Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I want to be going over the stages of labor. This video is part of an NCLEX review series over maternity nursing, so if you're studying this section be sure to check out the other videos in this series. And as always in the YouTube description below or at the end of this video you can access the quiz that will test your knowledge on the stages of labor. So let's get started.
Okay, as we go through the stages of labor, there are some things that you want to pay attention to for the NCLEX exam or your maternity lecture exams. Like for instance, there's four stages and what is happening during each of those stages, especially your first stage because the first stage has three phases and you want to know What's happening with cervical dilation, with contractions, and nursing interventions. And then throughout the other stages, like 2, 3, and 4, you want to pay attention to what's going on and what your role is as the nurse.
Like when the baby is delivered. what are some signs and symptoms the baby's about to be delivered or in stage three when the placenta is delivered What are you looking at after the placenta is delivered? Meaning and what's the placenta is supposed to look like and then in stage four What are you going to be doing during recovery?
So be sure you pay attention to all that as I'm going through this lecture So let's go over the four stages of labor. What are they? Okay, stage one is where the cervix dilates from zero to 10 centimeters. And this stage has three phases known as the latent which is also sometimes called early labor active and transition then you have stage two this stage is where the baby will be delivered and then stage three will be delivery of the placenta and then stage four will be the first one to four hours after the delivery of the placenta Let's look at stage one of labor in depth. Okay, the whole goal of stage one is to get the cervix dilated from zero to 10 centimeters and 100% of face.
So dilation is opening up. of the cervix and effacement is thinning of the cervix. And all this is going to happen due to the contractions the woman will be having. They'll start out very mild in the latent phase and then when you get to transition phase they're going to be really intense because that cervix is trying to open all the way up so that baby can be born.
That's the whole goal of this stage. Now some facts about stage one. Stage one is the longest stage of all the stages of labor and it tends to be longer for first-time mothers compared to women who've already had children and it starts when true labor starts.
Now as I said before stage one has three phases. So um I would remember the name of each phase, what happens in them in regards to the dilation of the cervix, your interventions, and remember the order of them. Because the transition, which is the third part of this stage, the phase, will lead into stage two where the baby will be delivered. So to help you remember the order and the name of the stages, remember this mnemonic.
Labor actively transitioning because our labor is transitioning to stage two, which is where the baby is going to be born. The whole goal is to have contractions, open up that cervix, thin that cervix so the baby can get out and be born. Okay, so let's look at the first phase. This is called the latent phase, or sometimes referred to as early labor. The cervix is gonna dilate from one to four centimeters and thin, contractions will be every three to five minutes.
five to 30 minutes and 30 to 45 seconds in length. Now these contractions are going to be very mild compared to what will be happening in the active and transition phase. And this phase is longest for first-time mothers. And sometimes women may not even know that they're in the latent stage of labor because the contractions may be mild. They may just have pain in their back and so they really don't know.
Now during this phase if the woman's at home she needs to stay at home until she's actively in active labor or the water breaks and the whole goal is to keep comfortable try to keep busy as the labor progresses. During this phase mother is going to be excited and nervous and talking. Now we're going to go into the active phase and this is where things start to heat up and start to get active.
okay in this phase the cervix is going to dilate from four to seven centimeters the woman will probably be dilating anywhere between about one centimeter per hour contractions are going to be every three to five minutes and 45 to 60 seconds long and the woman is going to notice that these contractions are a lot stronger and longer compared to what was happening in the latent phase this phase can last between 4 to 8 hours now if the mother is still at home it's time for her to go to the hospital. Also during this phase the water may break and you'll want to check if it breaks in the hospital or if it broke at home you'll want to ask her what color was the fluid that was leaking and because you're looking for what's called meconium stained fluid and this fluid will look like a yellow, brown or greenish fluid and what can happen is that the baby can aspirate this into its lungs. cause infection, block the airways, and it can be an indication of fetal distress.
So you'll want to ask that. Another thing you may be doing is performing a nitrazine paper test where you'll take the fluid, put it on a little strip of paper, and if it turns blue, that means that the woman is for sure leaking amniotic fluid. Okay, interventions during this phase is comfort because she's going to be having those intense contractions.
So comfort. either through non-pharmacological or pharmacological techniques. Non-pharmacological could be warm shower or bath or massage during contractions or an epidural, which is pharmacological breathing techniques and keeping the bladder empty.
