Stages Of Labor Recap

Prepared by :Prepared by :

Ms. Shenell A. Delfin,RNMs. Shenell A. Delfin,RN

CHARACTERISTICS PATIENT CHARACTERISTICS PATIENT BEHAVIORBEHAVIORFIRST STAGE – STAGE OF

DILATION AND EFFACEMENT

Latent Phase ( 4 – 6 hours)

Cervix dilation is 0-4 cm.Amniotic membranes may

be intact.There may be “bloody

show.”Contractions: q 20 minutes

decreasing to q 5 minutes

Duration: 15-40 secondsIntensity: mild to moderate

•Cooperative•Alert•Talkative•Welcomes diversions•Urinary frequency•Thirsty

NURSING INTERVENTIONSNURSING INTERVENTIONS •Establish positive relationships•Encourage alternating ambulation and rest•Assess fetal heart rate.•Time contractions•Document color of vaginal discharge•Assess for distended bladder•Provide lollipops for mother to hold and suck on between contractions for carbohydrate and fluid intake.•Assess vital signs q 2 hours•Woman may takes showers.•Teach what to expect as labor

progresses.

Active Phase (2-6 hours)Active Phase (2-6 hours)

► Cervix dilation is 4-8 cm.Cervix dilation is 4-8 cm.► Amniotic membranes Amniotic membranes

may rupture.may rupture.► Effacement of cervix Effacement of cervix

occurs.occurs.► Contractions:Contractions: 2-5 minutes 2-5 minutes

apartapart► Duration:Duration: 40-60 seconds 40-60 seconds► Intensity:Intensity: moderate to moderate to

firm.firm.

•Apprehensive•Anxious•Introverted•Less social•Focused on breathing•Perspires•Facial flushing•Requests pain relief•Fears losing control•May need epidural analgesia at this time

►NURSING INTERVENTIONSNURSING INTERVENTIONS •Help coach apply coping strategies• learned in prenatal classes (breathing, relaxation).•Continue maternal and fetal assessments•Reassure woman•Praise progress.•Provide back massage•facilitate position changes (avoid lying flat on back)•If taking nothing orally (NPO), moisten mouth•Monitor IV fluid intake•Watch for bladder distention.•Encourage voiding.•Report color, odor, amount of vaginal discharge' report if meconium is seen.•Maintain warmth•provide general comfort measures.

► Transition phase (30 Transition phase (30 minutes to 2 hours)minutes to 2 hours)

► Cervix dilation is 8-10 Cervix dilation is 8-10 cm; cervix fully cm; cervix fully effaced.effaced.

► Amniotic membranes Amniotic membranes rupture.rupture.

► Contractions:Contractions: q 2-3 q 2-3 minutesminutes

►Duration:Duration: 60-90 60-90 secondsseconds

► Intensity:Intensity: firm firm

•Irritable•Rejects support person•Introverted•Wants to give up •Restless •Tremor of legs•Fears losing control•Requests medication•Hates it when someone is touching her abdomen

►NURSING INTERVENTIONSNURSING INTERVENTIONS

•Provide firm coaching of breathing and relaxation techniques, focusing•Support coach•Praise and reassure woman.•Assess monitor strips of fetal heart rate and contractions.•Assess color of vaginal discharge.•Keep woman informed as to progress with each contraction.•Accept negative comments from woman.•Maintain positive approach.

► SECOND STAGE – SECOND STAGE – STAGE OF STAGE OF EXPULSION (30 EXPULSION (30 MINUTES TO 2 MINUTES TO 2 HOURS)HOURS)

► Cervix dilation is 10 cm.Cervix dilation is 10 cm.► Contractions:Contractions: q 1 ½ -3 q 1 ½ -3

minutesminutes►Duration:Duration: 60 -80 60 -80

secondsseconds► Intensity:Intensity: firm firm► Episiotomy may be Episiotomy may be

performed by health performed by health care provider.care provider.

