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STAGES OF LABOR
1st Stage: CERVICAL STAGE
a. Latent phase
b. Active phase
c. Transition phase
2nd Stage: EXPULSIVE STAGE
3rd Stage: PLACENTAL STAGE
4th Stage: IMMEDIATE POSTPARTUM

1st Stage: CERVICAL STAGE

 Begins with true labor contractions & ends with complete effacement & full dilatation of
the cervix
Cervical effacement/obliteration
 Shortening of the cervical canal from a length of 1-2 cm until it is paper thin
 Expressed in percentage (100%)
Cervical dilatation
 Enlargement / widening of the cervical opening
 Expressed in cm (10 cm)
During labor, the uterus is gradually differentiated into 2 distinct portions
1. Upper uterine segment – becomes thick & active to expel out the fetus
2. Lower uterine segment - becomes thin-walled, supple & passive so that fetus can be pushed
out easily
3 Phases of the cervical stage:
a. Latent phase – early in labor
 Cervical dilatation: 0-3 cm
 Contractions:
Duration : 20-40 sec.
Interval : 5-10mins.
 Takes up to 8 of the 12 hour first stage
b. Active / accelerated
 Cervical dilatation : 4-7 cm
 Contractions:
Duration : 40-60 secs
Interval : 3-5 mins
 Mother should be brought to the hospital
Nursing care:
Hospital admission:
a. Obtain personal data & obstetrical data
 EDC; GPA
 Amount & character of show
 Whether or not membranes have ruptured
b. General PE, IE, Leopold’s maneuver
c. Monitor progress of labor using the PARTOGRAPH
 Assess start of labor
 Monitor maternal status: BP, PR, T, uterine contractions, urine voided, vaginal bleeding
 Fetal status: FHR, color of amniotic fluid
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 Facilitates early identification of delayed progress of labor

Blood Pressure: Should not be taken during a contraction (tends to increase)
Fetal Heart Rate:
Uterine soufflé - synchronizes maternal heartbeat
Location of FHS:
Vertex: R or L lower quadrant of abdomen
Breech: At or above the level of the umbilicus
 FHR should not be taken during a contraction (will ↓)
 For any abnormality in FHR, the first nursing action: change the mother’s position
Signs of fetal distress:
 Fetal bradycardia
 Tachycardia
 Meconium stained Amniotic Fluid
 Fetal trashing
Danger signs of labor maternal:
 Blood pressure of > 140/90 or decreasing
 Abnormal pulse
 Inadequate or prolonged contractions
 Pathologic retraction ring
 Abnormal lower abdominal contour
 Apprehension
d. Emotional support
 Keep the patient constantly informed of the progress of labor
e. Health teachings
1. Bathing: if contractions are still tolerable
2. Mobility and position of choice
3. Allow woman to eat and drink easy to digest foods
4. Encourage the woman to void every 2-3 hours by offering a bedpan:
 A full bladder retards fetal descent
 Urinary stasis can lead to UTI
 A full bladder may be traumatized during delivery
5. Perineal preparation: Perineal flushing; NO routine perineal shaving
6. Encourage Sim’s position (left lateral decubitus)
 It favors anterior rotation of the fetal head
 It prevents supine hypotensive syndrome
 It promotes relaxation between contractions.
 Woman in labor should not bear down unnecessarily to prevent exhaustion and cervical
edema
Relief of Pain and Discomfort during Labor
 Communication - explain, inform, respect, praise, encourage, reassure
 Mobility- move freely, choice of position
 Urination- encourage every 2 hrs.
 Breathing technique
 Birth companion
When to transfer to the DR?
Primigravidas: when cervix is fully dilated or when there is bulging of the perineum
Multigravidas: 7-8 cm dilatation
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c. Transition Phase of the cervical stage

 Maximum cervical dilatation occurs
 Contraction:
Intensity : Peak
Interval : 2-3 mins.
Duration : 60-90 sec.
 Sudden gush of Amniotic Fluid
 Show is prominent
Second Stage (Expulsive Stage)
 Begins with full dilatation of the cervix & ends with delivery of the infant
Surest sign that the baby is about to be born:
o Bulging of the perineum or Crowning

THIRD STAGE: Placental Stage

 Begins with the birth of the infant and ends with the delivery of the placenta

Duration:

 50% of placental deliveries occur w/in 5 mins.

 90% are delivered w/in 15 mins.
 Mean delivery time of 8.3 mins. (WHO)
 Longer that 18 mins. is asso. w/ a significant risk of postpartum hemorrhage
 Longer than 30 mins., PPH occurs 6x more often

Approaches in the Management of the Third Stage of Labor:

PMSTL - Physiologic Management of the third stage of labor

AMSTL - Active Management of the third stage of labor
• Oxytocin 10 “iu” IM after delivery of the baby (exclude the possibility of a 2nd baby)
• Controlled cord traction with counter traction on the uterus
• Uterine massage

Fourth stage of Labor: Immediate Postpartum Period

- The period from delivery of the placenta until the condition of the woman has stabilized
(1-4 hours after delivery).
 Routinely inspect the vulva, vagina, perineum and anus to identify genital lacerations.
 Inspect the placenta and membranes.
 DO NOT DO routine manual exploration of the uterine cavity.
 Evaluate if the uterus is well contracted and massage the uterus at regular intervals.
 Teach the woman to massage her own uterus to keep it firm. DO NOT put ice pack on
the mother’s abdomen.
Signs of readiness for BF: crawling, tonguing, rooting, sucking
Signs of good attachment:
 Chin touching the breast
 Mouth is wide-open
 Lower lip turned upward
 More areola seen above than below the mouth.