I'm helping her. If she has an epidural, she'll get a Foley, but I'm helping her go to the bathroom every couple hours to void, to empty that bladder because a full bladder is not going to be able to keep her in the can prevent the uterus from contracting properly, which can slow down labor. And you'll also want to be monitoring the woman's vital signs and the heart rate of the baby. I have a whole video on fetal deceleration that's talking about early and variable and how to monitor those.
And a card should be popping up so you can access that. And the mom, she's going to be a lot different in this phase, especially as it progresses. She's going to be serious in pain and anger.
Now let's look at the transition phase. This phase is going to lead into stage two where the baby will be delivered. The cervix is going to dilate from eight to ten centimeters. Remember ten is where we wanted to get that perfect ten so the baby can be delivered.
Now the thing with this phase is it's the shortest of all the phases but it's the most intense and most painful for the mother. It can last anywhere from 30 minutes to 2 hours. Contractions are going to be very intense.
They're going to be long, sometimes back to back, overlapping each other. They can occur every 2 to 3 minutes and last 60 to 90 seconds. The mom will be concentrating. She's not going to feel like talking, be irritated, very much in pain, and could be shivering.
Also, she may start to feel an intense pressure in the rectum. as that baby is pushing down and descending. And you don't want the mother to start pushing even though she's going to want to push until that cervix is fully dilated. Because if the cervix is not dilated to 10 centimeters, you could be pushing, which can cause the cervix to become swollen and then it will never dilate. So you want to make sure that she's all the way to 10 before she starts pushing.
So some interventions, a lot of support, encouragement. encouragement and praise. Let her know you've made it this far, you can do this.
We're almost there. The breathing techniques, monitoring vital signs of mother and especially baby, the fetal heart rate, especially during those contractions after them and before. How's the baby responding?
Making sure it's not in any distress. And assessing cervical dilation and effacement. Is she at the 10 yet?
And fetal positioning. And what station is the baby at? Zero is where the baby is engaged. the little imaginary line you would draw on the pelvis.
Zero would be at the ischial spine which is the most narrow part of the pelvis and as the baby advances it'll be entering into the positive numbers because behind zero above the ischial spine are negative numbers like negative one, negative two, negative three, four, five. But as the baby's starting to descend and will be coming out we hit positive numbers. So it'll go from plus one to plus five and plus five is crowning so you'll want to be watching where baby is at okay now let's look at stage two okay this stage starts when the cervix has fully dilated in a face so it's all way open to that 10 centimeters and it's 100% thin and it ends after the baby is delivered. Then we go into stage three where our placenta will be delivered. So what's the big highlights you need to know about stage two?
Okay, stage two is where this woman is going to be feeling some really intense pressure. At the end of the transition phase in stage one, she felt some pressure as that baby was pushing down. But now the baby is going to start descending through the birth canal.
So it's going to start changing fetal stations. Remember, plus one to plus five is where we're going. And five is crowning. And for first-time mothers, this stage can last approximately... only about one hour.
It could last anywhere from two to three hours. So it lasts a little bit longer for the first time mothers. And for women who've already had children, it lasts about 20 minutes.
And the main thing that's going to be making up this phase is pushing. The woman's going to be pushing that baby out of the birth canal to be born. Okay, so contractions will be similar to what she experienced in the transition phase. They're going to be painful.
They're going to hurt. They're going to be about 60 to 90 seconds. and length and occurring every two to three minutes.
Now interventions from the nurse. You're gonna be teaching her how to push properly, when to push because if she has an epidural, she may not be able to feel the contractions, but you can see the contractions on the monitor. You're gonna help her breathe through them, how to do them.
Positioning high fowlers in lithotomy or squatting or side laying. You're also going to be offering lots of encouragement and praise, talking to her, telling her how far the baby is along. And you're going to be recording that exact time that baby is fully delivered because that's the birth time and monitoring vital signs and the fetal heart rate, of course, making sure everyone's doing good.
Also, you're going to be looking at the perineum and there will be specific changes in the perineum before the baby is born. So I remember these. You may see bulging of the perineum and the egg. anus or rectum as the baby's head is coming through that canal, an increase in bloody show or visible baby parts.
Of course, you may see the baby's head depending on the fetal position and you may see it presenting there. So that is telling you, hey, this baby is fixing to come out. Okay, now into stage three.
