FAMILY HEALTH NURSING
LABOR & DELIVERY STUDY GUIDE
Identify the four stages of labor and nursing interventions appropriate for each stage.
1st Stage (3.5)
The first stage is from the onset of regular uterine contractions to full effacement and dilation of the cervix. It is much longer than the second and third stages combined. Parity is a strong factor in the length of the first stage. Full dilation may occur in less than 1 hour in a woman who has had a lot of pregnancies. In first time mothers, it can take 20 hours or more. Variations can also occur in different client populations. There are three different phases of the first stage of labor. They include the latent phase, active phase, and a transition phase. The latent phase includes progress in effacement of the cervix and a little increase in descent. The active phase and transition phase includes rapid dilation of the cervix and increased rate of descent of the presenting part. When a woman is obese prior to pregnancy, the active phase of labor can be longer. Nursing interventions would be to assist the woman with breathing exercises, reassure her, emphasize positive aspects of the situation, provide continuous emotional support, and respect contraction time. Some other interventions include respecting her activities, her pain management efforts, respect her contraction time, and promote change of position, and voiding and bladder care.
2nd Stage (3)
The second stage of labor lasts from the time the cervix is fully effaced and dilated to the birth of the fetus. It usually takes anywhere from 20 minutes to 50 minutes. Labor of up to 2 hours can be considered normal, and ethnicity plays a role in that. It is composed of two phases: the latent phase and the active pushing (descent) phase. During the latent phase, the fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of uterine contractions. Some women do not experience the urge to bear down during this phase. The next phase is the active pushing phase and they do have the urge to bear down. Nursing interventions for the second stage would be to assess and record the temperature, pulse, respirations, FHR, and contractions, provide support, prepare the place of birth, turn on the radiant heat warmer, begin the sterile field, position the woman into the stirrups, place legs in lithotomy position, and promote effective second stage pushing. Also, the nurse may do perineal cleansing, aspirate the newborns nose and mouth, cut the cord, place the infant in the warmer, and apply prophylactic eye ointment. She may also cover the infants head and allow the mother the breastfeed if she wishes.
3rd Stage (3)
The third stage of labor lasts from the birth of the fetus until the placenta is delivered. It normally separates with the third or fourth strong uterine contraction after the birth of the baby. After separation, it can be delivered with the next contraction. It’s usually expelled within 15 minutes. This stage usually lasts 30 minutes, but the longer the stage, the greater the risk of hemorrhage. Nursing interventions are to inspect the placenta, obtain a baseline blood pressure, document the administration of oxytocics, perform perineal stitching, and obtain vitals every 15 minutes.
4th stage (3)
The fourth stage lasts 1-2 hours after delivery of the placenta. It is the recovery period and homeostasis is reestablished. It’s an important period to observe for complications such as abnormal bleeding. Nursing interventions would be to continue the vitals, perform more perineal care, offer a clean gown and warm blanket, and palpate the fundus for size, consistency, and position.
2. List the cardinal movements (mechanisms) of normal labor and delivery and define each of the cardinal movements (12.5)
The cardinal movements of normal labor and delivery include: engagement, descent, and flexion, internal rotation to...