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Stages of Labor

First Stage: Onset of labor to full cervical dilation (10 cm)

• Latent phase: 0-3 cm dilation; mild contractions every 5-10 min lasting 30-45 sec
• Active phase: 4-7 cm dilation; moderate contractions every 3-5 min lasting 45-60 sec
• Transition phase: 8-10 cm dilation; strong contractions every 2-3 min lasting 60-90 sec

Second Stage: Full dilation to birth of neonate

• Duration: up to 2 hours for nullipara; up to 1 hour for multipara
• Patient experiences urge to bear down
• Crowning occurs (presenting part remains visible between contractions)

Third Stage: Birth of neonate to expulsion of placenta

• Duration: 5-30 minutes
• Signs of placental separation: gush of blood, lengthening of cord, uterus becomes firm and globular

Fourth Stage: First 1-4 hours after delivery (stabilization period)

• Monitor vital signs, fundal height, lochia
• Encourage early bonding and breastfeeding

True vs False Labor

True Labor	False Labor
Regular, rhythmic contractions	Irregular contractions
Contractions increase in frequency, duration, intensity	Contractions remain unchanged
Progressive cervical dilation and effacement	No cervical change
Contractions continue despite position change	Contractions may stop with position change
Discomfort in abdomen and back	Discomfort usually only in abdomen
Bloody show present	No bloody show

Fetal Monitoring

• Early decelerations: Mirror contractions; caused by head compression; benign
• Variable decelerations: Abrupt, V-shaped; caused by cord compression
• Late decelerations: Occur after contraction peak; caused by uteroplacental insufficiency; ominous
• Accelerations: Increase in FHR; reassuring sign of fetal well-being

Nursing Interventions

• Monitor FHR, contraction pattern, maternal vital signs
• Provide comfort measures: position changes, back rubs, breathing techniques
• Encourage voiding every 2 hours
• Assess cervical dilation and effacement as indicated
• For late decelerations: turn mother to left side, increase IV fluids, administer oxygen, notify physician
• For variable decelerations: change maternal position, perform vaginal exam to rule out cord prolapse