Stage 1 Latent Phase
Beginning with stage 1 of the stages of labor, stage 1 has 3 distinct phases. Don’t confuse stages with phases. During phase 1 (latent phase) the cervix is at a dilation of around 1 – 4 cm. Contractions occur every 15 – 30 minutes with duration of 15 – 30 seconds and are of mild intensity. In phase 1 the mother is very chatty and excited to be in labor. Burn off that extra fat that baby left behind!!! The mother and father should be an active part of the care in this phase. Comfort is of the utmost importance, mother should seek assistance with changes in position and walking. Mother should also drink lots of fluids or ice chips. Voiding every 1 – 2 hours is important at this point.
Stage 1 Active Phase
In the active phase of stage 1 the cervix is dilated to 4 – 7 cm. Contractions take place every 3 – 5 minutes with duration of 30 – 60 seconds and are of moderate intensity. The mother becomes restless and anxious and because of this may have feelings of helplessness. For this reason it is important to keep the mother’s breathing pattern effective, keep the room as quiet as possible. Mother and father should be kept informed of the progress. Comfort measures used in this phase include back rubs, sacral pressure, support with pillows, and changes in position. Effleurage or Swedish massage should be done by the husband; medical staff can show him what to do. Mother can use ointment for dry lips and continue to drink fluids or ice chips and should void every 1 – 2 hours.
Stage 1 Transition Phase
During the transition phase of stage 1 the cervix is dilated to 8 – 10 cm. Contractions are occurring every 2 – 3 minutes with duration of 45 – 90 seconds and are of strong intensity. At this point the mother has become exhausted, is edgy and irritable, and feels out of control. The mother should rest between contractions to conserve energy. Mother should be awakened at beginning of a contraction so she can begin her breathing pattern. Continuing fluid intake or ice chips and voiding every 1 – 2 hours is important.
Stages of Labor: Stage 2
Finally we move on to stage 2, of the stages of labor. During stage 2 dilation of the cervix is complete. The progress of this stage of labor is measured by the changes in fetal station, which means the descent of the baby’s head through the birth canal. Contractions occur every 2 – 3 minutes with duration of 60 – 75 seconds and the intensity continues to be strong. The mother will feel and urge to bear down and the medical staff will assist the mother in her efforts to push. An increase in bloody show will occur. The vital signs of the mother are important to monitor at this point. The baby’s heart rate will be monitored before, during, and after a contraction. The normal heart rate of a baby is 120 – 160 beats a minute. Mother should be helped into positions of comfort and that assist in her efforts to push such as side-lying, squatting, kneeling, or lithotomy. The bulging of the mother’s perinea area or seeing the baby’s head are signs the birth is about to occur.
Stages of Labor: Stage 3
At stage 3 of the stages of labor the baby has already been born. Stage 3 is the delivery of the placenta. Contractions will continue until the placenta is born. The placenta separates from the wall and natural removal occurs by uterine contractions. The birth of the placenta takes place 5 – 30 minutes after the birth of the baby. There are two different mechanisms of birth of the placenta that can happen; they are “Dirty Duncan” or “Shiny Schulze’s”. For Duncan’s mechanism the margin of the placenta separates, and the dull, red, and rough maternal surface emerges from the vagina first. For Schulze’s mechanism the center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina. The mother has her vital signs and uterine fundus location checked. The fundus, at this point, is located 2 fingerbreadths below the umbilicus (belly button). The placenta will be checked for the presence of cotyledons (lobes of placenta), to make sure none of the placenta is missing, including making sure that the placenta membranes are intact. Mother may begin to shiver do to a decrease in body core temperature, provide blankets to warm up. Medical staff should promote baby-mother attachment.
Stages of Labor: Stage 4
Stage 4 extends 1 to 4 hours after delivery. During this time the mother’s blood pressure will return to pre-labor level, pulse is decrease than that of the labor pulse. The fundus remains contracted; this is normal and essential. Fundus is midline 1 – 2 fingerbreadths below the umbilicus (belly button). Lochia is scant and red. (Lochia is a discharge from the vagina after birth to 6 weeks and progresses as follows: mostly blood, followed by a more mucous fluid that contains dried blood, and later a clear-to-yellow discharge.) Checking the mother frequently after birth is important. She is checked first every 15 minutes for 1 hour, then every 30 minutes for an hour, and lastly every hour for 2 hours. Comfort is important at this stage of labor. Give the mother warmed blankets if possible, ice to the perinea area to decrease swelling, teach the mother to massage her uterus to prevent a “boggy” uterus, the uterus should stay firm. Teach the mother how to breast feed and ask open ended questions to promote conversation about breast feeding.