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    First Stage of Labor Management

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    Farheen khan
    The first stage of labor involves cervical dilation and effacement allowing the baby to move into the birth canal. It is divided into three phases: latent, active, and transitional. During each phase, the document outlines recommended nursing interventions and responsibilities to monitor labor progress, manage pain, and ensure safety. It also discusses evidence-based practices for labor management during the first stage, such as the use of oxytocin augmentation and upright positioning to shorten labor, while practices like routine enemas or amniotomies are not recommended.

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    First Stage of Labor Management

    Uploaded by

    Farheen khan
    108 views6 pages
    The first stage of labor involves cervical dilation and effacement allowing the baby to move into the birth canal. It is divided into three phases: latent, active, and transitional. During each phase, the document outlines recommended nursing interventions and responsibilities to monitor labor progress, manage pain, and ensure safety. It also discusses evidence-based practices for labor management during the first stage, such as the use of oxytocin augmentation and upright positioning to shorten labor, while practices like routine enemas or amniotomies are not recommended.

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    First stage of labor management

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    The first stage of labor involves cervical dilation and effacement allowing the baby to move into the birth canal. It is divided into three phases: latent, active, and transitional. During each phase, the document outlines recommended nursing interventions and responsibilities to monitor labor progress, manage pain, and ensure safety. It also discusses evidence-based practices for labor management during the first stage, such as the use of oxytocin augmentation and upright positioning to shorten labor, while practices like routine enemas or amniotomies are not recommended.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    108 views6 pages

    First Stage of Labor Management

    Uploaded by

    Farheen khan
    The first stage of labor involves cervical dilation and effacement allowing the baby to move into the birth canal. It is divided into three phases: latent, active, and transitional. During each phase, the document outlines recommended nursing interventions and responsibilities to monitor labor progress, manage pain, and ensure safety. It also discusses evidence-based practices for labor management during the first stage, such as the use of oxytocin augmentation and upright positioning to shorten labor, while practices like routine enemas or amniotomies are not recommended.

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    © All Rights Reserved
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    of 6

    First Stage of Labor

    The first stage of labor and birth occurs when you begin to feel regular
    contractions, which cause the cervix to open (dilate) and soften, shorten and thin
    (effacement). This allows the baby to move into the birth canal. The first stage is
    the longest of the three stages.
    Stages of Labor
    The progress of cervical effacement, cervical dilatation, and descent of fetal
    presenting part dictate stages of labor. Here are the stages of labor and significant
    events that mark their beginning and end:

    Duration
    Stages of Labor Start End

    Nullipara Multipara

    10-12 hr
    but 6-20 6-8 hrs but 2-12
    Full cervical
    First Stage True labor contractions hrs is the hrs is the normal
    dilatation
    normal limit
    limit

    Onset of regularly perceived uterine


    Latent 3 cm cervical
    contractions (mild contractions 6 hrs 4.5 hrs
    phase dilatation
    lasting 20-40 sec)

    Stronger uterine contractions lasting 7 cm cervical


    Active phase 3 hrs 2 hrs
    40-60secs dilatation

    Uterine contractions reaching their 10 cm


    Transitional
    peak, occurring every 2-3 minutes cervical 3 hrs 1.5-2 hrs
    phase
    for 60-90 s dilatation

    <2 hrs 0.5-1 hrs

    Second Stage Full cervical dilatation Infant birth


    3 hrs with 2 hrs with
    epidurals epidurals

    Placental
    Third Stage Infant birth Maximum of 30 min
    delivery
    First Stage of Labor

    As mentioned above, the first stage of labor is divided into three sub-phases,
    namely: latent, active, and transitional phases.

    1.Latent Phase

    Latent (Preparatory) Phase starts from the onset of true labor contractions to 3 cm
    cervical dilatation. Here are nursing responsibilities during this phase:

    -Assess patient’s psychological readiness. Provide continuous maternal support


    (compared to usual care).

    -Measure duration of latent phase. For nulliparas, it should not be more than 6
    hours. On the other hand, for multiparas, it should be within 4.5 hours. Determine
    if patient received anesthesia because it can prolong latent phase. One of the most
    common cause of prolonged latent phase is cephalopelvic disproportion (CPD) and
    it requires cesarean birth.

    -Allow patient to be continually active. Upright maternal positions are


    recommended for women on the first stage of labor. Patients without pregnancy
    complications can still walk around and make necessary birth preparations.

    -Conduct interviews and filling in of forms (e.g. birth certificate) at this phase
    while the patient experiences minimal discomfort and has control over contraction
    pains.

