Section II. FIRST STAGE OF LABOR
FIRST STAGE OF LABOR--THREE PHASES
a. Latent or Prodromal Phase (Early). In this phase, the mother feels slow,
rhythmic contractions radiating from the lumbar region to the anterior portion of her
abdomen. The contractions last from 30 to 45 seconds with the intensity gradually
increasing. The frequency of contractions is from 5 to 20 minutes. There is some
cervical effacement. Dilation is from 0 to 3 cm. "Bloody show" is usually present. The
mother is usually able to walk, talk, or laugh some during this phase. Diversion is
usually welcomed during this time. This phase may not be included as part of the first
stage of labor since it is before the onset of true labor. True labor is considered to be at
4 cm. Duration of this phase varies, sometimes as long as 24 hours and is referred to
as the "prolonged latent" phase. The mother may sometimes make some progress
dilating from 1 to 2 cm and will then stop. She is usually not admitted to the hospital at
this point unless the membranes are ruptured.
b. Active or Accelerated Phase. In this phase, the contractions become
stronger and last longer, usually 45 to 60 seconds. The frequency is from 3 to 5
minutes. The cervix dilates from 4 to 7 cm. This phase is considered the onset of true
labor. The mother is admitted to the hospital at this point. She, then, becomes involved
with bodily sensations and tends to withdraw from the surrounding environment. She is
not able to walk, but, desires companionship and encouragement.
c. Transient or Transitional Phase. In this phase, the contractions are sharp,
more intensified, and last from 60 to 90 seconds. The frequency is from 2 to 3 minutes.
The cervix dilates from 8 to 10 cm. Completion of this phase marks the end of the first
stage of labor. The mother may express feelings of frustration, loss of control, and/or
irritability. Her focus becomes internal. She has difficulty comprehending surroundings,
events, and instructions. There is an increase in bloody show as a result of the rupture
of capillary vessels in the cervix and the lower uterine segment. The mother feels an
urge to push or to have a bowel movement. This is considered the most severe and
difficult phase for the mother.
NURSING CARE DURING THE FIRST STAGE OF LABOR
a. Hospital Admission. After a physician or nurse has evaluated the patient,
an admission order is written. At this point, your duties as a practical nurse are as
Establish a rapport with the patient and significant others.
(2) Explain all procedures or routines, which will be carried out prior to
performing them. These include: