Stages of Labor

1. mental preparations mom makes thru meaningful actions (housecleaning, decorating baby room)
2. baby drops into the pelvis (leg cramps, pelvic pressure, increased venous stasis, secretions)
3. normal experience in the 3rd Trimester
4. glands in the cervix will secrete out during dialation (this is normal in full term pregnancies)

1. stretching of the opening of the cervix (10cm is a fully opened cervix)

2. thinning or shortening of the cervix

Frequency - time btw beginning of one contraction & the beginning of the next contraction.
Duration - beginning of a contraction to the end of it
Intensity - strength of the contraction
- contractions are involuntary (woman can't control them), sometimes coordinated and intermittent
- contractions start at the Fundus to squeeze baby down towards the pelvis
- contractions are a normal stressor b/c they decrease blood flow to fetus. if mother has other problems(smoker, drugs) that decreased blood flow could damage the fetus

- felt more in the back
- progresses in intensity, frequency, & duration
- pain increases when walking
- progressive cervical effacement & dilation(true identifier!!!!)

- felt more in abdomen
- irregular in intensity, frequency & duration
- pain decreases when walking
- little or no cervical change(true identifier!!!!)
- drink lots of water, warm shower will help

1. onset of regular contractions to 10 cm dilation
2. 10 cm dilation to birth
3. birth to delivery of placenta
4. delivery of placenta to one hour postpartum

- relaxes smooth muscle tissue

- stimulates uterine muscle contractions

- loosens to permit the softening, thinning & opening of the cervix

- mild contractions
- woman may think, am I really in labor?
- 0-3cm
- mixed emotions (excited, scared, ambivalent)
- maintain hydration, food (carbs)
- distracting activities (walking)
- conserve energy (rest)
- time the contractions (1st baby, every 5min per hr)
- call provider if: leaking of fluid (ruptured membrane) vaginal bleeding, decreased fetal mvmt
- slow-paced breathing, (In nose, Out mouth)

- 4-7cm
- Friedmans Curve: Primips at least 1.2cm/hr & Multips at least 1.5cm/hr (faster)
- focus is internal, objective, rationale
- good support system (family, Doula, CNM, RN)

- ASSESS FHR!!!!!!
- take vital signs but not during contraction
- assess labor status
- obtain history, review prenatal record & labs
- physical exam & labs (CBC, HCT, HMG, URINE)
- birth plans? cultural beliefs?
- notify MD/CNM
- provide privacy
- consent forms, open-ended questions
- IV access (18 gauge needle in case need blood)
- promote moderate-paced breathing (if breathe too fast can hyperventilate)
- effleurage/massage on belly

- assess VS q 1hr & FHR & contractions q 30 mins
- assess pain score freq
- offer Analgesia/Anesthesia as needed
Analgesia - IV pain meds (Nubain, Stadol)
Anesthesia - Regional (Epidural)
IV meds - not too close to delivery, will decrease variability FHR, Instruct to stay in bed, call bell, quiet
- treat with antibiotics if GBS is positive!!!
- if vaginal bleeding, do not perform vaginal examination (notify MD or CNM ASAP)
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- encourage position changes to promote comfort, rotation of fetal head, and fetal descent
- encourage voiding every hour
- offer mouth care/ clear liquids or ice chips
- support their family as well

- keep area clean and dry
- ROM w/o contractions are started on Oxytocin infusi
- Assess FHR immediately after ROM
- note time ruptured, color, odor & consistency
- Assess temp q 2 hr if ROM
SROM - occurs at height of intense contraction w/ a gush of fluid from vagina
AROM - membrane is ruptured by MD or CNM w/ amniohook (called amniotomy)
Nitrazine test - done by RN, MD, CNM (test pH of fluid, YELLOW/NEGATIVE, BLUE/POSITIVE)
Fern test - fluid smeared on slide (conclusive ROM test)