Stages of labor:

1. Latent – from true labor to full cervical dilation

a. Cervical dilation of 0-3 cms
b. Mild and short contractions last 20-40 seconds
c. Lasts 6 hours (nullipara) and 4.5 hours (multipara).
Management:
1. Allow her to continue to be active.
2. Encourage to continue or begin alternative methods of pain relief such as aromatherapy or
distraction.
3. Encourage oral and perineal hygiene.
4. May still take meals (if no indication for CS).

2. Active: -from full cervical dilation – to the delivery of the baby

a. 4 to 7 cm. dilation
b. Contractions are stronger, lasting 40 to 60 secs every 3 to 5 mins.
c. Lasts 3 hrs (nullipara) and 2 hrs (multipara).
d. Increased show
e. Spontaneous rupture of the membranes.
f. Exciting or frightening time.
g. Can still follow instructions but may deviate from what is taught.

Management:
a. Assume what position is most comfortable for her.
b. Start monitoring progress of labor via partograph

3. Transition – delivery of baby to the delivery of placenta

8 to 10 cm and full effacement
Contractions reach peak of intensity, every 2 to 3 mins with duration of 60 to 90 secs.
Show occurs as the last of the mucus plug.
Intense discomfort, accompanied by nausea and vomiting.
Experience a feeling of loss of control, anxiety, panic, or irritability.
Focus is entirely on the task of birthing her baby.
irresistible urge to push occurs.

Management:
a. Coach on proper bearing down techniques.
b. Encourage support persons to accompany during relaxation activities.
c. Update client and family members on progress of labor.
d. Administer HNBB as ordered to ripen the cervix.
e. FHT every hour
f. IE every 4 hours

Signs of placental separation/delivery:

1. Abdomen becomes globular
2. Cord lengthens
3. Sudden gush of blood
Management after placental delivery:
a. Check BP after placenta is out.
b. Massaged uterus until firm
c. Teach mother to massage

CERVICAL 0-3 cms 4-7 cms 8-10 cms

DILATION

LENGTH OF TIME/ N=6-20 hours N=3-5 hours N=2-3.6 hours

duration M=4.5-14 hour M=2-4 hours M=30 min-1hour

Uterine
contractions
Duration: 20-40 seconds 40-60 seconds 60-90 seconds
Interval: 5-20 minutes 2-5 minutes 1 ½ -2 minutes
Intensity: mild-moderate moderate-strong moderate-strong

Discomfort Minimal Can be frightening Intense discomfort/

panicky

Mechanisms of labor: EDFIERE

1. Engagement – biparietal diameter of fetal head reaches level of ischial spine of mother’s pelvis.
 Presenting part is a 0 station
2. Descent = downward movement through pelvic inlet through dilated cervix, reaches posterior
vaginal wall. Urge to bear down is felt by mother.
3. Flexion - uterine contractions push the fetus downwards, while the cervix resists resulting to
flexion of the head.
4. Internal Rotation – Fetal head rotates in the mid pelvis from transvers to anterior posterior
position
5. Extension – Increased tension around the symphysis pubis delvers the bregma, brow and face
6. External rotation/Restitution – head rotates to transverse position. Shoulders are aligned to the
antero-posterior diameter.
7. Expulsion – baby passes through the birth canal

Management:
1. Prepare needed equipment for delivery
2. Anticipate needs of client and doctor.
3. Encourage on proper bearing down technique and breathing exercises.
4. Oxytocin 10 units after baby out.
5. Congratulate the mother!!!
6. Provide essential new-born care

EINC – Essential Intrapartum New-born Care

Four core Immediate Early skin to skin Properly-timed Early breast
drying contact cord clamping feeding while on
skin to skin
contact
Time frame Within 1st 30 sec. After 30 sec of 1-3 mins Within 90 mins
 drying
Objectives Good breathing Warmth and Reduce anemia Facilitate BF
and warmth bonding and protects
against brain
hemorrhage in
premature new-
borns
Rationale Breathing allows prevents Protects infants
lung expansion hypothermia, from dying from
infection and infection. The first
hypoglycemia feed provides
colostrum, a
substance
equivalent to the
babies’ first
immunization in
its protective
properties.
Salient points Hand wash Place on prone -Remove 1st -continuous Skin
Double gloving position gloving to skin
Thorough drying Place on bonnet -Clamp and cut -observe for BF
Remove wet Cover with after pulsations signs
clothing blanket stop -health teaching
Suction only as Nametag on R - do not milk - eye care, vit k.
needed ankle -give oxytocin -anthropometrics
Bath within 6 hrs 10mg IM after 1st feeding

Don’t do the ff Wipe off vernix Wipe off vernix -milk cord Too much
Get foot prints -apply any handling
Slap substance Give sugar water
or milk formula