Stages and Five P's of Labor




The Stages of Labor are:

1. First Stage - onset of regular contraction to full dilation
  • Phase One (LATENT) - dilatation is 0 - 3 cm; duration is 10 - 30 sec; interval is 5 - 30 mins; intensity is mild to moderate
  • Phase Two (ACTIVE) - dilatation is 4 - 7 cm; duration is 30 - 40 sec; interval is 3 -5 mins; intensity is moderate to strong
  • Phase Three (TRANSITION) - dilatation is 8 - 10 cm; duration is 45 - 90 sec; interval is 2 - 3 mins; intensity is strong

    Nursing Care for First Stage of Labor
    1. monitor V/S and FHR every 15 mins
    2. bed rest for ruptured membrane
    3. empty the bladder
    4. pain relief
    5. teach breathing techniques
    6. maintain safety

    2. Second Stage of Labor - from full dilation to delivery of the fetus (30-60 mins for primigravida and 20 mins for multipara)
    • Phase One - station is 0 to +2; contraction is 2 to 3 mins apart
    • Phase Two  - station is +2 to +4; contraction is 2 to 2.5 mins apart with urgency to bear down
    • Phase Three  - station is +4 to birth; contraction is 1 to 2 mins apart;fetal head visible, increased urgency to bear down

      Nursing Care for Second Stage of Labor
      1. transfer to delivery room for 8-9 cm dilation for multigravidas and full dilation for primiparas
      2. monitor V/S and FHR
      3. prepare perineal area
      4. encourage pushing with contractions
      5. immediate newborn care

      3. Third Stage of Labor - from delivery of infant to delivery of placenta
      • 5 - 30 mins
      • sudden gush of blood
      • lengthening of the cord
      • rising of the fundus
      • globular uterus

      Nursing Care for Third Stage of Labor
      1. assess for placental separation
      2. inspection of placenta
      3. monitor V/S
      4. initiate breastfeeding
      5. administer oxytoxin and antilactation agents as ordered
      6. sending cord blood to laboratory if mother is O-positive or Rh-negative
      7. allow bonding

      4. Fourth Stage of Labor - time from delivery of placenta to homeostasis (first 4 hours after delivery of the placenta)

      Nursing Care for Fourth Stage of Labor
      1. monitor V/S every 15 mins
      2. take fundal height, position and consistency
      3. assess for lochia
      4. check perineum
      5. perform perineal care from front to back
      6. post partum care
      WATCH A VIDEO OF ACTUAL DELIVERY COURTESY OF YOUTUBE



        Labor is a coordinated sequence of involuntary uterine contractions resulting to effacement and dilatation of cervix followed by expulsion of products of conception.

        The five P's include:

        A. Passenger: the fetus
        • Attitude - relationship of fetal body parts to each other, normal uterine posture is completely flexed
        • Lie - relationship of fetal spine to maternal spine. Longitudinal or vertical is when fetus is parallel to mother's spine, transverse or horizontal if fetus is at right angle to mother's spine.
        • Presentation - portion of fetus that enters pelvis first: presenting part could be cephalic or breech (frank, footling)
        • Position - relationship of fetal reference point to one or four quadrants or sides of mother's pelvis. Maternal pelvis side: L-left, R-right; Fetal Reference points: O-occiput, M-mentum, B-brow, S-sacrum; Maternal Pelvis Quadrant: A-anterior, T-transverse, P-posterior
        • Station - degree of engagement from presenting part to ischial spine; Station 0 means at ischial spine, minus station means above spine, and plus station is below the spine.
        B. Passageways
        • Pelvis
        • Soft tissues - lower uterine segment, cervix, vagina, and introitus
        C. Powers
        - forces acting to expel fetus; primarily by involuntary uterine contractions, secondarily by voluntary bearing down.
        - functions of uterine contraction are effacement and dilation

        D. Person

        E. Psychological Response
        - response to contraction, perceptions and beliefs, pre-natal care and education, support systems and communication skills.


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