    -Conduct health teaching on breastfeeding, newborn care, and effective bearing


    down because during this time, patient’s anxiety is controlled and she is able to
    focus on nurse’s instructions.

    -Educate patient on different relaxation techniques. As early as this phase,


    encourage patient to begin alternative therapy of pain relief.

    -Ensure that the total number of internal examinations the woman receives in the
    entire course of labor is limited.
    -Ensure that birthing companion of choice is present all throughout the course of
    labor.

    2.Active Phase

    Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation.


    During this phase, contraction intensity is stronger, interval shortens, and duration
    lengthens. This is where true discomfort is first felt by the patient so she is
    dependent and her focus is on herself. Here are nursing responsibilities in this
    phase:

    -Inform patient on the progress of her labor to lessen her anxiety and obtain her
    trust and cooperation.

    -Start monitoring progress of labor with the use of WHO partograph, 2-hour action
    line.

    -Encourage patient to be continually active to maximize the effect of uterine


    contractions. Upright maternal positions are recommended if tolerated.

    -Assist patient in assuming her position of comfort. For those who can’t stay
    upright, left-side lying is recommended to avoid disruption in fetal oxygenation.

    -Monitor maternal vital signs and fetal heart rate every 2 hours, or depending on
    the doctor’s order.

    -Anticipate patient needs (e.g. sponging face with cool cloth, keeping bed clean
    and dry, providing ice chips or lip balm) to promote comfort.

    -Determine when patient last voided because a full bladder can hinder fast labor
    progress.

    -Institute non-pharmacological pain measures (e.g. breathing exercises, distraction


    method, imagery, music therapy, etc.)
    3.Transition Phase

    Transition Phase starts from 8 cm cervical dilatation to 10 cm (full) cervical


    dilatation and full cervical effacement. During this time, patient may be exhausted
    and withdrawn or aggressive and restless. Patient’s urge to push is noticeable. Here
    are nursing responsibilities in this phase:

    -Inform patient on progress of her labor.

    -Assist patient with pant-blow breathing.

    -Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or
    depending on the doctor’s order. Contraction monitoring is also continued.

    -When perineal bulging is noticeable, prepare for delivery. Check room


    temperature. The nurse should also notify staff and prepare necessary supplies and
    equipment, including resuscitation machine. Lastly, perform handwashing and
    double gloving.

    WHO do not recommend the following nursing interventions during labor


    because they have low quality of evidence

    -Routine perineal shaving

    -Routine use of enema

    -Admission cardiotocography (CTG) for low-risk women

    -Vaginal douching

    -Routine amniotomy for patients in spontaneous labor

    -Massage and reflexology


    RESEARCH ARTICLE

    Evidence-based labor management: first stage of labor

    PLACE- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology,


    Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA

    YEAR- 2020

    AUTHOR- LeenAlhafezMD , VincenzoBerghellaMD

    PUBLICATION- Volume 2, Issue 4, November 2020, 100185

    ABSTRACT

    There are several interventions during the first stage of labor that have been studied. Vaginal
    disinfection with chlorhexidine cannot be recommended. Intrapartum antibiotic prophylaxis is
    recommended for group B streptococcus–positive women. Antibiotic therapy can be considered
    in women with term prelabor rupture of membranes whose latency is expected to be >12 hours.
    Aromatherapy with essential oils through inhalation or back massage can be considered.
    Immersion in water can be considered. Oral restriction of fluid or solid food is not
    recommended. In the setting of oral restriction, intravenous fluid containing dextrose at a rate of
    250 mL/h is recommended. Upright positions and ambulation are recommended in women
    without regional anesthesia, and women with regional anesthesia can adopt whatever position
    they find most comfortable and choose to ambulate or not ambulate. Continuous bladder
    catheterization cannot be recommended. There is no recommended frequency of cervical
    examinations or sweeping of membranes. The use of a partogram cannot be recommended as a
    routine intervention. Routine use of the peanut ball cannot be recommended. Antispasmodic
    agents cannot be recommended. Routine amniotomy alone in normally progressing spontaneous
    first stage of labor cannot be recommended. Oxytocin augmentation is recommended to shorten
    the time to delivery for women making slow progress in spontaneous labor, and higher doses of
    oxytocin can be considered. Early intervention with oxytocin and amniotomy for the prevention
    and treatment of dysfunctional or slow labor is recommended. Routine use of intrauterine
    pressure catheter and ultrasound cannot be recommended. Cesarean delivery for arrest should not
    be performed unless labor has arrested for a minimum of 4 hours with adequate uterine activity
    or 6 hours with inadequate uterine activity in a woman with rupture of membranes, adequate
    oxytocin, and ≥6 cm cervical dilation

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