Nursing: Stages of Labor

• Nursing focuses on the holistic care of individuals, families, and communities to maintain, recover, or cope with health issues
• It involves assessment, diagnosis, planning, implementation, and evaluation of care
• Nursing is both a science and an art, requiring critical thinking, clinical judgment, and compassion
• Nurses work in a variety of settings, including hospitals, clinics, schools, and homes

Stages of Labor

• Labor is divided into four stages: Stage 1 (dilation), Stage 2 (expulsion), Stage 3 (placental), and Stage 4 (recovery)

Stage 1: Dilation

• Begins with the onset of regular contractions and ends when the cervix is fully dilated (10 cm)
• Has three phases: latent, active, and transition

Latent Phase

• Cervical effacement and dilation occur slowly
• Contractions are mild to moderate, irregular, and short (30-45 seconds)
• Woman is usually talkative, anxious, and welcoming of labor
• Nursing interventions include: encouraging ambulation, hydration, and providing education on labor process

Active Phase

• Cervical dilation progresses more quickly (4-7 cm)
• Contractions become more frequent, longer (45-60 seconds), and more intense
• Woman becomes more focused and may request pain relief
• Nursing interventions include: monitoring maternal and fetal well-being, providing comfort measures such as massage and position changes, administering pain medication as prescribed

Transition Phase

• Cervical dilation slows as it reaches full dilation (8-10 cm)
• Contractions are very strong, long (60-90 seconds), and close together
• Woman may experience nausea, vomiting, shaking, and increased rectal pressure
• She may feel irritable, out of control, and doubtful of her ability to cope
• Nursing interventions include: providing encouragement and support, assisting with breathing techniques, preparing for delivery

Stage 2: Expulsion

• Begins with full cervical dilation and ends with the birth of the baby
• Woman experiences an urge to push
• Contractions remain strong and frequent
• Nursing interventions include: assisting with pushing efforts, monitoring fetal heart rate, providing encouragement, preparing for delivery

Stage 3: Placental

• Begins immediately after the birth of the baby and ends with the expulsion of the placenta
• Usually occurs within 5-30 minutes after the birth of the baby
• Signs of placental separation include: lengthening of the umbilical cord, a sudden gush of blood, and a change in the shape of the uterus
• Nursing interventions include: monitoring for signs of placental separation, administering oxytocin as prescribed to contract the uterus, assisting with placental delivery, assessing the placenta for completeness

Stage 4: Recovery

• Begins after the expulsion of the placenta and lasts for 1-4 hours
• Physiological stabilization occurs
• Nursing interventions include: monitoring vital signs, assessing uterine tone and vaginal bleeding, promoting bonding and breastfeeding, providing comfort measures

The 7 Cardinal Movements of Labor

• The fetus undergoes several positional changes as it travels through the birth canal
• Engagement refers to when the fetal presenting part enters the true pelvis
• Descent is the downward movement of the fetus through the birth canal
• Flexion is when the fetal head flexes to present the smallest diameter to the pelvis
• Internal rotation is the rotation of the fetal head to align with the diameters of the pelvis
• Extension occurs as the fetal head passes under the pubic arch
• External rotation is the rotation of the fetal head to realign with the shoulders
• Expulsion is the delivery of the rest of the body

Factors Affecting Labor

• The 5 P's: Passenger (fetus and placenta), Passageway (birth canal), Powers (contractions), Position (maternal), and Psychological response
• Fetal factors: size, presentation, lie, and attitude of the fetus
• Passageway factors: size and shape of the pelvis, ability of the cervix to dilate and efface, and the ability of the vagina to distend
• Power factors: frequency, duration, and intensity of uterine contractions
• Maternal position during labor can affect the progress of labor
• Psychological factors: anxiety, fear, and fatigue can affect the progress of labor

Nursing Assessments During Labor

• Maternal vital signs, including temperature, pulse, blood pressure, and respirations
• Uterine contractions: frequency, duration, and intensity
• Fetal heart rate: baseline, variability, and presence of accelerations or decelerations
• Cervical dilation and effacement
• Fetal position and presentation
• Maternal pain level and coping mechanisms
• Status of membranes (ruptured or intact) and amniotic fluid characteristics (color, odor, amount)
• Maternal emotional status and support system

Nursing Interventions During Labor

• Monitoring maternal and fetal well-being
• Providing comfort measures: positioning, massage, hydrotherapy, and pain medication
• Encouraging ambulation and position changes
• Providing education and support
• Assisting with breathing techniques
• Preparing for delivery
• Supporting the woman's decisions regarding pain management and birth plan