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.