STAGES STAGES OF OF LABOR LABOR
STAGES OF LABOR LATENT
ACTIVE
TRANSITION
Nullipara
8.6 hours
4.6 hours
3 hours
Multipara
5.3 hour
2.4 hour
< 1 hour
0-3 cm
4-7 cm
8-10 cm
Every 10-30 minutes
Every 2-5 minutes
Every 1 ½-2 minutes
Duration
30 sec
40-60 sec
60-90 sec
Intensity
Mild – moderate; 25-40 mm Hg by intrauterine pressure catheter
Moderate –strong; 50-7- mm Hg by intrauterine pressure catheter
Strong by palpation; 70-90 by intrauterine pressure catheter
Cervical Dilatation Contractions Frequency
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 firm, 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 spontaneously, it manually.
With delivery of the placenta, the third stage of labor is complete.
A
does not deliver can be removed
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.
