Stages of Labor

I: Dilatation Stage

II: Delivery/Fetal Stage

III: Placental Stage

IV: Recovery Stage

 1st Stage
• Measured from the onset of true labor
contractions to complete cervical dilation

• divided into three phases:

Latent Active Transition

 1st Stage: LATENT Phase
• onset of regularly perceived uterine
contractions - rapid cervical dilation begins.
This is also called the “preparatory phase”.
Contractions Duration of Cervical Duration
Contractions Dilation

Mild and short 20 to 40 0-3 cm Nullipara: 6

seconds hours
Multipara: 4.5
hours
 Nursing Considerations

• Analgesia may prolong this phase

• Best time to reinforce health teachings

 1st Stage: ACTIVE Phase
• cervical dilatation occurs more rapidly

Duration of Cervical
Contractions Contractions Dilation Duration

Stronger, 40 to 60 4 to 7 cm Nullipara: 3
longer and seconds every hours
causes true 3 to 5 minutes Multipara: 2
discomfort hours
 Nursing Considerations

• Analgesia has little effect on the progress

of labor

• show and spontaneous rupture of

membranes
 1st Stage: TRANSITION Phase
• Maximum cervical dilatation and effacement.

Duration of Cervical
Contractions Contractions Dilation Duration

At peak 60 to 90 8 to 10 cm Until full

intensity seconds cervical
every 2-3 dilation
minutes
 Nursing Considerations

• if intact membranes, it will rupture as a rule

at full dilation

• accompanied by nausea and vomiting

• this stage ends at 10 cm of dilatation

 2nd Stage

• from full dilatation and cervical effacement

to birth of the infant:

– uncomplicated birth: stage takes about 1 hour.

• Crowning:
– fetal head pushes against the perineum, the
vaginal introitus opens and the fetal scalp appears
at the opening to the vagina
 Cardinal Movements of Labor
• E ngagement
• D escent
• F lexion
• I nternal R otation
• E xtension
• E xternal R otation
• E xpulsion
• ENGAGEMENT
– Presenting part of the fetus has passed far
enough into the pelvis so that it’s level with
the ischial spines

• DESCENT
– Downward movement of the fetus

• FLEXION
– Movement of the fetal head forward so that
the chin is pressed to chest
• INTERNAL ROTATION
– Rotation of head that enables passage
through the ischial spines

• EXTENSION
– Occiput is delivered; head extends; and the
head, face and chin are delivered

• EXTERNAL ROTATION (Restitution)

– Head rotates from anteroposterior position
back to diagonal or transverse position
• EXPULSION
– Delivery of the remainder of the fetal body
 3rd Stage

• Time between the delivery of the neonate and

delivery of the placenta

• Duration: 5 to 30 minutes
 Types of Placenta
Separation begins
in the center and
fold unto
themselves

Appears shiny
and glistening
from the fetal
membranes

Schultze
 Types of Placenta
Placenta separates
at its edges,
delivered with
maternal surface
exposed

Appears red, raw

and irregular from
the ridges that
separate the blood
collection spaces
Duncan
Signs of Placental Separation

Lengthening of the umbilical cord

Sudden gush of vaginal blood

Change in the shape of the uterus

(Calkin’s Sign)
During placental delivery:

Crede’s Maneuver
- gentle pressure by one hand on the
fundus of the contracting uterus
Brandt Andrews Maneuver
- controlled cord traction with the other
one hand

normal blood loss: 300 – 500 mL

 4th Stage (Recovery Period)
• 1st hour after delivery
• primary activity is stabilizing the status of the
neonate and mother
• Focus is on promoting
maternal-neonatal bonding