hey everyone it's sarah thread sterner sorry and calm and in this video I want to be going over the stages of labour this video is part of an inkless 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 labour so let's get started okay as we go through the stages of labour there are some things that you want to pay attention to for the ink Lex 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 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 & 4 you want to pay attention to what's going on and why 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 3 when the placenta is delivered what are you looking at after the placenta is delivered meaning and what's the placenta supposed to look like and then in stage 4 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 0 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 to 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 1 of labor in debt okay the whole goal of stage one is to get the cervix dilated from zero to ten centimeters and a hundred percent 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 and 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 face will lead into stage two where the baby will be delivered so to help you remember the order in the name of the stages remember this mnemonic labor actively transitioning because our labor is transitioning to stage two which is where the baby's 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 going to dilate from one to four centimeters in thin contractions will be every five to thirty 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 um this phase is longest for first-time mothers and sometimes women may not even know that they're in um the latent stage of labor because the contractions may be mild they not 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 labour 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 forty-five to sixty 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 four to eight 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 and if it breaks in the hospital or if it broke at home you'll want to ask for what color was the fluid that was leaking and because you're looking for what's called meconium staying 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 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 surely leaking amniotic fluid okay interventions during this phase is comfort because she's want to be having those intense contractions so comfort either through nonfarm illogical or Pharma logical techniques and non pharmacological could be warm shower or baths 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 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 and I have a whole video on fetal decelerations talking about early and variable 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 anxious now let's look at the transition phase this phase is going to lead into stage 2 where the baby will be delivered the cervix is going to dilate from 8 to 10 centimeters remember 10 is where we wanted to get that perfect 10 so the baby can be delivered now the thing with this phase is it's um 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 lasts 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 can be pushing which can cause and the cervix to become swollen and then we'll never dilate so you want to make sure that she's all the way to ten before she starts pushing so some interventions a lot of support 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 and especially during those contractions after them and before how's the baby responding making sure it's not any distress and assessing cervical dilation and effacement is she at the 10 yet and fetal positioning and what station is that is the baby I and 0 is where the baby is engaged it's a little imaginary line you would draw on the pelvis 0 would be at the ischial spine which is the most narrow part of the pelvis and as the baby advances it will be entering into the positive numbers because behind 0 above the ischial spine our negative numbers like negative 1 negative 2 2 3 4 or 5 but as the baby's starting to descend and will be coming out and we get positive numbers so it'll go from plus 1 to plus 5 and plus 5 is crowning so you'll want to be watching where baby is at okay now let's look at stage 2 okay this stage starts when the cervix has fully dilated in a face so it's all the way open to that 10 centimeters and it's a hundred percent sin and it ends after the baby is delivered then we go into stage 3 where our placenta will be delivered so what's the big highlights you need to know about stage 2 okay stage 2 is where this woman is going to be feeling some really intense pressure at the end of the transition stage and set phase in stage 1 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 + 1 2 + 5 is where we're going in 5 is crowning and and for first-time mothers this stage and lasts approximately about one hour anywhere it could last anywhere from two to three hours so it lasts a little bit longer for the first time others and for my women who've already had children last about twenty minutes and the main thing was 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 in length and occurring every two to three minutes now interventions from the nurse you're going to be teaching her how to push propria 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 going to help her breathe through them how to do them positioning and high fowlers and lithotomy or squatting or sideline you're also going to be offering lots of encouragement and praise talking to her and 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 bottle sons and the fetal heart rate of course making sure everyone's doing good although 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 would remember these and you may see bulging of the perineum and the 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 you may see it presenting there so that is telling you hey this baby is fixing to come out okay now on to stage three okay stage three starts with the full delivery of the baby and ends with full delivery of the placenta okay this stage is pretty short pretty easy for moments smooth sailing really after this and then we go into stage four which is a period so this stage lasts about five to 15 minutes we want it to be quick because the longer the stages 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 that you want to remember that the placenta is about to be delivered and 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 remembered questions from my maternity lecture exams on this okay and this is when the placenta is delivered which side is delivered first and so remember that and which side is the baby 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 um was delivered first so it was the baby side and how liked 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 a new length of baby it's the shiny Shultz and it was the saw that was facing the baby 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 dull dull dirty Duncan the 3ds and because this side looks dull red and rough and remember momma 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 in some interventions for this what you need to remember is you'll be monitoring the MoMA's blood pressure before and after delivery placenta there's a risk of hemorrhage so you want to monitor that and the doctor may order what's called pitocin a master the delivery of the placenta 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 still inside the uterus and you'll be looking at that cord which should have two arteries in one vein and 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 make sure you're monitoring those things so you'll be monitoring bottle signs especially her heart rate and blood pressure because I'm hemorrhage if she's hemorrhaging she'll have job and blood pressure and she'll become tachycardic as she's losing blood volume and her temperature because I'm risk of infection so your monitor that and the lochia this is the discharge after birth she'll be having a moderate to read 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 parry 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 midline and near or at the bellybutton the umbilicus make sure it's there so you will be filling that and depending on 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 going to do and videos are going to provide funds and massage on that fundus of the uterus and a sister 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