► Second stage ends with Second stage ends with birth of infantbirth of infant

•Bulging perineum•Mother may pass stool•Uncontrollable urge to push •States “baby is coming”•Exhaustion after each contraction.•Unable to follow directions easily•Excitement concerning imminent birth.

►NURSING INTERVENTIONSNURSING INTERVENTIONS

•Assist woman to assume position that helps her push.•Assist with open glottis pushing technique and coping strategies.•Support coach.•Maintain communication with health care

provider.•Monitor contractions and fetal heart rate q 5

minutes.•Assess perineum and vaginal discharge•report bulging or crowning•Observe for bladder distention•Prepare sterile supplies for delivery•Prepare infant resuscitation equipment•provide feedback to woman and partner.

► THIRD STAGE – THIRD STAGE – EXPULSION OF EXPULSION OF PLACENTAPLACENTA

► Duration:Duration: 5-30 minutes 5-30 minutes► Contractions:Contractions: intermittent intermittent► Intensity:Intensity: mild to moderate mild to moderate► Umbilical cord is cutUmbilical cord is cut► Signs of placental separation Signs of placental separation

include the followinginclude the following► Lengthening of cordLengthening of cord► Uterine fundus rises and Uterine fundus rises and

becomes firmbecomes firm► Fresh blood expelled from Fresh blood expelled from

vaginavagina► Placenta is expelled by Schultz Placenta is expelled by Schultz

mechanism (shiny fetal side mechanism (shiny fetal side first) or by Duncan's mechanism first) or by Duncan's mechanism (dull, rough maternal side first) (dull, rough maternal side first)

► Uterus contracts to size or Uterus contracts to size or grapefruit.grapefruit.

► Episiotomy is sutured by health Episiotomy is sutured by health carecare

•Elation•Relief•Tremors•Increased physical energy•Curiosity about infant•Desire to nurse infant•Pain is minimal as placenta is expelled.

►NURSING INTERVENTIONSNURSING INTERVENTIONS•Observe and document blood loss.•Document delivery of placenta.•Examine placenta to determine if all of it was expelled (retained placenta causes hemorrhage because it prevents uterus from contracting).•Monitor mother's vital signs q 15 minutes.•Assess vaginal discharge.•Massage uterus until it is firm in midline at or below level of umbilicus.•Administer oxytocin to other as ordered•Obtain cord blood if needed.•Note parent/infant interaction.•Dry newborn and place in radiant warmer.•Attach heart and temperature monitor.•Assess and provide immediate newborn care •perform Apgar evaluation.•Apply proper identification to mother, infant, and partner.

► FOURTH STAGE-FOURTH STAGE-RECOVERYRECOVERY

► Uterus remain midline, Uterus remain midline, firmly contracted at or firmly contracted at or below umbilicus level.below umbilicus level.

► Lochia rubra saturates Lochia rubra saturates perineal pad (no more perineal pad (no more than one pad per than one pad per hour).hour).

► Cramping may occurCramping may occur►Woman may have Woman may have

shaking chills that may shaking chills that may be a thermoregulation be a thermoregulation response.response.

•A get-acquainted period between woman, partner and infant•Mother breastfeeds

infant

►NURSING INTERVENTIONSNURSING INTERVENTIONS

► Provide proper identification of mother, Provide proper identification of mother, partner, and newborn.partner, and newborn.

►Obtain cord blood if needed.Obtain cord blood if needed.► Assess woman's vital signs q 15 minute.Assess woman's vital signs q 15 minute.► Assess maternal voiding.Assess maternal voiding.►Monitor heart rate and temperature of newbornMonitor heart rate and temperature of newborn► Provide warmth to newborn.Provide warmth to newborn.► Assess newborn for anomalies.Assess newborn for anomalies.► Assess fundus and massage to maintain firm Assess fundus and massage to maintain firm

contraction (a fundus that is displaced to the contraction (a fundus that is displaced to the side indicates a full bladder is pressing against side indicates a full bladder is pressing against it).it).