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This is the start of labor when the cervix becomes soft and thin to get ready for dilation
Contractions may begin and will be irregular and vary in frequency, strength, and length
Latent phase is commonly defined as 0-6 cm dilated (from Pearson),

0-3 cm

Longest Phase

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Contractions are more regular, moderate- strong
Occur every 3-5 minutes
last about 40-70 seconds
4-7cm dilation at this stage

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final phase of stage 1
dilate to 8-10cm and complete effacement
mom will feel stronger contractions
rectal pressure
contractions - 45-90 seconds and every 2-3 minutes

tired, out of control, restless, and ready to quit

Might want to push or urge to push

SROM has not occurred then they will by now. But if not they will do it now.

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Begins with complete cervical dilation and ends with the birth of the baby
primigravida- this should complete within 3-4 hrs after cervix is fully dilated
mulltiparas- is often less than 15 minutes
Contractions frequency 1.5- 2 minutes, duration of 60-90 seconds, strong intensity

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- Birth of baby to delivery of placenta
- Delivery of placenta should not be longer than 30 minutes after birth of baby
- Patient may bear down to aid in delivery of placenta
- Gentle traction may be placed on the cord with counter pressure placed on lower uterus (by the practitioner) in order to get the placenta to separate, should be careful to control the placenta the entire way, it should not fall out in a careless fashion as that can lead to snapping adherant membranes, causing increased risk of infection and bleeding

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1-4 Hours after birth
Physiological readjustment of the mother begins
Blood is redistributed which leads to a drop in both systolic and diastolic blood pressures, Increased pulse pressure, and moderate tachycardia
a temperature of up to 100.4 degrees is common due to dehydration and exertion
Uterus contracted at midline, fundus midway between symphisis pubis and umbilicus, cervis will still be open
Nausea and vomiting should stop
Thirsty and hungry
Can be shaking due to side effects of physical exertion + hormones or anesthetics given during birth process
Hypotonic bladder due to trauma and anesthetics, can lead to urinary retention

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Cervix begins to thin and dilate
Contractions may be irregular
Cardiovascular output increases by 40% during labor
May be in pain from beginning of contractions
Head may begin to decent into the pelvis

cervix expectations -
Fetus -

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Rapid dilation and effacement
Some fetal decent
Feelings of helplessness
Anxiety and restlessness as contractions become increasingly stronger

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restless and out of control and urge to push and bloody show, rectal pressure

Intense contractions

Grumpy and screaming - do not look at me

blame

may have N/V

Exhausting and tired and want to give up -- YOU GOT THIS!!

Most difficult of labor

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Has the urge to push as fetal head descends
As she pushes intra-abdominal pressure is exerted
As the head descends the perineum will flatten, bulge, and move anteriorly
Increasing severe pain and burning
Labia parts and the fetal head will appear and recede with contractions when it no longer recedes its called crowning

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Indicators of placental detachment:
--Uterus may rise in abdomen, becomes more globular or spherical
--May have gush of blood
--Cord lengthens
Mom may feel need to push
May be managed "expectantly" (or naturally), or "actively" with use of oxytocin and/or misoprostal to contract the uterus and slight tension applied to the umbilical cord (must be trained)
Uterus contracts into a ball to help stop bleeding

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Uterus contracts
Should be midline and 2 fingers below umbilicus
Oxytocin released during breastfeeding helps with bonding as well as uterine contraction
Drop in glucose, progesterone, and estrogen
Lochia DARK red and similar to heavy period for 2 hours then begins to lessen- bright red indicates a bleed
Increased appetite, constipation, hemorrhoids
Most changes to pre-pregnancy states occur over days, weeks, or months

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fetus should have a heart rate of 110-160, to show that fetus is tolerating labor
Baby will descend into the pelvis
Monitor movements

Decelerations - contraction, oxygenation and perfusion, - when is it concerns - if does not come back to normal after

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Deceleration of heart rate during contractions
Change in acid-based status with contractions
Hemodynamic changes
Fetal sensation

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getting ready to descend and ready for stage 2 - Fully effaced and dilated.

different plates in the head and this is when they can get a cone head because they are squished

really watch their fetal hr and decelerations - lots of pressure from the cervix on the head, fetus will be tired here too because of the contractions. WATCH from tachy and bradicardia, really watch for those changes. 10 minutes you ARE concerned!!

