Stages of Labor Lecture Notes

Introduction

• Presenter: Sarah Thread Sterner
• Part of an NCLEX review series on maternity nursing.
• Aim: Review stages of labor for exams like NCLEX/maternity lecture exams.
• Quiz available at the end.

Overview of Stages of Labor

• Stage 1: Cervical dilation from 0 to 10 cm.
  • Three phases: Latent (early labor), Active, Transition.
• Stage 2: Delivery of the baby.
• Stage 3: Delivery of the placenta.
• Stage 4: Recovery period (1-4 hours after placenta delivery).

Stage 1: Dilation and Effacement

• Goal: Dilate cervix 0 to 10 cm, 100% effacement.
• Starts with true labor.
• Longest stage, especially for first-time mothers.
• Three Phases:
  • Latent Phase:
    • Cervix dilation: 1-4 cm.
    • Contractions: 5-30 minutes apart, 30-45 seconds long.
    • Mild contractions, may not be noticeable.
    • Stay home unless active labor or water breaks.
  • Active Phase:
    • Cervix dilation: 4-7 cm.
    • Contractions: 3-5 minutes apart, 45-60 seconds long.
    • Stronger contractions; 4-8 hours duration.
    • Go to hospital; check for water break signs.
    • Interventions: Comfort (non-pharma and pharma), bladder management, monitor vitals.
  • Transition Phase:
    • Cervix dilation: 8-10 cm.
    • Shortest phase; most intense and painful.
    • Contractions every 2-3 minutes, 60-90 seconds.
    • Interventions: Support, monitor vitals, check cervical dilation, fetal positioning.

Stage 2: Delivery of the Baby

• Start: Cervix fully dilated.
• End: Baby delivered.
• Duration: 1 hour for first-time mothers, 20 minutes for others.
• Key Points:
  • Intense pressure and contractions similar to transition phase.
  • Interventions: Teach pushing techniques, offer encouragement, monitor vitals and fetal heart rate.
  • Observe perineum for changes.

Stage 3: Delivery of the Placenta

• Start: Baby delivered.
• End: Placenta delivered.
• Duration: 5-15 minutes.
• Signs of Placenta Delivery:
  • Lengthening of umbilical cord.
  • Trickle/gush of blood.
  • Uterus changes shape.
• Delivery Mechanisms:
  • Schultz: Shiny side (baby side) delivered first.
  • Duncan: Dull, dirty side (maternal side) delivered first.
• Interventions:
  • Monitor blood pressure, administer Pitocin, check placenta integrity, encourage mother-baby bonding.

Stage 4: Recovery

• Duration: 1-4 hours post placenta delivery.
• Monitoring:
  • Vitals: BP, heart rate (risk of hemorrhage), temperature (risk of infection).
  • Lochia assessment, urinary management.
  • Fundus assessment: Firm, midline, at or near umbilicus.
• Interventions:
  • Fundal massage if soft/boggy, assist to bathroom if displaced.
  • Pain relief, peri care, promote bonding/breastfeeding.

Conclusion

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