The first stage of normal labour involves gradually increasing uterine contractions that cause dilation of the cervix from 0-10cm over time. It is divided into latent, active, and transition phases. Nursing management in this stage includes emotional support, encouraging rest and ambulation, monitoring diet and bladder, assessing cervical dilation and fetal heart rate, administering pain relief as needed, and using a partograph to track labour progress. The goal is to support the natural physiological process through this first stage until full cervical dilation is achieved.

1. FIRST STAGE OF NORMAL
LABOUR AND NURSING
MANAGEMENT
BY – PREETI KULSHRESTHA
M.SC. NURSING PREVIOUS YEAR

2. Normal labour

3. LABOUR
Labour is described as the
process by with fetus,
placenta and membranes
are expelled through the
birth canal.

4. NORMAL LABOUR (EUTOCIA)-
 Labour is called normal if it fulfils the
following criteria-
 Spontaneous in onset and at term.
 With vertex presentation.
 Without undue prolongation.
 Natural termination with minimal aids.
 Without having any complications affecting the
health of the mother and /Or baby

5. STAGES OF LABOUR
 Events of labour are divided into 4 stages –
1) First stage
2) Second stage
3) Third stage
4) Fourth stage

6. 1. FIRST STAGE –
o Also called “CERVICAL STAGE”
o Starts From the onset of true labour pain and ends with
full dilatation of the cervix
o DURATION - 12 hrs in primigravidae
- 6hrs in multiparae
2. SECOND STAGE –
o Starts from the full dilatation of the cervix and ends
with expulsion of the fetus from the birth canal.
o DURATION – 2 hrs in primigravidae
- 30 mins in multiparae

7. 3. THIRD STAGE-
o Begins after expulsion of the fetus and ends with expulsion of
the placenta and membranes
o DURATION – 15 mins in both primigravidae and multiparae
4. FOURTH STAGE –
o Stage of observation for at least 1 hr.
o General condition and behaviour of uterus are to be
monitored.

8. PHYSIOLOGY OF NORMAL LABOUR
OR
EVENTS OF 1ST STAGE OF LABOUR
 Following are the major events during labour-
 Gradually increasing uterine contractions
 Retraction
 Dilatation of the cervix
 Effacement of the cervix or taking up of cervix
 Formation of lower uterine segment

9.  Gradually increasing Uterine contraction
 There is irregular uterine contractions which are painless
(BRAXTON – HICKS) and no effect on dilatation of the
cervix.
 During contraction, uterus becomes hard.
 Patient experiences pain.
 The pain of uterine contraction is distributed along the
cutaneous nerve distribution of T10 to L1.

10.  There are wide variations in –
a. frequency
b. Intensity
c. Duration
a)Frequency-
 in the early stage of labour, the contractions come at
intervals of 10 to 15 mins.
 The intervals gradually shorten with advancement of
labour until in the 2nd stage, when it comes every 2 or 3
mins.

11. b) intensity-
 The intensity gradually increases with advancement of
labour until it becomes max. in the 2nd stage during
delivery of the baby.
 Intrauterine pressure is raised to 40-50 mmhg during
1st stage and abt 100-120 mmhg in the 2nd stage of
labour during contraction.
c) Duration-
 In the 1st stage, the contractions last for about 30 sec
initially but gradually increases in duration with the
progress of labour.
 Thus in the 2nd stage, the contractions last longer than
in the 1st stage.

12. VARIATION OF PAIN

13.  RETRACTION
 Retraction is a phenomenon of the uterus in which the
muscle fibers are permanently shortened.

14.  Retraction results in permanent shortening and the fibers
are shortened once and for all.
 The net effect of retraction on normal labour are –
 Essential property in the formation of lower uterine
segment and dilatation and effacement up of the cervix.
 To maintain the advancement of the presenting part
made by the uterine contraction and to help in ultimate
expulsion of the fetus.
 To reduce the surface area of the uterus favouring
separation of placenta.
 Effective haemostasis after the separation of the
placenta.

15.  DILATATION OF THE CERVIX
 Dilatation of the cervix depends upon 2 factors –
A. Predisposing factors
B. Actual factors
A.PREDISPOSING FACTORS-
 Softening of the cervix.
 Fibro-Musculo -glandular hypertrophy.
 Increased vascularity.
 Accumulation of fluid in between collegen fibers.
 Breaking down of collegen fibrils by enzymes collagenase
and elastase.

16. Contd.
B. ACTUAL FACTORS-
 Uterine contraction and retraction.
 Bag of membranes.
 Fetal axis pressure.
 Vis-a- tergo
(1)UTERINE CONTRACTION AND RETRACTION=

17. Contd.
 The longitudinal muscle fibers of the upper segment are
attached with circular muscle fibers of the lower segment
and upper part of the cervix in a bucket holding fashion.
 Muscle becomes shortened and retracted.
 There is some co-ordination between fundal contraction
and cervical dilatation called “polarity of uterus”.
 While the upper segment contracts, retracts and pushes
the fetus, the lower segment and the cervix dilated.

