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
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- Progressive effacement and dilation of the cervix
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- Excitement (“This is it!”)
- Apprehension/anxiety (“I’m not ready for this.”)
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- 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.
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- 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
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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
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- 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)
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- Time contractions
- Help with relaxation through touch and words
- Company/support
- Encouragement/praise
- Monitor breathing: keep it slow and even
- Drive carefully to hospital
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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
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- Intense, serious mood
- Very absorbed and busy
- Tired
- Begins to doubt own ability to remain in control
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- Relaxation
- Focal point
- Effleurage/massage
- Breathing patterns
- Music
- Change position frequently
- Empty bladder regularly
- Remain very alert!
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- Positioning
- Extra pillows
- Back rubs and massage
- Ice chips
- Cold washcloth for face and neck
- Sour lollipop
- Help minimize distractions around mother
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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
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- 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
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- 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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