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:
- Latent Phase: From the time of the start of uterine contractions until the cervix if 3cm dilated.
- 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
- Passive Phase: When the patient’s cervix is fully dilated but she does not have the urge to push.
- Expulsive Phase: The patient’s cervix is fully dilated and she has the urge to push.
- Make sure the patient is comfortable lying in bed in the Lithotomy position
- 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).
- Use an “in and out catheter” to empty the patient’s bladder.
- 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:
- Gush of blood.
- Lengthening of cord
- 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
- Severe trauma
- Pulmonary embolism
- Amniotic embolism
7 Things to do when a patient is in Labor:
- Examination incl. Vitals, General physical, Abdomen examination
- Per vaginal Exam:
- Use sterile gloves and lubricant
- Assess cervical effacement and dilatation. (Note:
- 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
- Order new labs
- CTG to assess fetal heart sounds
- Counsel the patient and provide tender loving care
Things to do when a patient is in ACTIVE LABOR:
- Maintain an IV line
- Ask the patient to only eat light foods.
- Take the vitals of the patient (BP, Temp, Pulse, R/R)
- Abdominal examination
- 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.
- Artificial rupture of membranes using a Koker’s forcep.