Four
stages of labor:
First
stage: the longest stage occurs between
onset of true labor and the point of cervical dilation and effecement. Second
stage is the expulsion of the
fetus; third stage – delivery of
placenta; and fourth stage – 1st 4 hrs /p delivery of placenta
First
stage: divided into 3 phases
•Latent – begins with onset of regular contractions, with
contractions q 15 -20 min, lasting 20
-30 secs, gradually lnc to q 5 – 7 min, 30 – 40 secs duration. Little
or no cervical dilation. Women stay home. Phase ends when cervix is 3 cm. Lasts 8.6 hrs for primi, < 6 for
multi.
•Active phase – begins 4 cm, ends when dilated to 7cm;
contractions 2 – 3 mins, 40 – 60 secs; cervix should dilate about 1 to 1.5 cm /hr. Primi – avg 4.6 hrs, multi 2.4 hrs
•Transition phase – shortest, most intense. Dilation from
8 to 10 cm; contractions q 1.5 – 2 mins, lasting 60 – 90 secs (pain & rest about same). Lasts avg 3.6 hrs for
Primi; varies with multi. Woman becomes restless, angry, wants to go home, wants a C-sec, N&V, etc. Withdraws
from support (spouse, coach, etc), leaving partner feeling useless. NURSE IS VITAL at this point to both.
NURSE must prepare for 2nd stage.
Second
stage: cervix is completely dilated & effaced; known as pushing stage;
up to 3 hrs for primi, < 30 mins in multi. The woman bears down, abdominal muscles
contract, & help fetal head descend. When fetal head is visible at vulvar opening, crowning has
occurred and birth is imminent. Some women feel relief, birth is near; others feel frightened and overwhelmed. Pt can assume
different positions. In US, lithotomy position
most common.
Positional
changes of fetus: called cardinal
movements:
1.Descent: progression of head into pelvis d/t pressure of
amniotic fluid, the contracting uterus, the
effects of contractions on mother’s
abdominal muscles and diaphragm, and the extension and straightening of the fetus. Head enters at an oblique or
transverse position
2.Flexion – resistance from soft pelvic tissues →
flexion of chin against chest ::
smallest fetal diameter
3.Internal rotation – fetal head must rotate to accommodate the pelvis; head
rotates from left to right
4.Extension – fetal head pivots under symphysis pubis. Head emerges
through extension, followed by occiput, then the face, and finally the chin
5.Restitution – internal rotation causes shoulders to enter pelvis in
an oblique position and neck becomes twisted. When head is delivered, the neck untwists and
aligns with long axis of fetus.
6.External rotation – shoulders rotate, turning head further to one
side
7.Expulsion – anterior shoulder slips under symphysis pubis, followed by
posterior shoulder. Once shoulders are delivered, the trunk follows. (Sometimes rather
quickly!)
1.
Figure
15-13 (illustration), p 325
Birth
sequence Figure 15 -12, p 324