STAGE SIGNS AND SYMPTOMSEXPECTED BEHAVIOR

OF THE MOTHERNURSING INTERVENTIONS

First StageLatent Phase

Regular perceived uterine contraction Rapid cervical dilatation begins Tightening sensation in the woman’s

abdomen

Active Phase Cervical dilatation occurs more rapidly Contractions are stronger Increased vaginal secretions Spontaneous rupture of the membrane

Transition Phase Contractions reach their peak of

intensity,occurring every 2 to 3 minutes with a duration of 60 to 90 seconds.

Dilatation continues at a rapid rate Rupture of the membrane at full

dilatation Mucus plug from cervix is released Nausea and vomiting A feeling of loss of control, anxiety,

panic and irritability Intense sensation in the abdomen

Feeling of excitement and fear

Feeling of loss of control

Anxiety Irritability Powerlessness Tensed Panic

Assess couple for contributing factors related to feelings of loss of control Assist couple with using controlled breathing exercises and position

changes. Reinforce information learned in childbirth education classes. Slowly and clearly explain the events and changes occurring with the

active stage of labor. Inform the couple of things that can and cannot be controlled.

Reassure, as appropriate, that labor is proceeding without problems. Allow opportunities for the couple to manipulate the environment. Offer

couple options from which they can choose. Emphasize positive aspects of situation and what can be controlled Provide continued emotional support throughout labor and provide privacy

as appropriate. Encourage the husband to continue actively support the wife.

Respect contraction time Promote change of positions Promote voiding and provide bladder care Offer Support Respect and promote the support person’s activities Support the woman’s pain management efforts

Second Stage

Full dilatation Cervical effacement Overwhelming, uncontrollable urge to

push Momentary nausea or vomiting Perineum begins to bulge and appear

tense Stool might also expelled Vaginal introitus opens Fetal scalp becomes visible at the

opening of the vagina Crowning Involuntary uterine contraction

Feeling to push becomes strong

Argumentative Angry Crying or screaming Focus on the babies

birth

Assess and record the temperature, pulse, respirations, blood pressure, FHR, Contractions

Provide Support Prepare the place of Birth Convert the room to a birth room by opening the sterile packs of supplies

on waiting tables. Open the partition at the end of the room to reveal the “baby island” or

newborn care area. Turn on the radiant heat warmer in advance. Place sterile towels and a blanket on the warmer. Position the woman into the stirrup Raise both legs at the same time. Secure straps holding the legs in the stirrup Pad stirrup with abdominal pads if woman has ankle edema Top portion of the table is raised to 30—60 degrees angle. Place woman’s leg in a lithotomy position only at the last moment. Make sure that there is always someone at the foot of the broken delivery

room table. Promote effective second stage pushing Do perineal cleaning At birth, place a sterile towel over the rectum and press forward on the

fetal chin while the other hand is pressed downward on the occiput. Aspirate the newborn’s mouth and nose. Cut the cord and place infant to a sterile basket with the radiant heat

warmer Cover the infants head with a wrapped towel or cap Take infant to the parents Apply prophylactic eye ointment. Allow mother to breastfeed baby if she wishes.

Third and Fourth Stage

Uterus resumes contraction Active bleeding on the maternal

surface of the placenta Placenta sinks to the lower uterine

segment or the upper vagina Lengthening of the umbilical cord Sudden gush of vaginal blood Change in the shape of the uterus Bleeding occurs

Excited Feeling anticlimactic

Inspect the placenta to ensure that it is intact and without gross abnormalities and check the number of cotyledons.

Obtain a baseline blood pressure before handling oxytocic to the patient. Document the administration of oxytocics given in delivery or birthing

room on the maternal record. Perform perineal stitching. Be certain to include her in explanations and appreciate how anticlimactic

she may feel. Obtain vital signs every 15 minutes for 1 hour and according to the

agency’s policy. Palpate fundus for size, consistency, and position and observe the amount

and characteristics of the lochia. Perform perineal care Offer a clean gown and a warmed blanket..