Stages of Labor- Maternal (OB) Nursing

by | Jun 21, 2020 | Maternal Nursing

Stages of labor

Stages of Labor- Maternal (OB) Nursing

The process of giving birth is a truly beautiful experience to witness. Every mother has an individual experience and it is the nurse’s job to guide the mother and be her advocate during the birthing process (all while ensuring both mom and baby are safe).

Even though each mother will have their own unique experience, there is a general flow to childbearing and the nurse should be knowledgeable of the ins and outs of the childbearing process.

This content will review the stages of labor as well as other important information about the birthing process.

Once you read over the information in this post, be sure to download the PDF cheat sheet that highlights all the important information.

Also be sure to check out this other Maternal (OB) Nursing information:

True Labor vs False Labor

What is true labor?

  • Regular contractions
  • Contractions become stronger, last longer, and occur closer together
  • Fetus “engages” and begins to descend

What is false labor?

  • Contractions are irregular
  • Dilation, effacement, and descent do not occur
  • Activities, such as walking, relieve feelings of false labor

Maternal response to the birth process:

Labor contractions are intermittent, allowing placental blood flow and exchange of oxygen, nutrients, and waste products between maternal and fetal circulation during the intervals

The upper uterus contracts actively during labor as it pushes the fetus down

These actions bring about cervical effacement and dilation

Cardiovascular changes:

  • Blood flow decreases to the placenta during contractions causing an increase in maternal blood volume, increase in maternal BP, and a decreased pulse
  • Hypotension may occur if positioned supine- presses down on vena cava
  • Check BP between contractions

Respiratory changes:

  • Depth and rate increase
  • Avoid hyperventilation- help slow down breathing

Gastrointestinal changes:

  • GI motility decreases during labor
  • Avoid large amounts of glucose due to rebound hypoglycemia in the newborn
  • Fluids are restricted; ice chips can be offered

Urinary changes:

  • Decreased bladder sensation
  • Full bladder can lead to increased discomfort and can inhibit fetal descent
  • Foley may be inserted

Hematopoietic changes:

  • Blood volume increases during pregnancy 1-2 L; 500 mL is normal blood loss for a vaginal birth
  • WBC average during labor: 14,000 to 16,000/mm3 (as high as 25,000 can be normal)
  • Increased risk for venous thrombosis- increased clotting factors, fibrinolysis decreases- promotes coagulation to decrease hemorrhage

Fetal response to the birth process:

Placental circulation- during strong contractions maternal blood supply to placenta stops

Fetal protective mechanisms

  • Fetal hemoglobin
  • High hematocrit
  • High cardiac output

Cardiovascular system- reacts quickly to events during labor; normal fetal heart rate is 110-160 bpm

Pulmonary system- fetal lung fluid production decreases, and its absorption into lung tissue increases during late pregnancy and labor; thoracic compression during labor aids in expulsion of additional fluid

Mechanisms of labor:

  • Engagement of the presenting part at ischial spine
  • Descent
  • Flexion of the fetal head so the smallest diameter passes through
  • Internal rotation so largest diameter of head matches largest diameter of the pelvis
  • Extension of the fetal head at the symphysis pubis
  • External rotation
  • Expulsion of the fetal shoulders and body

What are the stages of labor?

There are four stages of labor. Stage one is dilation and effacement of the cervix. Stage two is the expulsion of the fetus. Stage three is the expulsion of the placenta. Stage four is the physical recovery of the mother.

Stage One: Dilation and effacement of cervix (L-A-T; latent, active, transition)

Latent:

  • Dilation 1-4 cm
  • Contractions:
    • Mild intensity
    • Occur every 15-30 minutes
    • 15-30 seconds duration
  • Mother is eager and talkative

Active:

  • Dilation 4-7 cm
  • Contractions:
    • Moderate intensity
    • Occur every 3-5 minutes
    • 30-60 seconds duration
  • Mother is becoming tired but still excited

Transition:

  • Dilation 8-10 cm
  • Contractions
    • Strong intensity
    • Occur every 2-3 minutes
    • 45-90 seconds duration
  • Mother is anxious

Stage 2: Expulsion of fetus

Cervical dilation is complete

Crowning occurs

Contractions:

  • Strong intensity
  • Occur every 2-3 minutes
  • 60-75 seconds duration

Mother feels urge to bear down

Fetus emerges

Stage 3: Expulsion of placenta

Placenta expulsion occurs 5-30 minutes after birth of fetus

Cord is cut and clamped

Examine placenta to ensure if it is intact and there are no retained parts in the uterus

Examine the cord- two arteries and one vein

Stage 4: Physical recovery

1-4 hours after delivery

Fundus should remain contracted, midline, 1-2 fingerbreadths below the umbilicus

Monitor lochia- may be a moderate amount and bright red in color

Massage uterus as needed

Perform maternal assessments:

  • Q 15 minutes x 1 hr
  • Q 30 minutes x 1 hr
  • Q 1 hr x 2 hrs

Contraction Cycle

What are the phases of the contraction cycle?

  • Increment
  • Peak
  • Decrement

Increment– contraction begins in fundus and spreads throughout the uterus

Peak– contraction is the most intense

Decrement– decreasing intensity as uterus relaxes

contraction cycle

The contraction cycle is described in terms of duration, frequency, and intensity.

Duration– length of each contraction; measured in seconds

Frequency– from beginning of one contraction to the beginning of another

Intensity– strength of contractions; described as mild, moderate, or strong

  • Mild- tip of the nose
  • Moderate- chin
  • Strong- forehead

Interval- allows placental blood flow and exchange of oxygen, nutrients, and waste products between maternal and fetal circulation

What are the nursing interventions during the labor process?

The nursing interventions the nurse should focus on will depend on which stage of the labor process the mother is in.

Nursing Interventions:

Provide encouragement for the mother and the partner, if one is present, throughout the labor process and postpartum period.

Assess for cultural preferences and act accordingly.

Provide comfort measures:

  • Dim lighting
  • Temperature per the mother’s preference
  • Comfortable positioning
  • Pharmacologic pain relief
  • Massage
  • Ambulation during early labor

Continually monitor the condition of the mother and the fetus during the labor process. Monitor fetal heart rate and monitor maternal vital signs.

Prepare the sterile table before delivery.

Provide perineal cleansing before delivery.

Observe for maternal hemorrhage after delivery. Monitor the fundus and lochia.

Administer medications such as oxytocin to contract the uterus and control blood loss.

Promote parent-infant attachment.

Provide breastfeeding education for women who choose to breastfeed their babies.

Provide education on how much and how often formula should be given to the infant for women who choose to formula feed.

I hope this was helpful to the nursing students out there learning about maternal (OB) nursing. It is a fascinating subject but it includes a lot of information!

As always, if you have any questions or just want to talk, feel free to contact me.

Happy Nursing!