STAGES OF LABOR
STAGES OF LABOR
Firts Stage
Second Stage
Third Stage
Fourth
FIRST STAGE begins with the initiation of true labor
contractions and ends when the cervix is
fully dilated.
cervix - 0-10 cm
SECOND STAGE extending from the time of full dilatation until
the infant is born
THIRD STAGE lasting from the time the infant is born until
after the delivery of the placenta
FOURTH STAGE the first 1 to 4 hours after birth of the placenta
THE FIRST STAGE
takes place about 12 hours to complete
divided into three segments:
(1) Latent Phase
(2) Active Phase
(3) Transition Phase
Latent Phase (Early Phase)
begins atthe onset of regularly perceived uterine contractions and ends
when rapid cervical dilatation begins
contractions are mild and short, lasting 20-40 seconds
cervical effacement occurs, and the cervix dilates minimally
multiparous usually progresses more quickly than a nullipara
a woman who enters labor with a “nonripe” cervix will probably have a longer
than average latent phase.
analgesia can be given (may prolong this phase)
cause only minimal discomfort and can be manage by controlled breathing.
encourage women to continue to walk about and make preparations for birth
such as doing last-minute packing
Active Phase
cervical dilatation occurs more rapidly
contractions grom stronger, lasting 40 to 60 seconds
occur approximately every 3 to 5minutes
show increase vaginal secretions
spontaneous rupture of the membranes may occur
encourage women to be active participants in labor by
keeping active and assuming whatever position is most
comfortable for them (except flat on their back)
Transition Phase
contraction reach their peak of intensity, occurring every 2 to 3 minutes with a
duration of 60 to 70 seconds.
maximum cervical dilatation of 8-10 cm
show will occur
if the membranes have not previously rupture, they will usually rupture at full
dilatation. (10 cm)
complete effacement
may experience intense discomfort that is so strong (may be accompanied
by nausea and vomiting)
THE SECOND STAGE
is the time span from full dilatation and cervical effacement to birth of
the infant.
uncontrollable urge to push or bear down with each contraction as if to
move her bowels
may experience momentary nausea or vomiting because pressure is
no longer exerted on her stomach as the fetus descends into the pelvis
the fetus begins descent and, as the fetal head touches the internal
perineum to begin internal rotation
perineum begins to bulge and appear tense.
anus may become everted, and stool may be expelled
as the fetal head pushes against the vaginal introitus, this opens and
the fetal scalp appears at the opening to the vagina and enlarges -
CROWNING
as the fetal head is pushed out of the birth canal, it extends and then
rotates to bring the shoulders into the best line with the pelvis.
the body of the baby is then born
THE THIRD STAGE
placental stage
begins with the birth of the infant and ends with the delivery of the placenta
two separate phases:
(1) placental separation
(2) placental expulsion
after the birth of the infant, the uterus can be palpated as a firm, round mass
just below the level of the umbilicus
after a few minutes of rest, uterine contraction begin again, and the organ
assumes a discoid shape.
it retains this new shape unitl the placenta has separated, approximately 5
minutes after the birth of the infant.
PLACENTAL SEPARATION
The placenta has loosened nd is ready to deliver when:
there is lengthening of the umbilical cord
a sudden gush of blood
The placenta is visible at the vaginal opening
the uterus contracts and feels firm again
can anywhere from 1 to 30 minutes
blood loss of about 300 to 500 ml.
PLACENTAL EXPULSION
once separationhas occurred, the placenta delivers either
by the natural bearing-down effort of the mother or by
gentle pressure on the contracted uterine fundus by the
primary lthcare provider - Crede maneuver
Note:
pressure should never be applied to a uterus in a non-
contracted state because doing so could cause the uterus
to evert (turn inside out) accompanied by massive
hemorrhage.