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

        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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