4 Stages Of

Labor
Know the Difference
Objectives:
• As a Midwifery student, you must be familiar with
each stage of labor and the nursing interventions
based on the specific stage of labor.
•  it is important to remember the following about the stages of labor:
•   what occurs in each stage
•   be able to identify each stage based on its description
•   cervical dilation ranges in each phase of stage 1 and contraction
length and frequency
•   nursing interventions for each stage
•   delivery mechanisms (Duncan or Schultz)
•   changes in the perineum that the baby is about to be delivered
•   Signs the placenta is about to be delivered
Stage 1 of Labor
• Goal: Cervical dilation (opening) 0-10 cm & 100%
effacement (thinning) due to contractions.
• Facts:
• Longest Stage (especially for first time mothers…
nulliparous)
• Has 3 Phases
• Starts with TRUE Labor
• Phases: Early Labor (Latent), Active, and Transition
• Remember the
mnemonic: “ Labor is Actively Transitioning”
 Phase 1: Early labor
(Latent)
• Cervix dilates from 1 to 4 cm* and thins
• *0-6 cm….ACOG.org (The American College of Obstetricians
and Gynecologists) has recommended guideline changes for
cervical dilation for the stages of labor.
• Contractions occur every 5 to 30 minutes and 30-45 seconds in
length
• Contractions are less intense compared to other phases and stages
• Longest of the phases (especially first time mothers >20 hours vs
>14 multipara)….some women notice contractions while others
don’t (can gradually occur over 8-12 hours or 1-3 days)
• If woman at home, should monitor contraction duration and
intensity…try to stay comfortable at home until water breaks or
enters active phase of labor.
• Woman will be talking, excited, and nervous.
Phase 2: Active Labor
• Cervix dilates to *4 to 7 cm and thins
• *Starts at 6 cm (instead of 4 cm)….ACOG.org (The American College of
Obstetricians and Gynecologists) has recommended guideline changes
for cervical dilation for the stages of labor.
• Contractions will be noticeably stronger and longer (45 to 60 seconds)
every 3 to 5 minutes
• Lasts about 4 to 8 hours
• If woman at home, time to go to the hospital.
• Water may break (if hasn’t already)
• Important to monitor for meconium -stained fluid which is greenish
brown/yellowish ammonitic fluid…baby can aspirate this into lungs
causing infection or blocking airway and this usually indicates fetal
distress)
• Perform Nitrazine paper test to confirm the water has broke (turns
blue if positive)
Interventions: Provide comfort
•changing positions, warm shower or bath,
massages between contractions, breathing
techniques, ice or fluids for dry mouth. 
•Pharmacological: epidural etc.
• Encourage frequent urination to keep
bladder empty (full bladder prevents uterus
from contracting properly and can slow
down labor), monitor vitals of mother and
fetal heart rate.
Mother will be serious, anxious, and in
pain.
Phase 3: Transition
• This phase will lead into Stage 2 where the baby will be
delivered.
• Cervix dilates to 8 to 10 cm and thins
• Shortest phase but most intense/painful
• Lasts 30 minutes to 2 hours (longer for first time mothers)
• Contractions will be very intense and long (back to back
contractions) 60-90 seconds length every 2-3 minutes.
• Mother will be concentrating, irritated, pain, nauseous, shivering.
• May report intense pressure (bowel movement) due to baby
pushing down…don’t want the mother to start pushing until fully
dilated because it can cause swelling of the cervix…hence it
won’t fully dilate.
Interventions: provide support,
breathing techniques, encouragement,
monitoring mother’s vitals and 
fetal heart rate (esp. during contractions,
and before, and after…want heart rate
110 to 160), mother’s contractions
(length, frequency) monitoring status of
cervix (dilation and effacement),
assessing fetal position and station
(station 0 baby head is engaged and at
ischial spine). The ischial spine is the
narrowest part of the pelvis.
Stage 2 of Labor
• Starts when cervix has fully dilated and ends when
baby is fully delivered.
• Cervix is fully dilated so baby can start descending
into the birth canal (woman will have intense
pressure in rectum as baby descending)…watch
fetal station +1 to 5+ (5+ is head crowning).
• Contractions will be strong and intense like in the
transition period…. 60-90 seconds length every 2-3
minutes).
• For first-time mothers this stage lasts
approximately 1 hour (may last 3 hours) and 20
minutes for multipara.
Interventions:
•  Monitor mother’s vital and baby heart during, after, and
before contractions with continuous fetal monitoring
(assessing for signs of distress).
• Watch for changes in perineum that represents birth of baby
is approaching:
• Bulging perineum and rectum
• Parts of baby present
• Increase in bloody show
• Teach mom how to push: exhale when pushing and
positioning (High-fowler and lithotomy), squatting, side-
lying , maintain comfort measures, encouragement and
praise, record exact time birth of the baby.
Stage 3 of Labor
• Starts with full delivery of baby and ends with full
delivery of the placenta.
• Lasts 5 to 15 minutes…the longer the stage the
increased risk for hemorrhage and retained
placenta (which can cause infection/hemorrhage).
• Signs that the placenta is about to be delivered:
• Umbilical cord starts to lengthen
• Trickling/gush of blood and uterus changes from an
oval shape to globular
Delivery Mechanisms of
the Placenta:
• Schultz Mechanism: REMEMBER “Shiny
Schultz”. This is the “shiny” side from the side
of the baby…remember shiny and new which
is the baby…this part comes out first.
• Duncan Mechanism: REMEMBER “Dull/Dirty
Duncan”. This side is “dull”, red, and rough
and is the side from the mother. Also, try to
remember the mother is dirty from labor and
is in rough condition, so it is the maternal side.
Stage 4 of Labor
• 1 to 4 hours after the
delivery of placenta
• Goal: monitor mother’s
health status after birth due
to risk for hemorrhage,
infection (retaining
placenta), and uterine atony
etc.
Monitoring vital signs (especially blood pressure and heart rate due
to risk of hemorrhage and an increased temperature due to risk of
infection).
Monitor discharge “Lochia”:  red, moderate, may have small clots,
however large clots not normal…assess how many peri-pads are
being used…if changing every 15 minutes…this is abnormal.
Monitor the fundus of the uterus for firmness: it should be firm
and midline, and at or slightly below the umbilicus….if soft/boggy or
displaced perform:  fundus massage and want to make sure bladder
is empty so have the patient void (will be checking fundus  every 15
minutes for 1 hour then 30 minutes for 2 hours).
The fundus of the uterus will decrease 1 cm a day and after 10 days
post-delivery cannot be felt.
Administering pain relief as ordered by MD.
Apply witch hazel to perineum and ice pack due to edema, tearing,
or episiotomy.
Promote bonding with parents and baby and help with
breastfeeding.
Labor Assessment:
• Intensity:Strength of the contraction. It is
evaluated with palpation using the
fingertips on maternal abdomen and is
described as mild, moderate, or strong.
Duration (of contraction):Time from the
beginning of one contraction to the end of
the contraction. It is recorded in seconds.
(ex: each contraction lasts 45-50 seconds)
frequency (of contractions):time from
beginning of one contraction to the
beginnning of another (ex: occuring every 3-
4 minutes)