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Cardinal movements- mechanisms of labor
Descent- head enters the inlet in the occiput transverse or oblique position
Flexion- fetal head descends and meets resistance from soft tissues of pelvis, pelvic floor, and cervix
Internal rotation- fetal head rotates to meet diameter of the cervix
Extension- resistance of pelvic floor and mechanical movement  assist with extension of fetal head (brows and face emerge from vagina)
Restitution- Shoulder of fetus enter pelvis, neck twists and then after head is through the vagina it will untwist
External rotation- As the shoulders rotate, the head turns to one side
Expulsion- After the external rotation, the anterior shoulder meets under surface of symphysis pubis, anterior shoulder is born and rest of the body follows

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Respiratory

Transition from breathing fluid to breathing air

60-70 respirations

acrocyanosis

Cardiovascular

BP highest after birth and drops to lowest at 3hours of age

HR 110-160 up to 180 if crying drop to 80-100 during deep sleep

May have murmur but is transient

Before birth right ventricle is larger

Hematopoietic

Hct may rise 1-2g/dL above fetal levels

hemoglobin declines in first 2 months of life cause a phenomenon known as physiologic anemia of infancy

RBC cell survival is lower and cell production is less (Normal RB is 5.1-5.3 million during first 24-48 hours of life)

Increased WBC

Blood volume of 306 ml (85mL/kg)

Thermal regulation

Neutral thermal environment (NTE)-optimal temperature for babies helps with respiration and cardiac output

Babies can't shiver, blood vessels closer to skin, larger surface area and thinner epidermis, limited subcutaneous fat

Hepatic

Palpable 2-3cm below right costal margin (relatively large and occupies 40 % of abdominal cavity)

Stores glycogen (glucose main energy source for first 4-6 hours after birth) glucose levels reach a steady state 3 hours after birth

Bilirubin is usually less than 3 mg/dL

Coagulation factors synthesized in the liver (activated by vitamin K prophylactic injection of vitamin is given on the day of birth to combat potential clinical bleeding problems)

Severe hypertension of mom can cause thrombocytopenia

Physiologic jaundice (caused by accelerated destruction of fetal RBC’s, normal biological function of newborn)

GI

normal function with enzymes for digestion

Bowel sounds present with first 30-60 minutes

Gastric PH less acidic

Bilious vomiting is abnormal

Breast fed stool are pale yellow

Immune system

Not fully activated

Can produce protective immune response to vaccines such as hep B immunoglobulin

IgG and IgM

Neuro

REM sleep and deep sleep

Growth hormone secretion during rest

Crying

eye movements

Relefexes

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Hemoglobin declines in first 2 months of life cause a phenomenon known as physiologic anemia of infancy

RBC cell survival is lower and cell production is less (Normal RB is 5.1-5.3 million during first 24-48 hours of life)

After glucose runs out baby goes to fat as fuel

requires 120 calories per kg per day

Weight loss of 5-10 percent occurs in the first 5-10 days

Pass meconium (first stool) within 8-24 hours and almost always within 48

hours (thick tarry black or dark green appearance) occurs for a day or two

Bowel movement range from one every 2-3 days to 10 daily (stool should be soft)

After glucose runs out baby goes to fat as fuel

Iron stored in liver after RBC destruction (iron storage should last up to 5 months) after 6 months baby will require food with iron or iron supplements to prevent anem

Reflexes

HR 110-160

Blood pressure stabilizes

Increase immunity through breastfeeding

Cardiac sphincter immature leads to regurgitation (avoid overfeeding and frequently burp during and after feeding)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Treat pain per doctors order
Teach the mother what is expected of this stage, such as dilation from 0-6 cm
Keep mom hydrated
Monitor fetal heart tones-Educate mom on why we monitor baby's heart rate
Monitor mom for bleeding and membrane rupture
Monitor mom's vitals (thinking preeclampsia)
Educate mom on how a normal labor progresses, like tell her how you will be checking for dilation and why we do it
Educate mom on what to expect immediately after birth (skin to skin)
Educate mom that her first milk supply contains colostrum and helps the baby by provides all the nutrients and fluid that the newborn needs in the early days, as well as many substance to protect newborn against infections

