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