STAGES OF LABOR Transition Phase -Cervix dilates from 8cm.

to
FIRST STAGE 10cm.
STAGE OF DILATATION -It starts with the  Strong contraction, duration (60-90 secs),
beginning of regular contraction and ends with frequency (2-3mins)
the full dilatation of cervix.  Most difficult for the mother, out of control
Three Phases and panicky.
Latent Phase -It starts with the beginning of  Mother feels irresistible to push once
regular contraction. relaxed.
 Cervical dilatation: 0- 3 cm. Intervention -Provide information, comfort,
 Mild contraction starts lasting 30 sec. with emotional and physical support.
the frequency of 5 - 15 minutes.  Assess contraction every 15 minutes.
 Characteristic: the mother is excited &  Assess vital signs every 15 minutes.
follows direction  Assess fetal heart tone every 15 minutes.
 Primis: 6 hrs. Multis: 4-5 hrs.  Assess cervical dilatation, effacement,
Intervention station and position of presenting part
 Provide information on emotional and with complete dilatation.
physical support in a pleasant,  The fetus descends in the birth canal and
comfortable environment. the patient feels increased rectal pressure
 Assess maternal temperature, blood or the urge to push.
pressure, pulse, respiration. every 4  Encourage fast-blow breathing
hourly. Nursing Alert!
 Assess uterine contraction every 30 Severe pushing is not allowed during this stage
minutes. because it will cause cervical edema resulting
 Assess fetal heart rate every 30 minutes. from repeated pressure of fetal head against
 Assess cervical dilatation, effacement, pelvic floor that interferes with dilatation and
station and position of presenting part. unnecessary exhaustion.
 Assess status of membrane. If Evaluation
membranes ruptured, color of amniotic The pregnant patient progresses to complete
fluid. dilatation.
Active Phase  The pregnant patient can begin pushing
-Cervix dilates from 4cm to 7cm. when completely dilated.
-Contractions become stronger (moderate),  The patient support system supports her
frequent (3-5mins), longer duration (40-60 secs). physically and emotionally to prepare her
 Analgesics may be given at this period. for delivery.
(check BP after 30mins)  Vital signs, FHR remain within normal
 Characteristic: spontaneous rupture of limits.
BOW  The patient works effectively with
 Primis: 3 hrs Multis: 2 hrs contractions to facilitate delivery.
Intervention  Hydration and elimination are adequate.
 Provide safety comfort, information,  Prepared for sterile delivery.
emotional and physical support.  Support person is physically and
 Provide support during contraction; coach emotionally prepared.
breathing, give back rubs.  Encourage to void every 2hrs
 Assess contractions every 15 minutes.  Position: LLRP (best position) LABOR-
 Assess cervical dilatation. Squatting (ideal position) =directs
 Assess fetal heart tone every 15 minutes presenting part towards the cervix -
 Provide pharmacologic support as Lithotomy (most common position)
indicated.  No walking is BOW is ruptured
 Assess hydration status.  IV fluids: not recommended
 Encourage voiding every 1 to 2 hours. -prevents DHN & F&E imbalance
 Assess status of membranes -Oxytocin administration
-PNSS (0.9 NaCl) (blood transfusion)
 SECOND STAGE OF LABOR  Skin-skin contact (let the baby look for the
Stage of Expulsion -It refers to the period from breast), cover
complete cervical dilatation to the expulsion of  Cord clamping & cutting:
the baby. -after the pulsation stops or after 3 mins
Characteristics -cut in between 1-2 inches from the umbilicus
 Contractions are severe at 2 to 3-minute -after cutting the cord: check the AVA
intervals with a duration of 50 to 90 THIRD STAGE OF LABOR
seconds. Placental Stage
 Should be completed within 1 hour after -It starts with the delivery of the newborn and
complete dilatation ends with the delivery of the placenta.
 In Primis – babies deliver in 20 -after the infant’s birth: uterus must be firm,
contractions (40 mins.) round mass inferior to the level of the umbilicus.
