Different stages of labor

Presented by:
Wyeth Ryan Ona
 Difference between False and True Labor
FALSE LABOR TRUE LABOR

Frequency of Irregular Regular

contractions
Intensity of No increase Increases
contractions
Pain relief Pain is relieved by Pain is intensified by
walking walking
Pain location Confirmed on Begins on lower back
abdomen and radiates to
abdomen
Cervical changes No cervical changes Effacement and
dilation
 First stage of Labor
Onset of contractions to full dilatation
and effacement of the cervix

Divided into three Phases:

< LATENT
< ACTIVE
< TRANSITIONAL
 First stage of Labor
LATENT ACTIVE TRANSITIONAL
DILATATION 0 - 3 cm 4 - 8 cm 8 - 10 cm

FREQUENCY q 5 - 10 mins. q 3 - 5 mins q 2 - 3 mins

DURATION 20 - 40 secs 30 - 60 secs. 45 - 90 secs

INTENSITY Mild Moderate Strong

MOTHER’S Apprehensive, Fears of losing Sudden behavioral

BEHAVIOR excited but can control of herself or mood changes
communicate usually accompanied
by hyperesthesia of
the skin
(hypersensitivity of
mother to touch
 First stage of Labor
Effacement - softening and thinning of
cervical canal denoted by percentage.

Dilatation - widening of the external

cervical os to 10 cm. as a result of
pressure of the presenting part and bag
of water(BOW) denoted by centimeters.
 First stage of Labor
Station - relationship of presenting part to
the ischial spine denoted in centimeters

< - 1 means 1 cm above the ischial spine

< 0 means fetus is engaged

< +3 to +5 means 3 to 5 cm below ischial spine,

Crowning occurs and signals the 2nd stage of
labor
 First stage of Labor
Presentation - relationship of the long axis to
the fetus to the long axis of the mother

Position - relationship of the fetal presenting

part to specific quadrant of the mother’s pelvis

- LOA (Left occiput Anterior) is most common and

favorable birthing position
 Second stage of Labor
Complete dilatation and effacement of birth of the baby, aka
“FETAL STAGE”

Mother is transferred to DR

Maternal Position

- Lithotomy and dorsal recumbent are positions most

comfortable
- Bulging of perineum is the surest sign that baby is about to
be delivered
- Advice mother to do panting, breathing exercise much like
blowing a feather
 Second stage of Labor
Engagement - head enters the pelvic inlet in the
transverse biparietal diameter

Mechanisms of Labor (D-F-IR-E-ER-E)

– Descent is the prerequisite of NSD
– Flexion occurs when head meets resistance of the birth canal
– Internal Rotation occurs when occiput gradually moves
anteriorly towards the symphysis pubis
– Extension is the delivery of the fetal head
– External Rotation when head undergoes rotation back to it’s
original position in direction opposite that of internal rotation
– Expulsion is the delivery of the rest of the body
 Second stage of Labor
Episiotomies
– Median is from the middle portion of the lower vaginal
border directed towards the anus
– Mediolateral begins in the midline but directed laterally away
from the anus

Process of Delivery
– Modified Ritgen’s Manuever is done by covering the anus
with sterile towel and exert upward and forward pressure on
the fetal chin while exerting gentle pressure with two fingers
on the head to contral the emerging head.
– Ease the baby’s head out and immediately wipe the nose
and mouth of secretions to establish airway
 Second stage of Labor
Process of Delivery
– After the delivery of the body of the newborn, held the
body below the level of the mother’s vulva for a few
minute to encourage flow of blood from the placenta to
the baby
– Suction of the nose is done
– The umbilical cord is doubly clamped and cut, leaving 2-3
cm (1 inch) of cord
– Take note of the exact time of delivery of the baby, proper
identification ,and foot printing
– Allow the mother to see the baby
– Wrap the baby in sterile cloth diaper to keep him warm
 Third stage of Labor
Birth of the baby up to expulsion of placenta aka
“PLACENTAL STAGE”

Care of the baby

- Clear airway of mucus
- APGAR scoring
- Keep baby warm
- Assess for visible abnormalities
- Administer antibiotic ophthalmic medication to
prevent ophthalmic neonatorum
 Third stage of Labor
Assist with the delivery of placenta
- Placenta is delivered about 3-10 minutes after the delivery of
the baby

Signs of Placental separation

– Calkin’s sign or fundus becomes globular and firm again
– Lengthening of the cord
– Sudden gush of blood from the vagina

Types of placental delivery

- Shultz - shiny part of placenta
- Duncan - dirty part of placenta
 Third stage of Labor
Do not hurry the expulsion of placenta by forcefully pulling out the cord
because it can cause Uterine Inversion. Just watch the signs of placental
separation

If the uterus becomes boggy or non-contracted, massage it gently and

properly, then put ice over the abdomen to help contract the uterus since
cold compress causes vasodilation

Check vital signs especially BP

Administer medication as ordered like Methergin and Oxytocin

Inspect for lacerations

Assist in Episiorrhapy or repair of episiotomy

 Fourth stage of Labor
The first 1-2 hours after the placental delivery aka
“RECOVERY STAGE”

Monitor VS

Two hours after delivery, the fundus is at the same height

of umbilicus

Check for bladder retention, a full bladder can lead to

uterine atony leading hemorrhage

Monitor mother as body gradually regains homeostasis

 Fourth stage of Labor
Check the Lochia
Types:
– Rubra
– Serosa
– Alba

Make mother comfortable

Promote maternal-infant bonding

Nursing Diagnosis and Nursing Care

Nursing diagnosis:
– Anxiety related to incoming labor and delivery as
evidenced by restlessness

Nursing Care:
– Inform patient the progress of labor
– Support the patient and family emotionally and
psychologically
Nursing Diagnosis and Nursing Care

Nursing diagnosis:
– Acute pain related to obstretical pain as evidenced by
frequency and intensity of uterine contractions

Nursing Care:
– Encourage walking to shorten first stage of labor
– Encourage to void every 2-3 hours
– Teach pant breathing
– Give medications as ordered
THE END