Stages of Labor Nursing OB for Nursing Students | Stages of Labour NCLEX Explained Video Lecture

The video introduces the four stages of labor, highlighting key areas for NCLEX and maternity lecture exams, such as cervical dilation, contractions, nursing interventions, and what happens at the delivery of the baby and placenta. It also covers the recovery period.

Stage 1 is the longest stage, where the cervix dilates from 0 to 10 cm and effaces (thins) 100%. It begins with true labor and has three phases: latent, active, and transition. This stage is particularly longer for first-time mothers. Bearing down and pushing should be avoided until full dilation to prevent cervical swelling.

In the latent phase, the cervix dilates from 1 to 4 cm. Contractions are mild, occurring every 5-30 minutes and lasting 30-45 seconds. The mother may not realize she's in labor and should remain at home until active labor or water breaks, focusing on comfort. She will be excited and nervous and talking.

The active phase involves cervical dilation from 4 to 7 cm, typically at 1 cm per hour. Contractions become stronger and longer (every 3-5 minutes, 45-60 seconds long). The mother should go to the hospital. Nurses monitor for ruptured membranes (water breaking) and check for meconium-stained fluid, performing a nitrazine paper test. Interventions focus on comfort, breathing techniques, keeping the bladder empty, and monitoring vital signs and fetal heart rate. The mother is serious, in pain, and anxious.

The transition phase is the shortest but most intense, with dilation from 8 to 10 cm. Contractions are very intense, long, and frequent (every 2-3 minutes, 60-90 seconds long). The mother will be concentrating, irritable, in intense pain, and may shiver or feel rectal pressure. Nurses provide support, encouragement, assist with breathing techniques, and monitor maternal and fetal vital signs, cervical dilation, and fetal positioning (station).

Stage 2 begins when the cervix is fully dilated (10 cm and 100% effaced) and ends with the baby's delivery. This stage involves intense pressure as the baby descends, moving from positive fetal stations. It typically lasts 1 hour for first-time mothers and about 20 minutes for subsequent births. Contractions remain painful. Nurses teach pushing techniques, suggest various positions, offer encouragement, record the birth time, monitor vital signs, and observe perineal changes like bulging, increased bloody show, or visible baby parts.

Stage 3 starts after the baby's delivery and ends with the placenta's expulsion, usually lasting 5-15 minutes. A longer duration increases the risk of hemorrhage. Signs of placental separation include umbilical cord lengthening, a gush of blood, and the uterus changing shape. The video describes two delivery mechanisms: Schultz (shiny, baby side first) and Duncan (dull, rough, maternal side first). Nursing interventions include monitoring blood pressure, administering Pitocin to prevent hemorrhage, assessing the placenta for intactness, checking the umbilical cord for two arteries and one vein, and providing maternal comfort and encouraging bonding.

Stage 4 is the 1-4 hours post-placenta delivery, a critical recovery period. Nurses monitor for hemorrhage, infection, and uterine atony by checking vital signs (heart rate, blood pressure, temperature), lochia (vaginal discharge, noting large clots as a warning sign), and the uterine fundus. The fundus should be firm, midline, and at or near the umbilicus. If soft, boggy, or displaced, fundal massage and assisting the mother to empty her bladder are crucial interventions. Other interventions include pain relief, perineal care (ice, witch hazel), and promoting bonding and breastfeeding.