Stages of Labor: In a Nutshell (Nursing)

00:01 All right, ready for a few more review questions? Here we go.

00:05 Which stage of labor is the most variable in length? You got it. First stage.

00:17 Think about all the things that are going on in terms of the cervix dilating and the client moving around and trying to get that cervix to stretch and open.

00:27 That's going to be more variable in length than second stage, third or fourth.

00:33 All right, so let's review all the things we've talked about.

00:38 Going back to the beginning.

00:40 First thing we want to remember is that cervical change is how we diagnose labor.

00:45 If the cervix doesn't change, it's not really labor.

00:49 We have several ways that we can confirm rupture of the membranes.

00:53 We can use a nitrazine test, we can use a fern, AmniSure is a lab test that we can do, or we might be able to see, and we say gross rupture, we don't mean gross as in 'yuck', We mean gross as in a lot.

01:06 When we talk about true labor, we think about how it's characterized.

01:10 Remember, the contractions are going to be regular, they're going to get stronger over time, they usually are going to move from the back to the front.

01:18 There are two phases within stage 1 and 2 - latent and active.

01:25 The latent phase in stage 1 is characterized by the onset of regular contractions and cervical dilation - definition of labor.

01:34 The active phase of stage 1, there's more rapid dilation so we go 6,7,8,9,10 a lot faster than 0 to 5.

01:43 Stage 1 ends in complete dilation of the cervix.

01:48 So we're ready to begin to have descent and push that baby out.

01:52 Second stage begins with complete dilation and it ends with delivery of the fetus.

01:58 Things that may affect the length of second stage include maternal exhaustion, medication, position of the fetus, the size of the fetus.

02:08 And we always recommend open glottis pushing, so no valsalva.

02:12 No holding the breath if possible.

02:14 Alright, stage 3 ends with delivery of the placenta.

02:18 So how do we know that the placenta is separating? Let's see if you can remember.

02:23 A gush of blood, lengthening of the cord and the uterus becoming firm and more globular.

02:29 So remember, the provider can actually feel that externally.

02:33 Fourth stage is the golden hour or golden hours because it includes the first two hours after delivery.

02:39 And this is a time where we can encourage skin to skin contact, and then make sure that the client and the baby are transitioning well.

02:48 Alright, nurses, it's very important that we are monitoring fetal vital signs that we're encouraging frequent position changes, we're monitoring the status of the of the patient in terms of their bladder and hydration and comfort and understanding through each stage of the labor.

03:06 The nurse can make a huge impact on the experience and the outcome if we are paying attention and we're aware of all the stages and phases of labor.