Stages of Labor Lecture Notes

Overview

• Lecture by Sarah Thread Sterner
• Part of a maternity nursing review series
• Includes a quiz to test knowledge on stages of labor
• Focus on key points for the NCLEX exam and maternity lecture exams

Stages of Labor

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

Stage 1: Cervical Dilation

• Goal: Dilate cervix from 0 to 10 cm and 100% effaced
• Phases:
  • Latent Phase: Cervix dilates 1-4 cm, contractions every 5-30 min, 30-45 sec long, mild intensity
  • Active Phase: Cervix dilates 4-7 cm, contractions every 3-5 min, 45-60 sec long, more intense
  • Transition Phase: Cervix dilates 8-10 cm, intense contractions every 2-3 min, 60-90 sec long
• Stage 1 is the longest stage, particularly for first-time mothers
• Mnemonic: "Labor Actively Transitioning"

Stage 2: Delivery of the Baby

• Starts when cervix is fully dilated
• Ends with delivery of the baby
• Highlights:
  • Intense pressure, fetal station changes from +1 to +5 (crowning)
  • For first-time mothers: Can last 2-3 hours; for others: about 20 minutes
  • Interventions: Teach proper pushing, monitor vitals, encourage and guide

Stage 3: Delivery of the Placenta

• Starts after baby delivery
• Ends with placenta delivery
• Lasts 5-15 minutes
• Signs of Placenta Delivery:
  • Lengthening of umbilical cord
  • Trickle or gush of blood
  • Uterus changes shape
• Delivery Mechanisms:
  • Schultz: Shiny side first, "Shiny Schultz" (fetal side)
  • Duncan: Dull side first, "Dull Dirty Duncan" (maternal side)
• Interventions: Monitor blood pressure, administer Pitocin, assess placenta integrity

Stage 4: Recovery

• Period 1-4 hours post-placenta delivery
• Monitor mother’s health due to risks like hemorrhage, infection
• Interventions:
  • Monitor vitals, especially heart rate & blood pressure
  • Assess lochia and fundus
  • Provide pain relief and promote bonding and breastfeeding

Key Interventions Across Stages

• Comfort measures: Non-pharmacological and pharmacological
• Monitor mother’s vitals and fetal heart rate
• Encourage and support mother through each stage

Important Considerations

• Recognize signs of fetal distress (e.g., meconium-stained fluid)
• Be aware of changes in mother’s emotional state across stages
• Understand implications of cervix dilation and contractions

Note: Remember to review fetal decelerations and positioning for additional insights.