All right, ready for a few
more review questions?
Here we go.
Which stage of labor is
the most variable in length?
You got it. First stage.
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.
That's going to be more variable in
length than second stage, third or fourth.
All right, so let's review all
the things we've talked about.
Going back to the beginning.
First thing we want to remember is that
cervical change is how we diagnose labor.
If the cervix doesn't
change, it's not really labor.
We have several ways that we can
confirm rupture of the membranes.
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.
When we talk about true labor, we
think about how it's characterized.
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.
There are two phases within
stage 1 and 2 - latent and active.
The latent phase in stage 1 is characterized
by the onset of regular contractions
and cervical dilation - definition of labor.
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.
Stage 1 ends in complete
dilation of the cervix.
So we're ready to begin to have
descent and push that baby out.
Second stage begins with complete
dilation and it ends with delivery of the fetus.
Things that may affect the length of
second stage include maternal exhaustion,
medication, position of the
fetus, the size of the fetus.
And we always recommend
open glottis pushing, so no valsalva.
No holding the breath if possible.
Alright, stage 3 ends with
delivery of the placenta.
So how do we know that
the placenta is separating?
Let's see if you can remember.
A gush of blood, lengthening of the cord and
the uterus becoming firm and more globular.
So remember, the provider
can actually feel that externally.
Fourth stage is the golden hour or golden hours
because it includes the first two hours after delivery.
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.
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.
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.