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Stage 1: Effacement (%) and Dilation (centimeters) of Cervix

June 26, 2017

Begins with the onset of true labor and ends with the complete effacement (100%) and dilation (10 centimeters) of cervix.

Stage of Labor Mother’s Feelings Mother’s Activity Coach
Onset of Labor

  • Contractions that increase in intensity, frequency, and duration
  • Progressive effacement and dilation of the cervix
  • Excitement (“This is it!”)
  • Apprehension/anxiety (“I’m not ready for this.”)
  • Relaxation
  • Usual activity with frequent rests
  • May have clear liquids but no solid food
  • Change position for comfort
  • Empty bladder regularly

REMEMBER:
Be flexible—each labor is unique.

  • Time contractions:
  • Intensity: mild, moderate, or strong
  • Frequency: beginning of one contraction to beginning of next contraction
  • Duration: beginning of one contraction to the end of same contraction
  • Company/support
  • Calm reassurance
  • Rest and eat
  • Make sure mother is ready to go to the hospital
  • Make final arrangements for siblings
Early Phase
Work:

  • Effacement
  • Dilatation 0–4%
  • Contractions: (ranges)
  • Intensity: mild/moderate
  • Frequency: regular, 5–10 minutes apart
  • Duration: 30–45 seconds long

Possible Signs:

  • Increased bloody show
  • Membranes continue to “leak” if ruptured
  • Possible back pain

REMEMBER: This phase is usually the easiest but longest part of labor

  • Excited
  • Confident
  • Comfortable
  • Talkative
  • In control
  • Relaxation
  • Focal point
  • Effleurage/massage
  • Begin breathing patterns when necessary
  • Music
  • Change position frequently
  • Empty bladder regularly
  • Enter hospital as directed
  • Keep calm

Hospital Admission

  • Interview
  • Vaginal check
  • Fetal heart tones
  • Buffalo cap
  • Fetal monitor
  • Enema (only if necessary)
  • Time contractions
  • Help with relaxation through touch and words
  • Company/support
  • Encouragement/praise
  • Monitor breathing: keep it slow and even
  • Drive carefully to hospital
Active Phase
Work:

  • Dilatation 4–8 centimeters

Contractions: (ranges)

  • Intensity: strong
  • Frequency: regular, 2–5 minutes apart
  • Duration: 45–60 seconds long

Possible signs:

  • Bloody show continues to be heavy
  • Difficulty in maintaining relaxation
  • Possible nausea/vomiting, increased perspiration or chilling, and trembling of legs as transition nears
  • May become tired
  • Intense, serious mood
  • Very absorbed and busy
  • Tired
  • Begins to doubt own ability to remain in control
  • Relaxation
  • Focal point
  • Effleurage/massage
  • Breathing patterns
  • Music
  • Change position frequently
  • Empty bladder regularly
  • Remain very alert!
  • Positioning
  • Extra pillows
  • Back rubs and massage
  • Ice chips
  • Cold washcloth for face and neck
  • Sour lollipop
  • Help minimize distractions around mother
Transition
Work:

  • Dilation 8-10 centimeters

Contractions: (ranges)

  • Erratic and often having more than one peak
  • Intensity: very intense
  • Frequency: 2–3 minutes apart
  • Duration: 60-90 seconds long

Possible signs:

  • Pressure sensations in rectum
  • Urge to push
  • Nausea/vomiting
  • Hiccups
  • Belching
  • Chills and/or profuse sweating
  • Trembling of extremities
  • Sensitivity to touch
  • Difficluty in maintaining relaxation and breathing patterns
  • Increased fatigue, drowsy between contractons
  • Increased bloody show

Remember: This phase is usually very intense but short!

  • Discouraged
  • Overwhelmed
  • Irritable
  • Confused/forgetful
  • Feelings of despair:
    “I can’t go on!”…
    “I’m losing control!”
  • Restless
  • Relaxation
  • Focal point: maximum concentration needed
  • Breathing patterns
  • Music
  • Do not push until completely dilated
  • For a premature urge to push: replace the blow with a grunt in shallow chest breathing
  • Relax between contractions as much as possible
  • Change position for comfort
  • Encourage! Praise!
  • Stay with mother
  • Firm directions and support
  • Monitor breathing:
  • Keep it in a controlled pattern and breathe with mother if necessary
  • Be alert for hyperventilation and correct breathing as necessary
  • Help with relaxation through touch and words
  • Physical comfort measures
  • Keep mother informed of progress
  • Remind mother that baby is almost here
  • Alert nurse if mother is having the urge to push
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