stages of labor by Julie Leavitt https://padlet.com/jleavitt5/j5wl3wv798vhnewp en-us 2022-11-14 18:26:08 UTC 2025-12-15 18:12:33 UTC hello@padlet.com https://padlet.net/icons/png/1f62c.png Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426494 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]]> 2022-11-14 18:32:14 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426494 Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426662 Contractions are more regular, moderate- strong 
Occur every 3-5 minutes 
last about 40-70 seconds 
4-7cm dilation at this stage ]]> 2022-11-14 18:32:20 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426662 Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426823 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. 


]]> 2022-11-14 18:32:26 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426823 Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426974 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

]]> 2022-11-14 18:32:31 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383426974 Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427095 - 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

]]> 2022-11-14 18:32:36 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427095 Add the description/characteristics jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427283 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]]> 2022-11-14 18:32:43 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427283 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427458 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 -

]]> 2022-11-14 18:32:50 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427458 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427631 Rapid dilation and effacement 
Some fetal decent 
Feelings of helplessness 
Anxiety and restlessness as contractions become increasingly stronger ]]> 2022-11-14 18:32:57 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427631 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427756 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


]]> 2022-11-14 18:33:03 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427756 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427889 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

]]> 2022-11-14 18:33:07 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383427889 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428004 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

]]> 2022-11-14 18:33:12 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428004 Maternal physio. adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428134 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]]> 2022-11-14 18:33:17 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428134 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428321 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]]> 2022-11-14 18:33:23 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428321 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428462 Deceleration of heart rate during contractions 
Change in acid-based status with contractions 
Hemodynamic changes 
Fetal sensation


]]> 2022-11-14 18:33:30 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428462 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428612 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!!



]]> 2022-11-14 18:33:35 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428612 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428769 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 ]]> 2022-11-14 18:33:40 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428769 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428883 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

]]> 2022-11-14 18:33:45 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383428883 fetal physio adaptation in each jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429028
  • 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)
    • ]]>     2022-11-14 18:33:50 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429028     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429234 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 ]]>     2022-11-14 18:33:58 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429234     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429373 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 


    ]]>     2022-11-14 18:34:03 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429373     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429488 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 





    ]]>     2022-11-14 18:34:07 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429488     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429750 Comfort
    Fetal monitoring 
    Position changes 
    Breathing techniques 
    Relaxation techniques 
    Education on what is happening 
    Education on what to expect during the phase of labor ]]>     2022-11-14 18:34:14 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429750     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429873 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 ]]>     2022-11-14 18:34:19 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429873     Nursing care throughout each stage/phase (think about education, comfort, and more) jleavitt5 https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429986 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

    ]]>     2022-11-14 18:34:24 UTC https://padlet.com/jleavitt5/j5wl3wv798vhnewp/wish/2383429986