Stages of Labour

Care of the
mother during
labour
Presented by:
Rekhamol VB Sidhanar
Topics covered
 Establishing Therapeutic Relationship
 Admission Assessment
 Stages of Labor
1. First Stage of Labor
 Latent Phase
 Active Phase
 Transition Phase
2. Second Stage of Labor
3. Third Stage of Labor
4. fourth stage of labor
Establishing Therapeutic
Relationship
 To gain patient and family’s cooperation and trust, it is
important that the nurse should be able to establish a
therapeutic relationship with them. The nurse should
introduce himself and make them feel welcome. At this
point, they are all anxious and it is best for the nurse to
convey his message gently and confidently.
Expectations of the family about birth should be
determined and it is also the best time to ascertain
cultural values.
Admission Assessment
 When a patient arrives at the labor floor, pertinent information about the pregnant
woman’s health history is taken during admission. These include personal data (e.g.
blood type, allergies, etc.), previous illness, pregnancy complications, preferences
for labor and delivery, and childbirth preparations. Standard obstetric, medical, and
social history taking is also done.
 In addition, the nurse assesses the following: vital signs, physical exam, contraction
pattern (frequency, interval, duration, and intensity), intactness of membranes
through vaginal exam, and fetal well-being through fetal heart rate, characteristic of
amniotic fluid, and contractions. The nurse performs Leopold’s maneuver to
determine fetal presenting part, point of maximum impulse, fetal descent and
engagement.
Stages of Labor
Stages of Start End Duration

Labor
Nullipara Multipara
First Stage True labor contractions Full cervical 10-12 hr 6-8 hrs
dilatation
Latent Onset of regularly perceived uterine 3 cm cervical 6 hrs 4.5 hrs

phase contractions (mild contractions dilatation
lasting 20-40 sec)
Active Stronger uterine contractions lasting 7 cm cervical 3 hrs 2 hrs

phase 40-60secs dilatation
Transitional Uterine contractions reaching their 10 cm cervical

phase peak, occurring every 2-3 minutes dilatation 3 hrs 1.5-2 hrs
for 60-90 s
Second Expulsion of the
Full cervical dilatation 30 min 15-30 min
Stage fetus
Placental
Third Stage Expulsion of fetus Maximum of 15 -20 min.
Latent Phase
 Latent (Preparatory) Phase starts from the onset of true labor contractions
to 3 cm cervical dilatation. Here are nursing responsibilities during this
phase:
1. Assess patient’s psychological readiness.
2. Measure duration of latent phase.
3. Allow patient to be continually active.
4. Conduct interviews and filling in of forms (e.g. birth certificate) at this phase
while the patient experiences minimal discomfort and has control over
contraction pains.
Cont…
5. Conduct health teaching on breastfeeding, newborn care, and effective bearing down
because during this time, patient’s anxiety is controlled and she is able to focus on nurse’s
instructions.
6. Educate patient on different relaxation techniques. As early as this phase, encourage

patient to begin alternative therapy of pain relief.
7. Ensure that the total number of internal examinations the woman receives in the entire
course of labor is limited to 5 only.
8. Ensure that birthing companion of choice is present all throughout the course of labor.
Active Phase
 Active Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation. During this
phase, contraction intensity is stronger, interval shortens, and duration lengthens. This is
where true discomfort is first felt by the patient so she is dependent and her focus is on
herself. Here are nursing responsibilities in this phase:
1. Inform patient on the progress of her labor to lessen her anxiety and obtain her trust
and cooperation.
2. Start monitoring progress of labor with the use of WHO partograph, 2-hour action line.
3. Encourage patient to be continually active to maximize the effect of uterine
contractions. Upright maternal positions are recommended if tolerated.
4. Assist patient in assuming her position of comfort. For those who can’t stay upright,
left-side lying is recommended to avoid disruption in fetal oxygenation.
Cont….
5. Monitor maternal vital signs and fetal heart rate every 2 hours, or
depending on the doctor’s order.
6. Anticipate patient needs (e.g. sponging face with cool cloth, keeping bed clean
and dry, providing ice chips or lip balm) to promote comfort.
7. Determine when patient last voided because a full bladder can hinder fast labor
progress.
8. Institute non-pharmacological pain measures (e.g. breathing exercises,

