LABOR

Labor is the coordinated sequence of involuntary uterine contractions. Understanding the stages of labor would allow the mother and the health care team facilitate a less stressful and safe childbirth. The four stages of labor are based on the changes that the uterus and cervix undergo as labor progresses.

First Stage of Labor The first stages of labor usually have 20 t0 40 contractions. Three Phases of the First Stage of Labor 1. Latent Phase. The mother is excited. This lasts from the beginning of labor until 3 cm of
cervical dilatation.

2. Active Phase. The mother is anxious. The cervix dilates from 4-7 cm and dilates in a more
rapid rate.

3. Transition Phase. The mother is irritable. The cervix dilates from 8-10 cm and the fetus
descends further into the pelvis.

Second Stage of Labor

Continues after the cervix is dilated to 10 cm until the delivery of your baby

Third Stage of Labor

This is where the vulva is stretching. Contractions are at 40-60. This begins with complete dilatation and full effacement of the cervix and end with the birth of the baby. (Delivery of Placenta)

Fourth Stage of Labor

This begins with the birth of the baby and ends with the expulsion of the placenta. The placenta is formed by the union of the chorionic villi and decidua basalis. (Get Vital Signs) (post partum)

Types of Placental Separation Schultz. The presenting part is the fetal side which is shiny. Duncan. The presenting part is the maternal side which is called dirty because it is raw
and red.

Nursing Care During the Third Stage of Labor

Do not hurry the expulsion of the placenta. This usually takes around 20 minutes. Tract cord slowly. Inspect for missing cotyledons. There should be 30. Palpate the uterus. Inject oxytocin. Inspect the perineum. Put down the legs of the mother together to prevent injury.

The mother should be flat on bed without pillows for 6 hours. If the client is experiencing chills, provide her with a blanket and NOT soup. Provide additional nourishment. Allow the mother to sleep to regain her strength. Fourth Stage of Labor The fourth stage of labor is the most critical stage. This lasts from the delivery of the placenta through the first 1-4 hours after birth. The nurse should assess the fundus, blood pressure and pulse rate, the lochia which should be moderate in flow, and the perineum. If the flow of the lochia is heavy the mother should be checked for lacerations and rechecked for retained placental fragments. Nursing Care During Labor

Monitoring the fetus. Monitoring the laboring woman. Helping the woman cope with labor.

Condition Assessment with Fetal Compromise

1. Fetal Heart Rate. Lower limit is 110-120 bpm and the upper limit is 150-160 bpm. 2. No variability in the electronic monitoring. 3. Slowing of the fetal heart rate. This persists or preceeds after contraction. 4. Meconium stained. The amniotic fluid is green.. 5. If the amniotic fluid is yellow, cloudy, or has a foul odor, it may indcate infection. 6. Contractions that last for 90 secs. 7. Incomplete uterine relaxation. 8. Maternal hypotension. 9. Maternal hypertension. 10. Maternal fever.

Evaluate Fetal Heart Rate

1. Baseline Rate. The range of contractions and its changes and fluctuations. This should be constant. 2. Variability. The decreases and fluctuations. 3. Periodic changes. The changes in baseline rate. Classified as acceleration and deceleration. Types: 1. Early decelerations. The rate of decrease during contraction but return to baseline by end of contraction. 2. Variable decelerations. 70 bpm or less for longer than 60 seconds. This may suggest fetal cord compression around the neck or inadequate amniotic fluid. 3. Late deceleration. This is similar to early deceleration except it does not return to baseline until contractions end.

Inspection of Amniotic Fluid

Normal color is clear with flecks of vernix caseosa.

Green stained fluid indicates the amniotic fluid is meconium stained. Cloudy or yellow amniotic fluid is infected.