Stage 1: Dilation Stage

Timeframe

• Can last up to 29 hours (longest stage)

  • Begins: Onset of true labor contractions.

  • Ends: Full cervical dilation (10 cm) and 100% effacement.

How many phases are there?

2 phases: Latent Phase and Active Phase

Latent Phase

• 0–6 cm

• Contractions: Irregular → become more regular.

• Mom: Excited, talkative, some nesting behavior.

• Discharge: Bloody show, mucous plug loss.

• Cervical change = effacement first, then dilation.

Active Phase

• 6–7 cm (8-10cm is transitional)

• Contractions: Stronger, every 2–3 minutes.

• Pain more intense → increased need for support.

• Fetal presenting part descends.

• Mom: More focused, may become anxious.

Maternal Changes

• ↑ Cardiac output, stroke volume, and heart rate (returns to baseline between contractions).

• ↑ Oxygen use → risk of hyperventilation.

• Delayed gastric emptying, N/V possible.

• ↑ Proteinuria, risk of incontinence.

• Endocrine: ↑ estrogen, prostaglandins, oxytocin.

Fetal Adaptations

• Transient hypoxia with contractions.

• ↓ fetal breathing movements.

• Head molding, sutures overlap.

• May pass meconium.

Nursing Care

• Assess contractions: frequency, duration, intensity, resting tone.

• Monitor fetal heart rate and variability (110–160 bpm is normal).

• Vaginal exam (dilation, effacement, station, membranes).

• Labs: GBS, Rh, HIV, Hep B, CBC, rubella, STIs.

• Comfort: breathing techniques, ambulation, positioning, hydration, hygiene.

• Pain: consent, epidural, IV meds as ordered.

• Support: education, encouragement, reassurance.

Maternal Care

• Encourage ambulation, upright positions (walking, squatting, kneeling).

• Monitor VS, contractions, fetal heart rate.

• Vaginal exam for dilation, effacement, station, and membranes.

• Pain relief: breathing techniques, meds, epidural.

• Support, reassurance, hydration, hygiene.

Labor Stages

• Engagement

• Descent

• Flexion

• Internal Rotation

• Extension

• External Rotation

• Expulsion