| 0 to 4 cm: Latent Phase and Early Active Phase |
| 1. Time: multipara 5-6 hours; nullipara 8-10 hours, average |
1. Usually comfortable, euphoric, excited, talkative, and energetic, but may be fearful and withdrawn |
1. Provide encouragement, feedback for relaxation, companionship |
| 2. Contractions: regular, mild, 5-10 minutes apart, 20-30 seconds duration |
2. Relieved or apprehensive that labor has begun |
2. Coach during contractions: signal beginning of contraction, mark the seconds, signal end of contraction; “Follow my breathing”,“Watch my lips," etc. |
| 3. Low-back pain and abdominal discomfort with contractions |
3. Alert, usually receptive to teaching, coaching, diversion, and anticipatory guidance |
3. Comfort measures: position for comfort; praise; keep aware of progress |
| 4. Cervix thins: some bloody show |
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| 5. Station: Multipara -2 to 4-1; nullipara 0. |
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| 4 to 8 cm: Midactive Phase, Phase of Most Rapid Dilations |
| 1. Average time: nullipara 1-2 hours; multi- |
1. Tired, less talkative, and less energetic para 1 %-2 hours |
1. Coach during contractions; husband (coach) may need some relief |
| 2. Contractions: 2-5 min apart, 30-40 seconds’duration, intensity increasing |
2. More serious, malar flush between 5 and 6 cm, tendency to hyperventilate, may need analgesia, needs constant coaching |
2. Comfort measures (to husband too-as needed): position for comfort while preventing hypotensive syndrome; encourage relaxation, focusing her on areas of tension; provide counterpressure to sacrococcygeal area, prn; praise; keep aware of progress; minimize distractions from surrounding environment (loud talking, other noises); offer analgesics and anesthetics, as appropriate; provide hygiene: mouth care, ice chips, clean perineum; warmth, as needed |
| 3. Membranes may rupture now |
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3. Monitor progress of labor and maternal/ fetal response |
| 4. Increased bloody show |
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4. If monitors are in use, attention on mother; periodically check accuracy of monitor readouts |
| 5. Station: -1 to 0 |
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| 8 to 10 cm: Transition, Deceleration Period of Active Phase |
| 1. Average time: nullipara 40 minutes-1 hour; multipara 20 min. |
1. If not under regional anesthesia, more introverted; may be amnesic between contractions |
1. Stay with woman (couple) and provide constant support |
| 2. Contractions: 1.5 - 2 minutes apart, 60-90 seconds duration, strong intensity |
2. Feeling she cannot make it; increased irritability, crying, nausea, vomiting, and belching; increased perspiration over upper lip and between breasts; leg tremors; and shaking |
2. Continue to coach with contractions: may need to remind, reassure, and encourage her to reestablish breathing techniques and concentration with each contraction; coach panting or “he-he” respirations to prevent pushing |
| 3. Increased vaginal show; rectal pressure with beginning urge to bear down |
3. May have uncontrollable urge to push at this time |
3. Comfort measures; remind her and husband her behavior is normal and “OK”; coach breathing to quell nausea |
| 4. Station: +3 to +4 |
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4. Assist with countertension techniques woman requested: effleurage |
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5. Monitor contractions, FHR (after each contraction), vaginal discharge, perineal bulging, maternal vital signs; record every 15 minutes |
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6. Assess for bladder filling |
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7. Keep mother (couple) aware of progress |
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8. Prepare husband for birth (scrub, gown, etc.) |