Stages of Labor
Stage 1: Onset to full dilation (10 cm). Early (latent): 0–6 cm, contractions q5–30 min, mild. Active: 6–10 cm, contractions q2–5 min, moderate-strong. Transition: 8–10 cm, intense, most difficult. Stage 2: Full dilation to delivery — pushing phase. Stage 3: Delivery of placenta (up to 30 minutes). Stage 4: First 1–2 hours postpartum — highest risk for hemorrhage.
Fetal Heart Rate Monitoring
Normal FHR: 110–160 bpm. Baseline variability: normal = moderate (6–25 bpm) — indicates fetal neurological health. Accelerations: ≥15 bpm above baseline for ≥15 sec — reassuring. Early decelerations: mirror contractions, head compression — benign. Variable decelerations: cord compression — position change, O2, fluid. Late decelerations: uteroplacental insufficiency — IMMEDIATE intervention. Category III (sinusoidal, absent variability + late/variable) = emergency.
Pain Management in Labor
Non-pharmacological: breathing techniques, hydrotherapy (water), massage, positioning, TENS, birthing ball. Pharmacological: neuraxial analgesia (epidural/CSE) — gold standard; assess BP (hypotension risk), motor block. IV opioids (fentanyl, morphine) — respiratory depression in newborn if given close to delivery; have naloxone ready. Nitrous oxide: inhaled, patient-controlled, mild relief.
Complications of Labor
Placenta previa: painless bright-red bleeding — NO vaginal exam, prepare for C-section. Placental abruption: painful dark-red bleeding, rigid abdomen — fetal monitoring, prepare for emergency delivery. Cord prolapse: emergency — elevate presenting part manually, knee-chest position, O2, stat C-section. Shoulder dystocia: McRoberts maneuver (hyperflexion of maternal thighs), suprapubic pressure. PPH: uterine atony most common — fundal massage, oxytocin, Methergine, Cytotec.
Important Notes
- Late decelerations = uteroplacental insufficiency — lateral positioning, O2 10 L/min, stop pitocin, notify immediately.
- Cord prolapse is an absolute obstetric emergency — keep hand in vagina elevating presenting part until OR.
Clinical Tips
- TPAL: T=term births, P=preterm births, A=abortions/losses, L=living children — accurate OB history.
- Maternal pulse and FHR can be mistaken for each other — always differentiate when monitoring.
Summary
Labor nursing requires expertise in fetal monitoring, labor progress assessment, pain management, and rapid recognition of obstetric emergencies. Timely intervention prevents maternal and fetal morbidity and mortality.
