2. Stage 1 is divided into :
Early Phase
Active Phase
Transitional Phase
Stage 1 begins from the beginning of true labor to
the complete dilation of the cervix

3. Early Phase averages 8.6 hours and should not
exceed 20 hours in a nullipara
5.3 hours and should not exceed 14 hours
multipara
No fetal descent present
Discomforts are mild contractions that increase in
duration, frequency and intensity.
Woman is able to cope, excited and a little
anxious.

4. Cervix is dilated to 4 to 7 cm
Fetal descent is progressive.
nullipara 1.2 cm per hour
multipara 1.5 cm per hour
Anxiety ↑
Contractions↑
Pain↑
Ability to cope varies

5. Cervical dilation slows as it reaches 8 to 10 cm
Fetal descent increases
Duration is 3 hrs nullipara and 1 hr multipara
Time increased by 1 hr if epidural is used.
Strong contractions occur lasting 1.5 to 2min from
60 to 90 seconds

6. Approaching 10 cm rectal pressure increases
Woman has an uncontrollable urge to push
Bloody show occurs
Fear and anxiety increase. Woman may begin
yelling, crying, shaking and asking for medication

8. Stage 2 begins with cervix completely dilated to
10 cm and ends with the birth of the infant.
Duration:
2 hrs for primigrava and 15 min for multigrava
Time may be extended 1 hr if anesthesia is used
Fetal descent continues until it reaches the
perineal floor

9. Strong contractions continue and crowning occurs
with acute/severe pain and fear of being “torn
apart.”

10. In order for the fetus to pass through the birth canal
the fetal head and body must adjust to positional
changes.
These changes are:
descent
flexion
internal rotation
extension
restitution
external rotation
expulsion

11. Stage 3 occurs from the birth of the baby to the
delivery of the placenta.
Signs of separation are:
a globular shaped uterus
a rise in the fundus in the abdomen
a gush or trickle of blood
Further protrusion of the umbilical cord out
of the vagina

13. The fourth stage of labor is 1 to 4 hrs after birth in
which the physiologic readjustment of the
mothers body begins.
Blood is redistributed B/P drops
Mild tachycardia occurs
Uterus is midway between symphysis pubis and the
umbilicus
Cervix is widely spread and thick
Hypotonic bladder due to trauma which causes urinary
retention may be treated with anesthetics.

14. Woman is tired, hungry and may experience a
shaking chill.