distraction method, imagery, music therapy, etc.)
Transition Phase
 Transition Phase starts from 8 cm cervical dilatation to 10 cm (full) cervical dilatation

and full cervical effacement. During this time, patient may be exhausted and withdrawn
or aggressive and restless. Patient’s urge to push is noticeable. Here are nursing
responsibilities in this phase:
1. Inform patient on progress of her labor.
2. Assist patient with pant-blow breathing.
3. Monitor maternal vital signs and fetal heart rate every 30 minutes -1 hour, or depending
on the doctor’s order. Contraction monitoring is also continued.
4. When perineal bulging is noticeable, prepare for delivery. Check room temperature (25-
280C and free of air drafts). The nurse should also notify staff and prepare necessary
supplies and equipment, including resuscitation machine. Lastly, perform handwashing
and double gloving.
Second Stage of Labor
 Second Stage of Labor starts when cervical dilatation reaches 10 cm
and ends when the baby is delivered. At this stage, the patient feels an
uncontrollable urge to push. The nurse at this stage must coach quality
pushing and support delivery.
 Here are nursing care tips for this stage:
1. Instruct patient on quality pushing. The abdominal muscles must aid the
involuntary uterine contractions to deliver the baby out.
2. Provide a quiet environment for the patient to concentrate on bearing
down.
3. Provide positive feedback as the patient pushes.
4. Repeat doctor’s instructions. At this phase, the patient barely hears the
conversation around the room because all her energy and thoughts are
being directed toward giving birth.
5. Take note of the time of delivery and proceed to initiate essential
Third Stage of Labor
 Third Stage of Labor or the placental stage starts from birth of infant to delivery of
placenta. It is divided into two separate phases: placental separation and placental
expulsion. Five minutes after delivery of baby, the uterus begins to contract again, and
placenta starts to separate from the contracting wall. Blood loss of 300-500 mL occurs as
a normal consequence of placental separation. Placenta sinks to the lower uterine
segment or upper vagina. The placenta is then expelled using gentle traction on the cord.
 Here are the signs of placental separation:
1. Lengthening of umbilical cord
2. Sudden gush of vaginal blood
3. Change in the shape of uterus (globular in shape)
4. Firm uterine contractions
5. Appearance of placenta in vaginal opening
Cont….
 At this stage, here are the nursing care tips:
1. Coach in relaxation for delivery of placenta.
2. Congratulate on delivery of baby.
3. Encourage skin-to-skin contact to facilitate bonding and early breastfeeding.
4. Ask patient whether placenta is important to them before it is destroyed. For those who
want to take it home, ensure that they understand and follow standard infection
precautions and hospital policy.
5. Administer prophylactic oxytocin as ordered.
6. Utilize controlled cord traction technique for placental expulsion.
7. Utilize absorbable synthetic suture materials (over chromic catgut) for primary repair of
episiotomy or perineal lacerations.
Fourth stage of labour
 For immediate postpartum, the nurse checks the vital signs and monitors for excessive
bleeding. The first four hours after birth is sometimes referred to as the fourth stage
of labor because this is the most critical period for the mother. The nurse is set to
perform nursing interventions that would prevent the patient from infection and
hemorrhage. Also, they are being reminded of the importance of breastfeeding,
ambulation, and newborn care.

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Care of the

Stages of Start End Duration

Latent Onset of regularly perceived uterine 3 cm cervical 6 hrs 4.5 hrs

Active Stronger uterine contractions lasting 7 cm cervical 3 hrs 2 hrs

Transitional Uterine contractions reaching their 10 cm cervical

6. Educate patient on different relaxation techniques. As early as this phase, encourage

8. Institute non-pharmacological pain measures (e.g. breathing exercises,

 Transition Phase starts from 8 cm cervical dilatation to 10 cm (full) cervical dilatation

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