STAGES OF LABOR AND NURSING CARE

DILATATION STAGE:

- FIRST STAGE OF LABOR
- It is the period from the FIRST TRUE LABOR CONTRACTIONS TO COMPLETE DILATATION OF THE CERVIX.
- The forces involved are uterine contractions

PHASES OF THE FIRST STAGE OF LABOR:

latent phase, active phase, transition phase

LATENT PHASE:

- In this phase, the mother feels slow, rhythmic contractions radiating from the lumbar region to the anterior portion of her abdomen (from back to abdomen).
- The contractions last from 30 to 45 seconds with the intensity gradually increasing.
- The frequency of contractions is from 5 to 20 minutes.
- 6-8 hours
- Dilation is from 0 to 3 cm.
- "Bloody show" is usually present.

ACTIVE PHASE:

- In this phase, the contractions become stronger and last longer, usually 45 to 60 seconds.
- In EINC, 2-3 contractions in 10 min
- The frequency is from 3 to 5 minutes.
- Moderate to strong contractions
- The cervix dilates from 4 to 7 cm.
- This phase is considered the onset of true labor.
- The mother is admitted to the hospital at this point.

TRANSITIONAL PHASE:

- Contractions are sharp, more intensified, and last from 60 to 90 seconds.
- The frequency is from 2 to 3 minutes.
- The cervix dilates from 8 to 10 cm.
- The mother may express feelings of frustration, loss of control, and/or irritability.
- There is an increase in bloody show due to the rupture of capillary vessels in the cervix and the lower uterine segment.
- The mother feels an urge to push or to have a bowel movement.

WHEN TO POSITION YOUR PATIENT: SUBIRBA

S - Sudden gush of blood
U - Urge to defecate
B - Bloody show
I - Increase in contractions
R - Rupture of membranes
B - Bearing down
A - Anal dilatation

VALSALVA MANEUVER

The mother is asked to take a deep breath, hold the breath (closed glottis), and push downward when uterine contraction starts.

DELIVERY OR EXPULSIVE STAGE

- This is the period from complete dilatation of the cervix to delivery of the fetus.
- This stage averages about 45 to 60 minutes in a first pregnancy and 15 to 30 minutes in subsequent pregnancies.
- Imminent signs (SUBIRBA)
- 2nd stage

CROWNING:

- the appearance of the infant's head on the perineum.
- Occurs when the fetal head is encircled by the external opening of the vagina (introitus), which means birth is imminent.

series of passive, adaptive movements of the fetal head and shoulders through the birth canal.

A mechanism of labor is a

Mechanisms of Labor: (EDFIEEE)

Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion

PLACENTAL STAGE:

- THIRD STAGE OF LABOR
- This is the period from birth of the baby until delivery of the placenta.
- The forces involved are uterine contractions and intra-abdominal pressure.
- This stage usually lasts only a few minutes but may last up to 30 minutes.
- This is considered a dangerous time because of the possibility of hemorrhaging
- Placenta: made up of 20-25 lobes called cotyledons.

2 MECHANISMS OF PLACENTAL SEPARATION

Schultze & Duncan

Schultze

Separates from the inside to the outer margin; expelled with the fetal side: "Shiny"

Duncan

Separates from the outer margins inward, rolls up and presents sideways with the maternal surface; "Dirty"

UNANG YAKAP:

- Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.
- Unang Yakap (90 minutes)

RECOVERY STAGE:

- FOURTH STAGE OF LABOR
- This period begins with the delivery of the placenta and ends when the uterus is contracted
- The woman is observed frequently for signs of hemorrhage or other complications; 1-4 hours after birth
- The primary goal is to prevent hemorrhage from the uterine atony and the cervical or vaginal lacerations.
- Blood loss ranges from 250-500ml
- Uterus remains contracted in the midline

CHARACTERISTICS OF A FULL BLADDER:

- Bulging of the lower abdomen
- Spongy feeling mass between the fundus and the pubis.
- Displaced uterus from the midline, usually to the right.
- Increased lochia flow.
- Full bladders may cause postpartum hemorrhage because they prevent the uterus from contracting appropriately.

FORCEPS DELIVERY

Method of delivering infants through the use of forceps extraction