18. Contd.
(2) BAG OF MEMBRANE=
 The membranes are attached loosely to
the decidua lining the uterine cavity
except over the internal os.
 In vertex presentation girdle of head fit
in the lower uterine segment and
divides amniotic cavity into 2 parts that
are hind waters and fore waters.
 This generates hydrostatic pressure and
dilates the cervical canal.

19. contd.
(3) FETAL AXIS PRESSURE=
 In longitudinal lie, there is tendency of
straightening out of the fetal vertebral
column due to contraction of circular
muscles of the body of uterus.
 This allows the fundal contraction to
transmit into the fetal axis and mechanical
stretching of the lower segment and
opening up of the cervical canal.
 In transverse lie, fetal axis pressure is
absent.

20. Contd.
(4) VIS-A-TERGO=
It is the final phase of dilatation and retraction of the
cervix
It is downward thrust of the presenting part of the fetus
upward pull of the cervix over the lower segment.

21.  EFFACEMENT OR TAKING UP OF CERVIX
 Effacement is the process by which the
muscular fibers of the cervix are
pulled upward and mixed with the
fibers of the lower uterine segment.
 The cervix becomes thin during first
stage of labour.

22.  FORMATION OF LOWER UTERINE
SEGMENT
 During labour the wall of upper
segment becomes progressively
thickened with progressive thinning
of the lower segment
 A distinct ridge is produced at the
junction of the two, called
physiological retraction ring.

23. CLINICAL COURSE OF FIRST STAGE OF
LABOUR
(1) PAIN- initially, pains are come at varying intervals of 15 to 30 mins.
With duration of about 30 secs.
but gradually the interval become shortened with increasing
intensity and duration comes at intervals of 3 to 5 mins. And lasts for about
45 secs.
(2) DILATATION AND EFFACEMENT OF THE CERVIX- cervix dilatation
is expressed either in terms of fingers – 1,2,3 or fully dilated (10cm) or
better in terms of cm. effacement of the cervix is expressed in terms of %
i.e. 25%, 50% or 100%.
(3) STATUS OF THE MEMBRANES – membranes usually remain intact
until full dilatation of the cervix or sometimes even beyond, in the 2nd stage
.it may rupture any time after the onset of labour but before full dilatation
of cervix –when it is called early rupture. When the membranes rupture
before the onset of labour it is called premature rupture membrane.

24. Contd.
(4) MAERNAL SYSTEM- pulse rate is
increased by 10-15 b per min. during
contraction . Systolic B.P. is raised by
about 10mmhg during contraction.
temperature remains unchanged.
(5) FETAL EFFACT – during
contraction there may be slowing of FHR
by 10-20 b per min which soon returns
to its normal rate of about 140 per min.

25. PHASES OF 1ST STAGE OF LABOUR
This stage is subdivide into 3 phases-
 Latent phase (early labour)
 Active phase (active labour)
 Transition phase
Latent phase (early labour)-
 Starts – with contraction of true labour
 Ends – when cervix is dilated 4 cm.
 Intensity – mild frequently occurs every 30 mins.
 Frequency – 5-10 mins.
 Duration – 30-45 sec.
 Dilatation – 0-3 cm

26. Contd.
ACTIVE PHASE ( ACTIVE LABOUR) –
 Starts – at 4 cm of cervix dilatation
 Ends – when the cervix is dilated 8 cm
 Intensity – moderate in every 2-5 mins.
 Dilatation – in primiparous women – 1.2 cm per hr.
- in multiparous women – 1.5 cm per hr.
TRANSITION PHASE –
 Starts – when cervix is dilated 8 cm.
 Ends – full dilatation of cervix .
 Intensity – strong occurs every 2-3 mins.
 Duration – 60-90 sec.

27. Nursing
management

28. Nursing management during
the first stage of labour
• GENERAL – emotional support and
encouragement.
• BOWEL – enema with soap and water or glycerin
suppository is given in early stage.
• REST AND AMBULATION – when membranes are
intact women is encouraged for ambulation,
when ruptured women advised for rest.
• DIET – fruit juice, soup, salt lemon juice is
recommended . ice chips or plain water may be
given in early labour.
• BLADDER CARE – encourage the women to empty
the bladder, if failed the catheterization is to be
done with aseptic techniques.

29. CONTD.
• RELIEF OF PAIN –
- Pethidine 50-100 mg I.M. (analgesic)
- Metoclopramide10 mg I.M. (Antiemetic)
• PARTOGRAPH – monitor the progress of the labour by
plotting the partograph.
• Abdominal palpation = 1. uterine contraction
= 2. pelvic grip
• FHR.

30. THANK YOU