Stages of

Labor
The First Stage
It is divided into three phases: the
latent, the active and the
transition phase.
Latent Phase
◦ Begins at the onset of regularly
perceived uterine contractions
and ends when rapid cervical
dilatation begins. Contractions
are mild and lasts for only 20-40
seconds. Cervical effacement
occurs, and the cervix dilates
from 0-3 cm. The phase lasts
approximately 6 hrs in a
Active Phase
Cervical dilatation occurs more
rapidly, going from 4-7 cm.
Contractions are stronger, lasting
40-60 seconds and occurring
approximately every 3-5 minutes.
Lasts approximately 3 hrs in
nullipara and 2 hrs in multipara.
Transition Phase
Maximum dilation of 8-10 cm
occurs.
Contraction reach their peak of
intensity, occurring every 2-3
min. with a duration of 60-90
seconds.
Dilatation occurs in rapid rate.
SECOND STAGE
Full dilatation and cervical effacement
to birth of the infant.
Contractions change from crescendo-
descrescendo pattern to aan
overwhelming, uncontrollable urge to
push or bear down with contactions as
if she had to move her bowels.
Woman may experience momentary
nausea and vomiting.
As fetal head touches the internal side
of the perineum, the perineum begins to
bulge and appear tense.
Anus of the woman may appear
everted.
As fetal, head is pushed still tighter
against the perineum, the vaginal
introitus opens and the fetal scalp
becomes visible at the opening of the
vagina.
At first, this is a slitlike opening, which
then becomes oval, then circular.
 Third Stage
Begins with the birth of the infant
and ends in the delivery of the
placenta.
Placental separation & placental
expulsion
Normal blood loss: 300-500ml
Placental Separation
Occurs as the uterus resumes contractions
(Culkin’s sign).
Active bleeding on the maternal surface of
the placenta begins with separation; the
bleeding helps to separate the placenta still
further by pushing it away from its
attachment site.
As the separation is completed, the
placenta sinks to the lower uterine segment
or the upper vagina.
 The following signs indicate that the
placenta has loosened and is ready to
deliver:
Lengthening of the umbilical cord.
Sudden gush of vaginal blood.
Change in the shape of the uterus
Placental Expulsion
The placenta is delivered either by
the natural bearing down of the
mother or by gentle pressure on the
contracted uterine fundus by the
physician or nurse-midwife (Crede’s
maneuver).
Fourth Stage
Delivery of the placenta – 1 to 4 h after
delivery
◦ Asses uterine contractility
 Uterus must be full and well contracted
 Check for uterine involution
 Immediate after delivery
 1 hr after delivery: uterus @ level of the umbilicus
 1 day after delivery: uterus 1 fingerbreath below umbilicus
(1cm)
 2nd -9th day – 1 fingerbreath a day
 10th day – nonpalpable
Assess for lochial discharge
◦ Lochia Rubra
 Bloody, red
 Up to 3 days
◦ Lochia Serosa
 4-6 days
 brownish
◦ Lochia Alba
 7-10 days
 whitish
Assess perineum for bleeding.
Assess for level of pains
◦ Alterpains- abdominal pain associated with
uterine contractions