4 Stages of Labor
- 1. 4 Stages of Labor First Stage 0-10cm Second Stage 10cm to birth Third Stage Birth of baby to birth of the placenta Fourth Stage Birth of placenta to 4 hours postpartum
- 2. First Stage Latent Phase 0-3 cm longest visceral pain contractions q 5-10 min, 30-45 sec, mild talkative
- 3. Nursing Care Establish relationship Review record Review birth plan Labor assessment Lab studies Explain and provide guidance V/S, pain, FHR, uterine activity, breathing
- 4. First Stage Active phase 4-7 cm fetal descent contractions q 2-5 min, 40-60 sec anxiety increases
- 5. Nursing Care Supportive Maternal V/S hourly FHR q 15-30 min Hydration – IV? Membranes Comfort measures Pain control Labor assessment
- 6. First stage Transition Phase 8-10 cm significant anxiety contractions q 1 ½ - 2 min, 60-90 sec strong hot flashes, chills, N&V amnesic
- 7. Nursing Care Support Comfort measures Labor assessment Maternal V/S and FHR q 15 min
- 8. Second Stage 10 cm to birth of the baby contractions q 1 ½ - 2 min, 60-90 sec bulging perineum crowning ring of fire
- 9. Mechanisms of Labor Descent and flexion Internal rotation Extension External rotation Expulsion
- 11. Nursing Care Nursing presence, support, reassurance Monitor V/S q 5-15 min and FHR Assist with pushing Position changes Prepare for birth
- 12. Episiotomy
- 13. Third Stage of Labor Birth of baby to birth of placenta strong contractions placental separation repair of perineum
- 14. Nursing Care Focused on newborn and birth of placenta Pitocin Warmth Explain assessments Ascertain needs V/S q 15 min, fundal assessment Assist with breastfeeding
- 16. Newborn Respirations Suction Warmth APGAR SCORE
- 17. APGAR SCORE
- 18. Fourth Stage of labor From birth of the placenta to the first 4 hours postpartum Recovery phase
- 19. Nursing Care Assess for hemorrhage, fundus Comfort Bonding V/S q 15 min x 1 hr q 30 min x 1 hr q hour x 2 hours Perineum Lochia Bonding
- 20. Pain During Labor Non pharmacological measures
- 21. Pain During Labor Pharmacologic Measures Opioids – stadol, demerol Opioid antagonist - narcan Barbituates – seconal Ataractics – phenegran
- 22. Regional Anesthesia Provides pain relief without loss of consciousness Epidural Spinal (Intrathecal) Combined Nursing care assist monitor
- 23. Pudendal Block
- 24. Early Decelerations Fetal head compression inversely mirrors uterine contractions begins with and ends with contraction BENIGN
- 25. Late Decelerations Uteroplacental insuffiency inversely mirror contractions but begin late in onset and recovery Requires prompt attention
- 26. Variable Decelerations Umbilical cord compression vary in onset, occurrence, duration and have NO relation to contractions Requires prompt attention