This document provides terminology and describes the stages of labor and delivery. It summarizes that labor has three stages: first stage is cervical dilation from 0-10 cm; second stage is baby passing through birth canal; third stage is delivery of placenta. It also outlines assessing fetal and maternal status during each stage using measures like contractions, cervical exam, APGAR scoring.

2. Terminology
 Gravida - number of pregnancies
 Para - number of pregnancies carried to viability
and delivered
 Primigravida - pregnant for first time
 Multigravida - pregnant more than once
 Viability - able to survive outside the womb (24+
weeks gestation)
 Nulliparous - never carried a pregnancy to viability
 Multiparous - has had two or more deliveries that
were carried to viability

3. Duration of Pregnancy
 Average 280 days or 40 weeks (9 lunar months)
 Estimated Date of Confinement (EDC)
 Nagele’s rule
 Date of first day of LMP
 Subtract 3 months
 Add 7 days
 Accurate to plus or minus 2.5 weeks

4. First Stage of Labor
 Begins with onset of coordinated contractions
leading to dilation of cervical os and ends with
complete dilation (10 cm) of the cervical os.
 False Labor (Braxton Hicks contractions)
 Cervix fails to dilate greater than 2 cm
 Duration of first stage -
 Primigravida: 12 hours
 Multiparous: 7 hours or less

5. First Stage of Labor
Contractions-
 Interval
 10 to 20 minutes between contractions: early labor
 3 to 5 minutes between contractions: late labor
 Duration
 20 second long contraction: early labor
 40 to 80 second long contraction: late labor
 Quality
 Uterus can be dented (poor quality): early labor
 Uterus is hard (good quality): late labor

6. First Stage of Labor
Management-
 Take VS between contractions
 Fetal Heart Rate should be between 120 - 160 BPM
 Mother should be coached to relax and conserve
energy between contractions

7. Assessing Progress of Labor
 Vaginal Exam
 Cervix
 Soft or Hard
 Effaced or Thick
 Dilatation
 Presentation
 Part (cephalic, breech, shoulder)
 Flexion, Extension
 Station

8. Second Stage of Labor
 Begins with complete dilation of the cervix and ends
with delivery of fetus
 Duration of Second Stage -
 Primigravida: 50 minutes
 Multiparous: 20 minutes or less
 Contractions
 Interval: 2 to 3 minutes
 Duration: 50 to 100 seconds

9. Second Stage of Labor
 Management
 Mother may feel urge to push, coach to push only during
a contraction once the cervix has been determined to be
fully dilated
 Episiotomy
 Perform to avoid unecessary tearing when head is
crowning
 Controlled delivery avoids need for episiotomy in most
cases

10. Second Stage of Labor
 Episiotomy
 Anesthetize with pudendal block
 Put two fingers into the vagina along the posterior wall
 Place one blade of scissors between fingers inside
vagina, other blade outside vagina toward anus
 Cut to approximately 1 inch away from anus during a
contraction

12. Second Stage of Labor
 Delivery of head - CONTROL head to prevent
explosive delivery and subsequent tearing
 Check for presence of cord around neck
 Aspirate oral and nasal cavities with bulb syringe
 Deliver anterior shoulder with downward pressure
 Complete delivery and HANG ON TO BABY!

13. Second Stage of Labor
 Clear airway, Assess respirations, Resuscitate if
necessary
 Clamp cord when pulsations cease
 Leave 3 - 6 inches of cord on baby
 Obtain blood for fetal labs from the placental stub of
cord

14. Third Stage of Labor
 Begins after delivery of baby and ends with delivery
of the placenta
 Average duration: 8 minutes
 Signs of separation
 Uterus rises to become globular
 Increase (gush) of blood from vagina
 Lengthening of cord
 Do not PULL cord. Apply gentle traction
 Check Placenta for completeness

16. Third Stage of Labor
 Recover missing pieces of placenta as necessary
 Massage uterus to aid in hemostasis
 IV Oxytocin can be given if available to aid uterine
contractions and aid in hemostasis

17. Neonatal Care
 Reassess Airway and Respirations
 Keep warm and dry
 Eye drops (1% silver nitrate or Neosporin)
 Allow for maternal bonding
 Stimulation of nipples during attempts at
breastfeeding will aid in release of oxytocin by
posterior pituitary gland resulting in uterine
contraction and hemorrhage control

18. APGAR
 Taken at 1 minute and 5 minutes after delivery
 Score of zero to two is given for each category
 The higher the score, the more vigorous and “healthy”
the child is considered to be

19. APGAR
 APPEARANCE:
 2: Completely Pink
 1: Hands and Feet are blue
 0: Paleness and blue color over entire body
 PULSE: (most important sign)
 2: Greater than 100 BPM
 1: Detectable rate below 100 BPM
 0: No heart rate detected

20. APGAR GRIMACE: (flexing and muscle tone of limbs and
resistance to straightening)
 2: Normal muscle tone
 1: Limp to normal muscle tone
 0: No resistance to straightening
 ACTIVITY: (response to flicking of foot)
 2: Infant cries in response to flick
 1: Weak cry or head movement in response
 0: No response

21. APGAR
 RESPIRATORY: (Second most important)
 2: Regular respirations and vigorous cry
 1: Weak cry
 0: No respiratory response
 Scoring:
 7 to 10 provide supportive care
 4 to 6 indicates moderate depression
 < 4 requires aggressive resuscitation