Stages and Management of Labor

Stages of Labor

Labor: [After 37 weeks of gestation] Progressively increasing uterine contractions (in intensity and duration), leading to cervical dilatation and effacement, resulting in the delivery of the fetus and the placenta.

Signs and Symptoms of Labor:

- Severe intermittent pain starts from the back and radiates to the lower abdomen.

- Show (Mucus plug of cervix).

- Rupture of amniotic fluid

I. First Stage of Labor

- Lasts for approximately 8-12 hours

- Primigravida < 12 hours

- Multigravida < 8 hours

The first stage of labor is further divided into two phases:

  1. Latent Phase: From the time of the start of uterine contractions until the cervix if 3cm dilated.
  2. Active Phase: Lasts until the cervix is 10cm dilated.

II. Second Stage of Labor

- From the full dilatation of the cervix until the delivery of the baby.

- Primigravida < 2 hours

- Multigravida < 1 hour

The second stage of labor is further divided into: Passive and Expulsive phases

  1. Passive Phase: When the patient’s cervix is fully dilated but she does not have the urge to push.
  2. Expulsive Phase: The patient’s cervix is fully dilated and she has the urge to push.
  1. Make sure the patient is comfortable lying in bed in the Lithotomy position
  2. Monitor fetal heart sounds with each uterine contractions to make sure that the baby does not go into fetal distress (Fetal distress: FHR< 120 beats per minute).
  3. Use an “in and out catheter” to empty the patient’s bladder.
  4. Empty the patient’s rectum if needed.

III. Third Stage of Labor

- From the time of the delivery of the baby until the delivery of the placenta.

- Normal length < 30 minutes

- Uterine contractions originating in the fundus will result in the delivery of the placenta.

Three Signs of the 3rd Stage of Labor:

  1. Gush of blood.
  2. Lengthening of cord
  3. Fundus becomes globular

Active Management of the 3rd stage of Labor:

- Give the patient oxytocin (parenterally) to prevent PPH (post-partum hemorrhage). Ocytocin will act to increase the contractions and prevent blood loss.

Complications of 3rd Stage of Labor:

- Primary PPH

- Shock

- Severe trauma

- Pulmonary embolism

- Amniotic embolism

7 Things to do when a patient is in Labor:

  1. History
  2. Examination incl. Vitals, General physical, Abdomen examination
  3. Per vaginal Exam:

- Use sterile gloves and lubricant

- Assess cervical effacement and dilatation. (Note: Normal length of a cervix is 10cm).

- Check to see if the membranes are intact (If the membranes are ruptured, then labor should start within 12 hours).

- Check the color of the amniotic fluid

- Assess Station: Presenting part of the baby in relationship with the ischial spine. If the presenting part is at the level of the ischial spine, the Station = 0. If the presenting part is 1cm above the ischial spine, the Station = -1. If the head of the baby is seen, Station = +2

  1. Enema
  2. Order new labs
  3. CTG to assess fetal heart sounds
  4. Counsel the patient and provide tender loving care

Things to do when a patient is in ACTIVE LABOR:

  1. Maintain an IV line
  2. Ask the patient to only eat light foods.
  3. Take the vitals of the patient (BP, Temp, Pulse, R/R)
  4. Abdominal examination
  5. Augmentation: to increase frequency of contractions and to decrease the duration of labor (Pharmacological and Mechanical).

Pharmacological Augmentation: give the patient Oxytocin (Syntocinol).

- Note: 1 Ampule= 1ml = 5 units

- In a primigravida patient: Give 10 units of oxytocin in 1000ml of Ringer’s solution at 10 drops/minute.

Mechanical Augmentation:

- Artificial rupture of membranes using a Koker’s forcep.