Stages of Labor

The four stages of the childbirth process are based on changes in the uterus and cervix as labor progresses. The beginning and end of each stage are described below:

First Stage of Labor Begins at the onset of labor and ends when the cervix is 100 percent effaced and completely dilated to 10 centimeters. Average length ranges for a first-time mother is from ten-to-fourteen hours and shorter for subsequent births. Read more in our Health Libarary

The first stage of labor Cerival Effacement and Dilation Illustration of Cervical Effacement

Second Stage of Labor Begins when the cervix is completely effaced and dilated and ends with the birth of the baby. Average length for a first time mother ranges from 1 to-2 hours and shorter for subsequent births. Read more in our Health Library

The second stage of labor

Third Stage of Labor Begins with the birth of the baby and ends with the delivery of the placenta. Average length for all vaginal deliveries ranges from five-to-fifteen minutes.

Fourth Stage of Labor Begins with delivery of the placenta and ends one-to-two hours after delivery.

REFLEX Rooting and sucking

NORMAL RESPONSE Newborns turns headin direction of stimulus, opens mouth, and begins to suck when cheek, lip, or corner of mouth is touched with finger or nipple. Newborn pushes tongue outward when tip of tongue is touched with finger or nipple.

ABNORMAL RESPONSE Weak or no response occurs with prematurity, neurologic deficit or injury, or central nervous system (CNS) depressionsecondary to maternal drug ingestion (eg. narcotics). Continuous extrusion of tongue or repetitive tongue thrusting occurs with CND anomalies and seizures.

Extrusion

Swallowing

Newborn swallows in coordination with sucking when fluid is placed on back of tongue.

Gagging, coughing, or regurgitation of fluid may occur, possibly associated with cyanosis secondary to prematurity, neurologic deficit, or injury; typically seen after laryngoscopy. Asymmetrical response is seen withperipheral nerve injury (brachial plexus) or fracture of clavicle or long bone or arm or leg. No response occurs in cases of severe CNS injury.

Moro

Bilateral symmetrical extension and abduction of all extremities, with thumb and forefinger forming characteristic C are followed by adduction of extremities and return to relaxed flexion when newborns position changes suddenly or when newborn is placed on back on flat surface.

Stepping

Newborn will step with one foot and then the Asymmetrical response is other in walking motion when one foot is touched seen with CNS

to flat surface.

or peripheralnerve injury or fracture of long bone of leg.

Prone crawl

Newborn will attempt to crawl forward with both arms and legs when placed on abdomen or flat surface.

Asymmetrical response is seen with CNS or peripheralnerve injury or fracture of long bone of leg.

Tonic neck or fencing

Extremities on side to which head is turned will extend, and opposite extremities will flex when newborns head is turned to one side while resting. Response may be absent or incomplete immediately after birth.

Persistent response after 4th month may indicate neurologic injury. Persistent absence seen in CNS injury and neurologic disorders.

Startle

Newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement or loud noise.

Absence of response may indicate neurologic deficit or injury. Complete and consistent absence of response to loud noises may indicate deafness. Response may be absent or diminished

during sleep.

Crossed Extension Newborns opposite leg will flex and then extend rapidly as if trying to deflect stimulus to other foot when placed in supine position; newborn will extend one leg in response to stimulus on bottom of foot. Glabellar blink Newborn will blink with first 4 or 5 taps to bridge of nose when eyes are open.

Weak or absent response is seen withperipheral nerve injury or fracture of long bone. Persistent blinking and failure to habituate suggest neurologic deficit. Response is diminished in prematurity. Asymmetry occurs with peripheralnerve damage (brachial plexus) or fracture of humerus. No response occurs with severe neurologic deficit. Diminished response occurs with prematurity. No response occurs with severe neurologic deficit. No response occurs with CNS deficit.

Palmar grasp

Newborns finger will curl around object and hold on momentarily when finger is placed in palm of newborns hand. Newborns toes will curl downward when a finger is placed against the base of the toes. Newborns toes will hyperextend and fan apart from dorsiflexion of big toe when one side of foot is stroked upward from heel and across ball of foot.

Plantar Grasp

Babinski sign

The five criteria of the Apgar score: Component of backronym

Score of 0

Score of 1

Score of 2

Skin blue or pale all color/Complexion over

blue at extremities body pink (acrocyanosis)

no cyanosis body and extremities pink

Appearance

Pulse rate

Absent

<100

100

Pulse

Reflex irritability

no response to stimulation

grimace/feeble cry when stimulated

cry or pull away when stimulated

Grimace

Muscle tone

none

some flexion

flexed arms and legs that resist extension

Activity

Breathing

absent

weak, irregular, gasping

strong, lusty cry

Respiration