The document outlines the 4 stages of labor: 1) First stage from 0-10cm dilation with early, active, and transition phases. Nursing care includes assessments, comfort measures, and pain management. 2) Second stage from 10cm dilation until birth. Nursing focuses on support during pushing and preparing for delivery. 3) Third stage is from birth until delivery of placenta. Care includes newborn assessments and supporting breastfeeding. 4) Fourth stage is the recovery period for 4 hours postpartum with assessments and comfort measures.

1. 4 Stages of Labor First Stage 0-10cm Second Stage 10cm to birth Third Stage Birth of baby to birth of the placenta Fourth Stage Birth of placenta to 4 hours postpartum

2. First Stage Latent Phase 0-3 cm longest visceral pain contractions q 5-10 min, 30-45 sec, mild talkative

3. Nursing Care Establish relationship Review record Review birth plan Labor assessment Lab studies Explain and provide guidance V/S, pain, FHR, uterine activity, breathing

4. First Stage Active phase 4-7 cm fetal descent contractions q 2-5 min, 40-60 sec anxiety increases

5. Nursing Care Supportive Maternal V/S hourly FHR q 15-30 min Hydration – IV? Membranes Comfort measures Pain control Labor assessment

6. First stage Transition Phase 8-10 cm significant anxiety contractions q 1 ½ - 2 min, 60-90 sec strong hot flashes, chills, N&V amnesic

7. Nursing Care Support Comfort measures Labor assessment Maternal V/S and FHR q 15 min

8. Second Stage 10 cm to birth of the baby contractions q 1 ½ - 2 min, 60-90 sec bulging perineum crowning ring of fire

9. Mechanisms of Labor Descent and flexion Internal rotation Extension External rotation Expulsion

11. Nursing Care Nursing presence, support, reassurance Monitor V/S q 5-15 min and FHR Assist with pushing Position changes Prepare for birth

12. Episiotomy

13. Third Stage of Labor Birth of baby to birth of placenta strong contractions placental separation repair of perineum

14. Nursing Care Focused on newborn and birth of placenta Pitocin Warmth Explain assessments Ascertain needs V/S q 15 min, fundal assessment Assist with breastfeeding

16. Newborn Respirations Suction Warmth APGAR SCORE

17. APGAR SCORE

18. Fourth Stage of labor From birth of the placenta to the first 4 hours postpartum Recovery phase

19. Nursing Care Assess for hemorrhage, fundus Comfort Bonding V/S q 15 min x 1 hr q 30 min x 1 hr q hour x 2 hours Perineum Lochia Bonding

20. Pain During Labor Non pharmacological measures

21. Pain During Labor Pharmacologic Measures Opioids – stadol, demerol Opioid antagonist - narcan Barbituates – seconal Ataractics – phenegran

22. Regional Anesthesia Provides pain relief without loss of consciousness Epidural Spinal (Intrathecal) Combined Nursing care assist monitor

23. Pudendal Block

24. Early Decelerations Fetal head compression inversely mirrors uterine contractions begins with and ends with contraction BENIGN

25. Late Decelerations Uteroplacental insuffiency inversely mirror contractions but begin late in onset and recovery Requires prompt attention

26. Variable Decelerations Umbilical cord compression vary in onset, occurrence, duration and have NO relation to contractions Requires prompt attention