🤱 Maternity & Newborn · Lesson 6 of 6 · 6 min
Stages of Labor and What the Nurse Does in Each
⏱️ 'How dilated am I?' is the question every laboring client asks. 'What stage is she in and what is my job right now?' is the question the exam asks you.
💡 Key idea
First stage to 10 cm (latent, active, transition), second stage to birth, third stage the placenta, fourth stage recovery with fundal checks every 15 minutes.
🧠 Why it matters
TRUE labor: regular contractions that intensify with activity, cervical change, and pain starting in the back and moving to the front; FALSE labor contractions are irregular, ease with walking and cause no cervical change. FIRST STAGE runs from the onset of labor to full dilation (10 cm): the LATENT phase (0 to about 5 or 6 cm) is the time for teaching and encouraging ambulation; the ACTIVE phase brings stronger contractions and faster dilation, with monitoring of contractions, fetal heart rate and maternal vital signs; TRANSITION (8 to 10 cm) is the most intense, with nausea, shaking, irritability and an urge to push that must be resisted until full dilation. SECOND STAGE runs from full dilation to birth: support pushing with contractions, monitor the fetal heart rate after each contraction, and prepare for delivery. THIRD STAGE is the delivery of the placenta, within about 30 minutes, with signs of separation (a gush of blood, lengthening cord, globular uterus); oxytocin is given afterward to prevent hemorrhage. FOURTH STAGE is the first 1 to 4 hours of recovery, with vital signs and fundal checks every 15 minutes for the first hour. Comfort measures and epidurals: a fluid bolus before placement, monitor for maternal hypotension (treat with side-lying, fluids and ephedrine) and fetal bradycardia, and bladder checks because the client cannot feel fullness.
🏥 In the real world
🧊 A client in transition says she cannot do this anymore and wants to push at 8 cm. The nurse coaches her to blow through contractions, reassures her that this phase is the shortest, and keeps her from pushing on a cervix that is not yet open. Twenty minutes later she is complete, and pushing becomes productive instead of harmful.
📌 Takeaways
- True labor changes the cervix; false labor does not
- Transition: 8 to 10 cm, intense, no pushing until complete
- After an epidural: watch maternal blood pressure and bladder
📖 Terms in this lesson
Oxytocin: The IV hormone that induces or strengthens labor and contracts the uterus after birth; titrate by pump with continuous fetal monitoring, and stop it, turn the client, give oxygen and notify the provider for more than five contractions in 10 minutes or late decelerations.
Terbutaline: A beta agonist that relaxes the uterus to delay preterm labor briefly; injectable use beyond 48 to 72 hours (and any oral use) carries a boxed warning for maternal heart deaths, so hold it for a maternal pulse over 120 and report chest pain.
Betamethasone (antenatal steroids): Two IM doses of 12 mg given 24 hours apart to a woman expected to deliver between 24 and 34 weeks, to mature the fetal lungs and cut respiratory distress, brain bleeding and bowel injury; watch the mother's glucose and for signs of infection.
✅ Test yourself
A laboring client at 8 cm is shaking, nauseated and says she has to push. What is the nurse's best response?
- Coach her to breathe through contractions until she is fully dilated
- Tell her she is not in real labor
- Leave to notify the provider
- Encourage pushing with each contraction
Answer: A · Coach her to breathe through contractions until she is fully dilated
Transition brings a premature urge to push; pushing before 10 cm can cause cervical edema and injury.
Which finding distinguishes true labor from false labor?
- Contractions that stop when the client walks around
- Progressive cervical dilation and effacement
- Irregular contractions that vary in intensity
- Discomfort felt mainly in the lower abdomen and groin
Answer: B · Progressive cervical dilation and effacement
Cervical change is the defining feature of true labor regardless of how the contractions feel.
Fifteen minutes after an epidural is placed, the client's blood pressure drops from 124/78 to 88/50. What should the nurse do first?
- Place the client in a high Fowler's position with her legs dangling
- Stop the fetal monitor to reduce anxiety
- Prepare the operating room for an immediate cesarean delivery
- Turn the client to her side and increase the IV fluid rate
Answer: D · Turn the client to her side and increase the IV fluid rate
Epidural-related hypotension is treated with lateral positioning and a fluid bolus; ephedrine is given if it persists.
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