Stage One Labor Overview

Stage One Labor

• Latent phase: Cervical dilation from 0-5 cm
• Active phase: Cervical dilation from 5-10 cm (ending in birth)
• Admission to labor unit: Includes prenatal data, complications, abuse, and cultural/language differences.
• Assessment: Leopold's maneuver (assessing baby position), fetal heart rate & pattern, contractions, and cervical checks.
• ROM assessment: Color, odor, consistency, and amount. Includes lab tests.
• CBC: Checks white blood cells (infection), hematocrit, hemoglobin, and platelet count (clotting factors, HELLP syndrome).
• HIV and titers: Checking for HIV, rubella immunity, and syphilis (harmful to baby).
• Type and screen: Blood type and screen (for potential complications)
• GBS (group B strep): Antibiotic treatment if positive.
• Nutrition: Oral and IV fluid intake
• Elimination: Monitoring urination (at least every 2 hours). Intermittent catheter or Foley catheter as needed.
• Positioning: Frequent repositioning of the mother.

Stage Two Labor

• Latent phase: Labor in preparation
• Active phase: Active pushing or bearing down.
• Ferguson reflex: Ejection reflex, cannot control pushing.
• Positioning: Commonly lithotomy position preferred.
• Bearing down: Valsalva maneuver (sneezing, coughing, pushing).
• Monitoring: Continuous fetal heart rate monitoring.

Stage Three Labor

• Quickest stage: Shortest stage, from birth to expulsion of the placenta.
• Intervention may be needed at 30 minutes after birth to assist with placenta expulsion
• Inspection of placenta: Assure all parts have expelled and prevent retained pieces.

Stage Four Labor

• Recovery: A period of 1-2 hours, post-birth.
• Assessments: For blood loss, vital signs, and bonding between parent and baby
• Post-partum care: Facilitate breastfeeding/bonding.
• Post-anesthesia care:
• Monitoring during recovery: Activity, respiration rate, blood pressure, and color

Fetal Assessment During Labor

• Fetal heart rate (FHR) patterns: Baseline, accelerations, decelerations, and variability.
• Category 1: Desirable patterns
• Category 2: Uncertain, further observation required
• Category 3: Concerns requiring intervention
• Recurrent late decelerations: Signals placental insufficiency.
• Bradycardia: Slow heart rate
• Sinusoidal pattern: Irregular FHR pattern needing immediate intervention.

Other Interventions and Considerations

• Equipment Setup: Equipment in case of certain emergencies.
• Birth: Crowning, nuchal cord, episiotomy.
• Post-birth care: Skin-to-skin contact, lotus birth.
• Stage 3 interventions: Stimulating baby, vibroacoustic stimulation, amnioinfusion, tocolytic therapy.
• Complications: Preterm labor and birth (20-36+6 weeks of gestation), low birth weight (<2500g), preterm births.
• Cervical length: >30mm in 2nd & 3rd trimesters correlates with less likelyhood of preterm birth.
• Fetal fibronectin test: Predicts likelihood of labor within 2 weeks.
• Bed rest: Not supported unless in extreme cases
• Tocolytics: Medications to relax the uterus muscles
• Antenatal glucocorticoids: For lung maturity in premature births
• Premature ROM (PROM): Rupture of membranes before labor.
• Preterm premature rupture of membranes (PPROM): Rupture of membranes before labor.
• Chorioamnionitis: Infection of the fetal membranes and amniotic sac.
• Post-term pregnancies: Are pregnancies beyond 42 weeks. High risk of stillbirth.
• Dystocia: Difficult labor, including obstructions (like bony pelvis).
• Pelvic dystocia: Pelvis size is a problem.
• Positional dystocia: Maternal positional issues causing difficulty.
• Psychologic dystocia: Mother being stressed.
• Obesity: High BMI increasing risk of complications.
• Fetal monitoring: Continuous and intermittent monitoring for fetal wellness.
• Positioning: Maintaining proper positions to aid in labor progress

Procedures and Assessments

• Bishop score: Evaluating cervical readiness for labor induction.
• Cervical ripening methods.
• Amniotomy.
• Oxytocin.
• Augmentation.
• Operative vaginal birth.
• Forceps delivery.
• Vacuum extraction.
• Assessments of the baby (e.g., for brain bleeding/head injuries).
• Section.
• VBAC (Vaginal birth after cesarean): 60-80% success, but with complications.
• TOLAC (Trial of labor after cesarean): Labor attempt after cesarean.
• Scheduled/Elective cesarean sections.
• Unplanned cesarean section.
• Forced-choice cesarean section (labor continued).
• Incission type (vertical vs. horizontal)
• Skin vs uterine incisions: Different approaches for incisions during Cesarean delivery.

Emergencies and Complications

• Ob emergency issues: Meconium stained fluid, stress, premature birth, and labor complications like uterine rupture.
• Shoulder dystocia.
• Fetus problems (Asphyxia, brachial plexus damage, Fractures)
• Prolapsed cord.
• Amniotic fluid embolism (AFE).
• Risk factors for all of these emergencies
• Resolution of issues (Weight loss, dehydration, etc)