diff. stages of labor

8/7/2019 DIFF. STAGES OF LABOR

1/19

Different stages of labor

Presented by:

Wyeth Ryan Ona


2/19

Difference between False and True Labor

FALSE LABOR TRUE LABOR

Frequency of

contractions

Irregular Regular

Intensity of

contractions

No increase Increases

Pain relief Pain is relieved by

walking

Pain is intensified by

walking

Pain location Confirmed on

abdomen

Begins on lower back

and radiates to

abdomen

Cervical changes No cervical changes Effacement and

dilation


3/19

First stage of LaborOnset of contractions to full dilatation

and effacement of the cervix

Divided into three Phases:

< LATENT

< ACTIVE

< TRANSITIONAL


4/19

First stage of Labor

LATENT ACTIVE TRANSITIONAL

DILATATION 0 - 3 cm 4 - 8 cm 8 - 10 cm

FREQUENCY q 5 - 10 mins. q 3 - 5 mins q 2 - 3 mins

DURATION 20 - 40 secs 30 - 60 secs. 45 - 90 secs

INTENSITY Mild Moderate Strong

MOTHERS

BEHAVIOR

Apprehensive,

excited but can

communicate

Fears of losing

control of herself

Sudden behavioral or

mood changes

usually accompanied

by hyperesthesia of

the skin

(hypersensitivity of

mother to touch


5/19

First stage of Labor

Effacement - softening and thinning of

cervical canal denoted by percentage.

Dilatation - widening of the external

cervical os to 10 cm. as a result of

pressure of the presenting part and bagof water(BOW) denoted by centimeters.


6/19

First stage of LaborStation - relationship of presenting part tothe ischial spine denoted in centimeters

< - 1 means 1 cm above the ischial spine

< 0 means fetus is engaged

< +3 to +5 means 3 to 5 cm below ischial spine,Crowningoccurs and signals the 2nd stage oflabor


7/19

First stage of LaborPresentation - relationship of the long axis to

the fetus to the long axis of the mother

Position - relationship of the fetal presenting

part to specific quadrant of the mothers pelvis

- LOA (Left occiput Anterior) is most common and

favorable birthing position


8/19

Second stage of LaborComplete dilatation and effacement of birth of the baby, akaFETAL STAGE

Mother is transferred to DR

Maternal Position

- Lithotomy and dorsal recumbent are positions mostcomfortable

- Bulgingof perineum is the surest sign that baby is aboutto be delivered

- Advice mother to do panting, breathing exercise much likeblowing a feather


9/19

Second stage of Labor

Engagement - head enters the pelvic inlet in thetransverse biparietal diameter

Mechanisms of Labor (D-F-IR-E-ER-E) Descentis the prerequisite of NSD

Flexion occurs when head meets resistance of the birth canal

Internal Rotation occurs when occiput gradually movesanteriorly towards the symphysis pubis

Extension is the delivery of the fetal head External Rotation when head undergoes rotation back to itsoriginal position in direction opposite that of internal rotation

Expulsion is the delivery of the rest of the body


10/19


Episiotomies

Median is from the middle portion of the lower vaginal borderdirected towards the anus

Mediolateral begins in the midline but directed laterally away

from the anus

Process of Delivery

Modified Ritgens Manuever is done by covering the anuswith sterile towel and exert upward and forward pressure on

the fetal chin while exerting gentle pressure with two fingerson the head to contral the emerging head.

Ease the babys head out and immediately wipe the noseand mouth of secretions to establish airway


11/19


Process of Delivery

After the delivery of the body of the newborn, held thebody below the level of the mothers vulva for a fewminute to encourage flow of blood from the placenta to

the baby Suction of the nose is done

The umbilical cord is doubly clamped and cut, leaving 2-3cm (1 inch) of cord

Take note of the exact time of delivery of the baby,

proper identification ,and foot printing Allow the mother to see the baby

Wrap the baby in sterile cloth diaper to keep him warm


12/19

Third stage of Labor

Birth of the baby up to expulsion of placenta akaPLACENTAL STAGE

Care of the baby- Clear airway of mucus

- APGAR scoring

- Keep baby warm

- Assess for visible abnormalities- Administer antibiotic ophthalmic medication toprevent ophthalmic neonatorum


13/19

Third stage of Labor

Assist with the delivery of placenta

- Placenta is delivered about 3-10 minutes after the delivery ofthe baby

Signs of Placental separation

Calkins sign or fundus becomes globular and firm again

Lengthening of the cord

Sudden gush of blood from the vagina

Types of placental delivery

- Shultz - shiny part of placenta

- Duncan - dirty part of placenta


14/19

Third stage of LaborDo not hurry the expulsion of placenta by forcefully pulling out thecord because it can cause Uterine Inversion. Just watch the signsof placental separation

If the uterus becomes boggy or non-contracted, massage it gentlyand properly, then put ice over the abdomen to help contract theuterus since cold compress causes vasodilation

Check vital signs especially BP

Administer medication as ordered like Methergin and Oxytocin

Inspect for lacerations

Assist in Episiorrhapy or repair of episiotomy


15/19

Fourth stage of LaborThe first 1-2 hours after the placental delivery akaRECOVERY STAGE

Monitor VS

Two hours after delivery, the fundus is at the same heightof umbilicus

Check for bladder retention, a full bladder can lead touterine atony leading hemorrhage

Monitor mother as body gradually regains homeostasis


16/19

Fourth stage of LaborCheck the Lochia

Types:

Rubra

Serosa Alba

Make mother comfortable

Promote maternal-infant bonding


17/19

Nursing Diagnosis and Nursing Care

Nursing diagnosis:

Anxiety related to incoming labor and delivery asevidenced by restlessness

Nursing Care:

Inform patient the progress of labor

Support the patient and family emotionally andpsychologically


18/19

Nursing Diagnosis and Nursing Care

Nursing diagnosis:

Acute pain related to obstretical pain as evidenced byfrequency and intensity of uterine contractions

Nursing Care:

Encourage walking to shorten first stage of labor

Encourage to void every 2-3 hours

Teach pant breathing

Give medications as ordered


19/19

THE END

diff. stages of labor

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