins sudden gush of blood lengthening of the cord rising of the fundus globular uterus

Nursing Care for Third Stage of Labor

1. 2. 3. 4.

assess for placental separation inspection of placenta monitor V/S initiate

breastfeeding

5. administer oxytoxin and antilactation agents as ordered 6. sending cord blood to laboratory if mother is O-positive or Rh-negative 7. allow bonding 4. Fourth Stage of Labor - time from delivery of placenta to homeostasis (first 4 hours after delivery of the placenta) Nursing Care for Fourth Stage of Labor 1. 2. 3. 4. 5. 6. monitor V/S every 15 mins take fundal height, position and consistency assess for lochia check perineum perform perineal care from front to back post partum car

Labor is a coordinated sequence of involuntary uterine contractions resulting to effacement and dilatation of cervix followed by expulsion of products of conception. The five P's include: A. Passenger: the fetus

Attitude - relationship of fetal body parts to each other, normal uterine posture is completely flexed Lie - relationship of fetal spine to maternal spine. Longitudinal or vertical is when fetus is parallel to mother's spine, transverse or horizontal if fetus is at right angle to mother's spine. Presentation - portion of fetus that enters pelvis first: presenting part could be cephalic or breech (frank, footling) Position - relationship of fetal reference point to one or four quadrants or sides of mother's pelvis.Maternal pelvis side: L-left, R-right; Fetal Reference points: O-occiput, M-mentum, Bbrow, S-sacrum;Maternal Pelvis Quadrant: A-anterior, T-transverse, P-posterior Station - degree of engagement from presenting part to ischial spine; Station 0 means at ischial spine,minus station means above spine, and plus station is below the spine.

B. Passageways

Pelvis Soft tissues - lower uterine segment, cervix, vagina, and introitus

C. Powers - forces acting to expel fetus; primarily by involuntary uterine contractions, secondarily by voluntary bearing down.

- functions of uterine contraction are effacement and dilation D. Person E. Psychological Response - response to contraction, perceptions and beliefs, pre-natal care and education, support systems and communication skills.

Immediate Nursing Care of the Newborn Newborns undergo profound physiologic changes at the moment of birth, as they are released from a warm, snug, dark liquid-filed environment that has met all of their basic needs, into a chilly, unbounded, brightly lit, gravity based outside world. Within minutes after being plunged into this strange environment, a newborns body must initiate respirations and accommodate a circulatory system to extrauterine oxygenation. How well the newborn makes these major adjustments depends on his or her genetic composition, the competency of the recent intrauterine environment, the care received during the labor and birth period, and the care received during the newborn or neonatal periodfrom birth through the first 28 days of life. (Adele Pillitteri, 2007) Two thirds of all deaths that occur during the first year of life occur in the neonatal period. More than half occur in the first 24 hours after birthan indication of how hazardous this time is for an infant. Close observation of a newborn for this indication of distress is essential during this period (National Center for Health Statistics, 2005).