Stages & Phases of Labor (exam 2) Flashcards
- aka stage of dilation
- longer than stages 2&3 combined
- has 2 phases
- begins with onset of labor and then ends with complete dilation (10cm)
Stage 1
Latent (early) Phase
- extends from onset of labor - characterized by regular, painful contractions that cause cervical change -> then moves to the active phase
Stage 1, Phase 1
Effacement of the cervix is more progressive than the fetal descent
Contractions – Mild to moderate per palpation, 2-30 minutes apart lasting 30-40 seconds
Show – brownish discharge, mucous plug, pale pink mucous.
- With scant amount
- Mom is excited.
- Thoughts are centered on self, labor and baby, may be calm or tense, handles pain fairly well, alert and follows directions
- Can be talkative, but in some cultures this is when they transcend into a silent, calm phase - open to instructions
Active Phase
- more rapid dilation of the cervix
- increased rate of fetal descent
- 100% effacement
- contractions are 1.5-5 minutes apart, lasting 40-90sec and regular
Stage 1, Phase 2
Bloody Show – Pink to bloody, moderate to copious amount
Usually when pain medication is introduced
- If no epidural, pain may be described as severe
- Backache is common
Mom becomes more serious, doubtful of pain control, more apprehensive, Needs encouragement
- Mom may become frustrated
we don’t need contractions to be closer than 2 min apart (need a break)
Mom may become shaky because the body is starting to produce endorphins (to tolerate the pain)
- May hyperventilate
- May feel the need to defecate
- Has pressure on anus
Stage 1 ends when
the woman is 10cm
100% effacement
- Begins at 10cm, 100% effaced
- Ends with birth of the baby
- “pushing stage” (latent and active pushing phases)
Stage 2
- Lasts usually on average 50min (nulliparous), 20min (multiparous), or up to 3hrs (regional anesthesia)
- Contractions still 2-3min apart and strong, lasting about 90sec
- Intense concentration on pushing, may doze between contractions
- epidurals can sometimes prolong this stage
Latent Phase (passive fetal descent)
- quiet, concern over progress
- “Laboring Down” phase
Stage 2, Phase 1
Active Phase (pushing phase)
- has to be 10cm, completely effaced
- Announces contractions - increase in strength (contractions extremely strong)
- Urge to push
- Fetal head visible at Introits, then baby on perineum
Stage 2, Phase 2
- Frequent repositioning
- Mother may become vocal
- Excitement immediately after birth of head
- Only push when she’s having contractions
Stage 2 ends with
a baby being delivered
Begins with birth of baby, ends with delivery of the placenta
Stage 3
Stage 3
- Lasts 5-30min (usually about 15min)
- A gush of blood may be expelled when the placenta separates from the uterine wall
- Placenta becomes globular in shape (palpate)
- Notice the lengthening of the cord (wait 30sec to cut cord after delivery)
- Expulsion of the placenta (“placental stage”)
- Excited, relieved baby is here
- Important the placenta comes out quickly, and intact so that the mom doesn’t hemorrhage (if it takes >30min, placenta considered to be retained and interventions may need to take place)
the placenta is attached to the
decimal layer of the basal plate’s thin endometrium by fibrous anchor villi (post it notes)
- The sudden decrease in uterine volume after delivery along with contractions cause the placenta to shrink, the anchor villi to break, and the placenta is detached (may see a gush of blood prior to release)
- uterus changes shape and becomes globular
begins with the expulsion of the placenta, and lasts until the woman is stable in the immediate postpartum period (usually 1-2hrs after birth)
“Recovery Stage”
Stage 4
- The stage of physical recovery for infant and mother
- Mom and baby get acquainted - bonding process starts
- Uterus continues to contract, starting its descent back to pre-pregnancy state
- Mother is excited, but tired
Assessment in 4th Stage of Labor
Assess BP and pulse q15min for the first 2hrs
Temperature q4hrs 2x then q8hrs
Fundus
- Check for tone (firm or boggy)
- Location in relationship to the umbilicus
- Document in cm (finger breaths)
Bladder
- Check for distention
- Assist mom to void
- Catheterize if necessary
Lochia (vaginal discharge after vaginal delivery)
- Check for amount by looking at peripad and linens
- Observe for areas of bleeding
Perineum
- Turn patient on side, lift buttocks, have good lighting
- Assess for episiotomy or lacerations
- Assess for hemorrhoids
Check for post anesthesia sensation (should not go to PP if she still has a prickly sensation in her legs)
goes from 0-10cm
stage 1
calm or excited phase
stage 1, phase 1
