STAGES OF LABOR CHART A GUIDE FOR SUPPORTING MOTHERS

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					STAGES OF LABOR CHART – A GUIDE FOR SUPPORTING MOTHERS IN LABOR

                    STAGE ONE – THE DILATATION STAGE
             This period begins with the onset of true labor contractions
                  and ends with complete dilatation of the cervix.
DURATION

Total time of first stages; anywhere from 2 to 16 or more hours.

CHARACTERISTICS

(In early phase, when cervix dilates 1 cm. to 4 cm.)
Uterine contractions, which may follow a regular pattern and may be accompanied by:

   Abdominal cramps
   Backache
   Rupture of membranes
   Show (blood-tinged mucoid vaginal discharge)

(In mid-phase, when cervix dilates 4 cm. to 8 cm.)
Uterine contractions may become stronger, longer (40-45 seconds), more frequent, and
may be accompanied by pain.

HOW SHE MAY FEEL

Excited. She may also feel:

   A sense of anticipation
   A sense of relief
   Happy
   Some apprehension

WHAT SHE MAY DO

Continue with routine nursing care needed.
Try pelvic rocking if back aches.
Try abdominal breathing if contractions are strong and painful.
Time duration and frequency of contractions.
Ask Health Care Provider (HCP) when to go to hospital.

(In mid-phase)
Assume comfortable position.
Try abdominal breathing during contractions and breathe normally between contractions.
Try pelvic rociking or have back rubbed if it aches.
Ask for medication if unable to relax.
When doctor does a pelvic examination, relax pelvic floor.
                        STAGE TWO – THE EPULSIVE STAGE

                 This period begins with the complete dilatation of the
                         cervix and ends with birth of the baby.


DURATION

Total time of second stage:: anywhere from 2-60 minutes or more.

CHARACTERISTICS

Full dilatation of the cervix, accompanied by:
Contractions which may be 1 or 2 minutes apart, become increasingly expulsive in nature;
    increased show. Expulsive grunt when exhaling. Rectal bulging with flattening of
    perineum. Increased amnesia between contractions. Gradual appearance of
    presenting part at vaginal opening (the doctor may do an episiotomy to facilitate delivery
    of baby.)

HOW SHE MAY FEEL

Increasingly involved in the birth process. She may also feel:
Relief because second stage has begun
Desire to bear down or push
Tremendous satisfaction with each push or, conversely, acute pain with each push
Desire to move bowels
Complete exhaustion after each expulsive contraction
Unable to follow directions readily
Desire to participate fully in birth process or, conversely, to be “put to sleep”
A splitting sensation due to extreme vaginal stretching as baby is born

WHAT SHE MAY DO

Notify nurse of desire to bear down
Respond to urge to push:
If in own bed: (1) take deep breath, (2) bend knees, spread them apart and grasp them
     firmly while bringing them up toward shoulders, (3) with mouth closed, pull back on
     knees while bearing down or pushing, keeping hips flat in bed.
Continue to push down for as long as each contraction lasts
Rest completely between contractions
Take anesthesia as it is offered
If necessary, ask for anesthesia
Pant when asked to do so or when asked not to push
                    STAGE THREE – THE PLACENTAL STAGE

                This period begins with the birth of the baby and ends
                 with the expulsion of the placenta and membranes


DURATION

Total time of third stage: anywhere from 1-20 or more minutes


CHARACTERISTICS

Contractions temporarily cease upon birth of baby. When they resume, they are usually
painless and may be accompanied by:
Upward rise of uterus in abdomen
Uterus resuming globular shape
Visible lengthening of umbilical cord as placenta moves into vagina
Trickle or gush of blood


HOW SHE MAY FEEL

Exhausted, but elated and proud of achievement. She may also feel:
Eager to hear and see baby
A sense of relief
Delight that abdomen is flat
Ravenously hungry
Thirsty


WHAT SHE MAY DO

Relieve tension by giving in to emotions
Watch expulsion of placenta and membranes in overhead mirror
Ask to have baby put to breast for a first feeding
                       STAGE FOUR – THE RECOVERY STAGE

                This period begins with the expulsion of the placenta and
                               ends 2 hours post-delivery


DURATION

Total time of fourth stage: approximately 2 hours or more


NURSING ASSESSMENT

Perform overall general physical assessment of client

   - fundal height, consistency, and location every 15 minutes during first hour
   - assess lochia with the client supine and in lateral position
   - perineum for integrity and amount of swelling
   - BP and pulse every 15 minutes for 1 hour, or until stable, then every 30 minutes
           times two
   - urinary bladder for distention – encourage to void
   - amount of discomfort: afterpains and episiotomy site
   - IV site and rate


NURSING INTERVENTIONS

   - Settle mother comfortably in bed
   - Share in excitement and joy over birth
   - Facilitate mother-father-child attachment
   - Change perineal pads as necessary; wash vulva and thighs, if needed
   - Encourage to void completely; if unable to void, catheterize and record amount
   - Teach regarding afterpains, lochia, reason for checking fundus and expressing clots
   - Provide fluids and nourishment
   - Transfer client to post-delivery unit when her condition stabilizes.

				
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