Okay, stage three starts with the full delivery of the baby and ends with full delivery. delivery of the placenta. Okay, this stage is pretty short, pretty easy for mom.
It's smooth sailing really after this and then we go into stage four, which is our recovery period. So this stage lasts about five to 15 minutes. We want it to be quick because the longer this stage is, the longer it takes to deliver the placenta, it increases the risk of hemorrhage or retain placenta parts, which will cause hemorrhage or infection.
Now some signs and symptoms. Symptoms that you want to remember that the placenta is about to be delivered. The umbilical cord starts to lengthen.
There may be a trickle or a gush of blood all of a sudden. And the uterus will change shape from an oval to a globular shape. So that are some signs and symptoms that the placenta is fixing to make its entrance. Okay, some delivery mechanisms. I would remember this.
I remember questions from my maternity lecture exams on this. Okay, this is when the placenta is delivered, which side is delivered first. And so remember that. And which side is the baby's side and which side is the maternal side that was attached to the uterus.
Okay, so you have two delivery mechanisms. You have the Schultz and you have the Duncan. Okay, Schultz is the side that is shiny that was delivered first.
So it was the baby's side. And how I like to remember this was taught this. Shiny Schultz.
And remember, it's the baby side because the baby is shiny and new. So it's shiny and new like the baby. It's the shiny Schultz. And it was the side that was facing the baby and it was delivered first. Then you have the Duncan side, the Duncan mechanism.
And this is the side of the mother, the maternal side of the placenta that was delivered first. A lot of people like to remember this, dual dirty Duncan, the three Ds. And because... this side looks dull. red and rough and remember mama just went through labor so she is dirty from labor and she's in rough condition so that's the maternal side so remember those and some interventions for this what you need to remember is you'll be monitoring monitoring the mama's blood pressure before and after delivery of placenta because there's a risk of hemorrhage.
So you want to monitor that. The doctor may order what's called Pitocin after the delivery of the placenta because because this prevents hemorrhage. So remember, you may be giving Pitocin after the delivery of the placenta.
And you'll be assessing the placenta, making sure it's fully intact and nothing is missing and it's still inside the uterus. And you'll be looking at that cord, which should have two arteries in one vein, making mother comfortable, getting her cleaned up, the sheets changed, peri care, encouraging bonding. between the mother and the baby and helping her with breastfeeding.
Okay, now stage four. This is our last stage. And this is the hours one to two, one to four hours after delivery of the placenta. So what you're going to be doing is you're going to be monitoring the mom, making sure her health is doing good. And she's adjusting after she's just given birth because she's at risk for a lot of things like hemorrhage, infection, uterine atony, all that stuff.
So you want to want to make sure you're monitoring those things. So you'll be monitoring vital signs, especially her heart rate and blood pressure because hemorrhage, if she's hemorrhaging, she'll have drop in blood pressure and she'll become tachycardic as she's losing blood volume and her temperature because risk of infection. So you want to monitor that. And the lochia, this is the discharge after birth.
She'll be having a moderate to red amounts of lochia. There may be little small clots. but large clots is a huge warning sign and you want to assess how often she's having to change that peri pad and she's changing it every 15 minutes because there's just so much blood that is not normal that's abnormal she's possibly hemorrhaging so you'll want to assess that and another thing is you'll be assessing the fundus of the uterus this is the top portion of the uterus and you want to make sure that it is firm it's midline and near or at the belly button, the umbilicus.
Make sure it's there so you'll be feeling that. Depending on the hospital protocol, you'll be checking it every 15 minutes for one hour and then every 30 minutes for two hours. Now, a lot of questions like to ask you, okay, you feel the fundus. It's soft and boggy and it's displaced.
What are you gonna do? Bidiaj are gonna provide fundal massage. on that fundus of the uterus and assist her to the bathroom because a lot of times a full bladder can cause the fundus to become displaced and soft so those are the things you would do for that if that question ever came up and other things you're going to do is you're going to administer pain relief per doctor's orders provide peri care like ice and witch hazel because she'll have a lot of swelling and she may have suffered from some tears or an episiotomy and promote bonding and breastfeeding with the woman and her baby.
Okay, so that wraps up the lecture on stages of labor. Thank you so much for watching. Don't forget to take the free quiz and subscribe to our channel for more videos.