Leopold man. - palpating the fetal lie position, attitude, descent, and presenting part. To put your fetal heart monitors

monitors -
* tocotransducer - electronic - uterine
*external fetal monitoring (EFM) - HR

lab work and dx tests:
Rh factor
type and cross
CBC - Hemoglobin and HCt
Strep B ( 36+ weeks or right then) if + then they will get a course of antibiotics (before the rupture occurs)
UA - protein in urine, UTI, STI, glucose/ketones
STI screening
CMP - dehydration, glucose
Tox screen

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Position changes
Monitor fetal heart rate and contractions
Encourage movement
Breathing and relaxation techniques
Educate on what is happening at this stage (labor is progressing and baby will be here soon)
Answer questions that the mom/dad would have

Educate on the epidural and ask if this is something that mom might want - passed 8cm then it is too late to get one, they like the mom to be at 5cm to receive

Cool wash cloths to help keep mom cool
Encourage rest when needed
Educate them on what to expect form this point on

SROM - when labor is naturally induced, bodys natural

AROM - the MD will rupture. When (3-5 cm (julies head) dilated) usually transitional phase according to ATI

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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teach to breath, slow and deep breaths
focus on something
getting ready to push
take their mind of the stress and anxiety
If able to move, change positions and comfort
Coach!!

monitor mom and baby HR

if provider is not there, lets call them and get them there

prepping the bed, supplies, PPE,

delegate the family to help - O2 or removing family as needed

get that mom ready!!!

Check IVF and get extra supplies

Talk with anesth. epidural - new or dc

no epidural void every 2 hrs

rupture membranes - is it clear, cloudy, meconium staining in it, do the pH testing strip (if not done), measure the volume 700-1400mL, look at that mucous plug, bloody show, is it odorous or non-odorous - chorioamnionitis -- GET supplies to ensure the mess is contained. Montori the FHR at this point.

monitor moms VS (Temp) every 2 hrs

Cord prolapse - see it before the head of the baby --> left side, and possibly hold the baby off the cord, Trendelenburg

Nuchal cord - around the neck

administer 8-10L NRB

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Comfort
Fetal monitoring
Position changes
Breathing techniques
Relaxation techniques
Education on what is happening
Education on what to expect during the phase of labor

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Assessment
Vital signs Q15 minutes
Fundus firmly contracting
Swift gush of dark blood from introitus
Umbilical cord appears to lengthen as placenta descends
Vaginal Fullness on exam
--> 2 arteries and 1 vein,
Placental assessment
-->make sure that it is intake, dark purple, depends on what side is up and down - assess odor, rule out infection of the anio fluid.
Assignment of 1 and 5 minute apgar scores to the neonate
Interventions
Education to push once findings of placental separation are present
Administer oxytocids to stimulate uterus contraction and prevent hemorrhage
Administer analgesics
Gently cleanse the perineal area with warm water and apply a perineal pad or ice pack to the perinium -- pat not rub., peri bottle,
Promote baby-friendly activities (skin to skin, breastfeeding)
Allow privacy
Continue support and encouragement measures

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Nursing care throughout each stage/phase (think about education, comfort, and more)

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Assessment
Maternal vital signs per facility policy
Recommended every 15 minutes for the first 2 hours, then every 4 for 8, then every 8 hours
Fundus assessment every 15 minutes for the first hour then according to facility protocol
Lochia assessment every 15 minutes for the first hour then according to facility protocol
Urinary output
Bonding

Interventions
Massage the uterine fundus and/or administer oxytocics to maintain uterine tone and prevent hemorrhage
Encourage voiding to avoid bladder distention
Assess episiotomy or laceration repair for erythema
Promote bonding
Promote rest after bonding period
Allow privacy
Promote oral intake of food and liquids
Continue support and encouragement measures
Continue with analgesics and pain management
Apply hot or cold packs
Provide goodies for perineal care