 In Multis - babies deliver in 10 -the uterus has a discoid shape (5mins after
contractions ( 20 mins. ) birth)
 Infant moved along birth canal by cardinal Two Phases
movements or mechanisms of labor.  Placental Separation
MECHANISMS OF LABOR  Placental Expulsion
(E-D-F-Ir-E-Er-E) Signs of Placental Separation
Descent – preceded by engagement of the fetal  Calkin’s sign: uterus is firm, globular, &
head (pelvic inlet). rising to the level of umbilicus
Flexion - as descent occurs, pressure from the  Sudden gush of blood from the vagina
pelvic floor causes the chin to bend forward into  Lengthening of the umbilical cord
the chest • Firm contraction of the uterus
• Appearance of the placenta at the vaginal
opening
Methods of Placental Separation
 Schultze – If placenta separates first at
center, then sides.
- most common, present within 80% cases.
- shiny clean side first, inverted umbrella
presenting fetal sides.
 Duncan – placenta separates first at the
edge's folds like umbrella.
-dirty sides and presents remaining 20%.
 Contraction of the uterus controls uterine
bleeding and aids placental separation
 Internal Rotation – head is in level of the and expulsion.
ischial spine; it rotates from TD to AP  Oxytocin drugs are generally
diameter. administered to help contract the uterus.
 Extension - fetal head extends towards Nursing Alert!
the vaginal opening. As the head  Apply Brandt Andrews Maneuver – in
extends, the chin is lifted up & then it is careful delivery of the placenta, winding it
born. around clamp until spontaneous delivery
Assisting the mother in the DR of placenta, placenta must be expelled
 Coach the mother to push effectively. otherwise it may cause severe bleeding in
(reinforce) the mother. (CCT with CT)
 Instruct the woman to pant-blowing Intervention
 During crowning, instruct mother to pant  Promote physiologic adaptation by the
new mother.
 Perform Ritgen’s Maneuver while
delivering the fetal head  Initiate fundal massage, gently with
adequate support to the lower uterine
 Episiotomy-
segment.
 Just after delivery, dry the baby
(take note of the TOB)
 Nursing Alert! Nursing Alert!
Massage gently and properly the uterus once Immediately after delivery, a perineal pad can be
detected as relaxed, boggy, non-contracted. completely saturated after 30 minutes. If
saturated by 15 minutes check other findings
 Promote parent infant initial bonding by like fundus, perineal discharges and monitor
placing the infant on the mother’s vital signs and refer promptly.
abdomen and encouraging parents to UTERUS
touch the infant.  Uterine Involution is the process whereby
 Monitor mother and newborn for potential the uterus returns to its nonpregnant
complications. state.
 Documents Intrapartal care:  The uterus decreases in size 1
 Time of delivery fingerbreadth a day until it is no longer
 1 – 5 minute APGAR score. palpable at day 10.
 Any immediate neonatal care.  After an hour after delivery: @ the level of
 Extent and repair of perineal lacerations the umbilicus
or episiotomy.  BF promote uterine involution
 Estimated maternal blood loss (500mL)  If uterus is boggy: massage, BF, Oxytocin
for detected perineal lacerations.
 Medications administered before, during
and after delivery.
 Placement identification bands
 Maternal vital signs and fetal vital signs.
 Anthropometric measurements
EVALUATION
 Maternal bleeding is within normal limits
with firm uterine tone and maternal vital
signs.
 Parents and newborn bonding developed. BLADDER
 Documentation of intrapartal care is  Is full as evidenced by fundus slightly
accurate and complete. displaced to right or left.
FOURTH STAGE Note: first voiding which occurs after 6-8 hours.
It refers to the first 1-2 hours after delivery which Nursing Alert!
said to be the most crucial to the mother Perform the first independent nursing measure
because of unstable vital signs. to stimulate voiding prior catheterization. It may
FUNDUS initiate ascending infection because of cervical
 Checked every 15 minutes for 1-2 hrs mucus changes postpartum.
then hourly if stable.
 Located in midline and after 12 hours
above the umbilicus.
 Massage gently and properly
 If uterus displaced, note distended
bladder since full bladder may cause
uterus to relax.
 Make sure that the bladder is emptied
before assessment.
LOCHIA
Differences in Lochial Discharges
Lochia Rubra – red color, moderate amount
and seen 1-3 days postpartum.
Lochia Serosa – pink-brown in color, scanty
and seen 4-10 days postpartum.
Lochia Alba – white color, slight and occurs 10-
14 days postpartum