📌 NCLEX Topic: Stages of Labor

Description:

Labor is divided into four stages, each with specific physiological changes and nursing interventions. Understanding these stages is crucial for managing labor progression, assessing fetal and maternal well-being, and preventing complications.

The Four Stages of Labor

🔹 Stage 1: Onset of Labor to Full Cervical Dilation (0-10 cm)

This is the longest stage and is divided into three phases:

• 1️⃣ Latent Phase:
  • Cervical dilation: 1-4 cm
  • Contractions: Every 15-30 minutes, lasting 15-30 seconds, mild intensity.
  • Nursing Interventions: Encourage ambulation, position changes, voiding every 1-2 hours, hydration, and relaxation techniques.
• 2️⃣ Active Phase:
  • Cervical dilation: 4-7 cm
  • Contractions: Every 3-5 minutes, lasting 30-60 seconds, moderate intensity.
  • Nursing Interventions: Support effective breathing, provide back rubs, apply sacral pressure, encourage voiding, administer pain relief as needed.
• 3️⃣ Transition Phase:
  • Cervical dilation: 8-10 cm
  • Contractions: Every 2-3 minutes, lasting 45-90 seconds, strong intensity.
  • Nursing Interventions: Encourage rest between contractions, guide breathing, and provide emotional support.

💡 Key Assessment: Monitor fetal heart rate (FHR), contractions, and cervical dilation/effacement.

🔹 Stage 2: Full Cervical Dilation to Birth of Baby

• Cervical dilation: Complete (10 cm)
• Contractions: Every 2-3 minutes, lasting 60-75 seconds, strong intensity.
• Signs of Approaching Birth:
  • Increased bloody show.
  • Urge to push (Ferguson reflex).
  • Perineal bulging or crowning.

🚨 Nursing Interventions:

1. Encourage pushing efforts while monitoring fetal descent.
2. Monitor FHR before, during, and after contractions.
3. Position for effective pushing (e.g., lithotomy, squatting, kneeling).
4. Provide emotional support and reassurance.
5. Monitor for complications: Cord prolapse, fetal distress, maternal exhaustion.

💡 Key Assessment: Fetal descent, maternal exhaustion, perineal status.

🔹 Stage 3: Birth of Baby to Expulsion of Placenta

• Time Frame: 5-30 minutes after birth.
• Signs of Placental Separation:
  • Sudden gush of blood.
  • Lengthening of the umbilical cord.
  • Uterus becomes firm and globular.

🚨 Nursing Interventions:

1. Monitor for complete placenta expulsion (check for intactness).
2. Administer oxytocin (Pitocin) as prescribed to promote uterine contraction.
3. Assess for excessive bleeding (postpartum hemorrhage risk).
4. Encourage skin-to-skin contact and breastfeeding.

💡 Key Assessment: Monitor for postpartum hemorrhage, retained placenta.

🔹 Stage 4: Immediate Postpartum (1-4 Hours After Birth)

Goal: Monitor for maternal stabilization and recovery.

🚨 Nursing Interventions:

1. Monitor vital signs every 15 minutes for the first hour.
2. Assess fundal height and firmness (should be midline and contracted).
3. Assess lochia (vaginal discharge) – should be moderate in amount, red (rubra).
4. Encourage early ambulation to prevent thrombosis.
5. Apply ice packs to the perineum (reduce swelling).
6. Encourage bonding and breastfeeding.

💡 Key Assessment: Postpartum hemorrhage, uterine atony, perineal healing.

Key Terms in Labor & Delivery

• Dilation: Opening of the cervix (0-10 cm).
• Effacement: Thinning of the cervix (0-100%).
• Fetal Station: Descent of the fetal head (-5 to +5).
• Variability: Fluctuations in FHR (absent, minimal, moderate, marked).

Summary for NCLEX:

• ✅ Four Stages of Labor: Progression from dilation to delivery to postpartum recovery.
• ⚠️ PRIORITY: Monitor FHR, contraction patterns, maternal well-being, and signs of complications.
• 🩺 Key Interventions: Pain management, fetal monitoring, promoting effective pushing, and postpartum care.