Stages of Labor

STAGES OF LABOR
STAGES OF LABOR
LATENT
Nullipara Multipara
Cervical Dilatation Contractions Frequency Duration Intensity Every 10-30 minutes 30 sec Mild moderate; 25-40 mm Hg by intrauterine pressure catheter Every 2-5 minutes 40-60 sec Moderate strong; 50-7- mm Hg by intrauterine pressure catheter Every 1 -2 minutes 60-90 sec Strong by palpation; 70-90 by intrauterine pressure catheter ACTIVE TRANSITION
8.6 hours 5.3 hour

0-3 cm
4.6 hours 2.4 hour

4-7 cm
3 hours < 1 hour

8-10 cm
Latent Phase
Anxiety Smiling and eager to talk Excitement is high
Latent Phase
Cervix dilate and effaces No evident fetal descent Amniotic membranes bulge (cone) SROM Amniotomy (AROM)
Active Phase
Increases in anxiety intense contractions and pain Decreased ability to cope, fear of loss of control Sense of helplessness Progressive fetal descent Cervical Dilatation: nullipara1.2 cm/hr Multipara 1.5 cm/hr
Transition Phase
Significant anxiety Restless, frequently changing positions Inner directed, tired Fear of being left alone Cervical dilatation slows but fetal descent dramatically increases
Transition Phase
Increased rectal pressure Uncontrollable desire to bear down Increased amount of bloody show Rupture of membranes Peak of contraction torn open or split apart hyperventilation
Transition Phase
Increased apprehension and irritability Generalized discomfort (low backache, shaking, cramping, increased sensitivity to touch) Sense of bewilderment, frustration, and anger at contractions
Second Stage of Labor

Fetal Stage
Second stage of Labor

Begins with complete cervical dilation and ends with birth of infant
Multipara: 7-8 cm, 15 minutes Primipara: 10 cm, 3 hours
Contractions
Frequency : every 3 minutes Duration : 60-90 minutes Intesity: strong
Crowning
Nursing responsibilities
Ritgens Maneuver Support head Check cord if coiled Check time and Identification of baby Assist doctor in doing episiotomy
Cardinal Movements
Engagement Descent Flexion Internal rotation Extension Restitution External rotation Expulsion
THIRD STAGE OF LABOR
Begins with the birth of the infant and ends with the delivery of the placenta. After the birth of an infant, a uterus can be palpated as a rm, round mass just inferior to the level of the umbilicus.
Two separate phases are involved:

Placental separation Placental expulsion/delivery
Placental Separation
As the uterus contracts down on an almost empty interior, there is such a disproportion between the placenta and the contracting wall of the uterus that folding and separation of the placenta occur. Active bleeding on the maternal surface of the placenta begins with separation
Signs of placental separation:

Lengthening of the umbilical cord Sudden gush of vaginal blood Change in the shape of the uterus Firm contraction of the uterus Appearance of the placenta at the vaginal opening
Placental Delivery
After the signs of placental separation appear, the placenta is delivered either by the natural bearing down effort of the mother or by gentle pressure on the contracted uterine fundus Pressure must never be applied to a uterus in a non-contracted state
If the placenta does not deliver spontaneously, it can be removed manually. With delivery of the placenta, the third stage of labor is complete. A placenta is considered to be retained if 30 minutes have elapsed from completion of the second stage of labor.
Schultze presentation (Shiny Schultze) -appearing shiny and glistening from the fetal membranes Duncan presentation (Dirty Duncan) -looks raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces showing
Bleeding is a normal consequence of placental separation, before the uterus contract sufficiently to seal maternal sinuses Normal blood loss is 300 to 500 ml.
FOURTH STAGE OF LABOR
This stage of labor is the time, from 1 to 4 hours after birth, during which physiologic readjustment of the mother's body begins. Blood loss and removal of the weight of the pregnant uterus from the surrounding vessels result in moderate drop in both systolic and diastolic blood pressure, increased pulse pressure, and moderate tachycardia.
The uterus remains contracted in the midline of the abdomen. The fundus is usually midway between the symphysis pubis and umbilicus. Immediately after birth of the placenta, the cervix is widely spread and thick. Nausea and vomiting usually cease.
The woman may be thirsty and hungry She may also experience a shaking chill The bladder is often hypotonic due to trauma during the second stage and/or the administration of anesthetic

Stages of Labor

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STAGES OF LABOR

8.6 hours 5.3 hour

4.6 hours 2.4 hour

3 hours < 1 hour

Second Stage of Labor

Second stage of Labor

Multipara: 7-8 cm, 15 minutes Primipara: 10 cm, 3 hours

THIRD STAGE OF LABOR

Two separate phases are involved:

Signs of placental separation:

FOURTH STAGE OF LABOR

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