NurseSavvy Cheat SheetProcedure
Stages of Labor
Overview
Labor has four stages, each with distinct landmarks and nursing priorities. Stage 1 (onset to full dilation) is the longest and is subdivided into latent, active, and transition phases. Stage 2 runs from complete dilation to birth. Stage 3 is delivery of the placenta. Stage 4 is the recovery period and carries the highest hemorrhage risk.
The four stages of labor
- Stage 1: dilationlatent -> active (6 cm) -> transition (8-10 cm); cervix 0 -> 10 cm
- Stage 2: birthcomplete dilation (10 cm, 100% effaced) -> delivery of infant
- Stage 3: placentaplacental delivery, ~5-30 min after birth
- Stage 4: recoveryfirst 1-2 h postpartum; q15min fundus, lochia, VS
Interpretation
Phases of Stage 1 by dilation and contraction pattern
LatentActiveTransition
Cervical dilation0-6 cm6-10 cm8-10 cm
Contractionsmild, irregularevery 2-3 min, 60-90 secevery 1.5-2 min, 60-90 sec, strongest
Patient behaviortalkative, mobileincreasing pain and focusirritable, nauseated, urge to push
Latent
- Cervical dilation
- 0-6 cm
- Contractions
- mild, irregular
- Patient behavior
- talkative, mobile
Active
- Cervical dilation
- 6-10 cm
- Contractions
- every 2-3 min, 60-90 sec
- Patient behavior
- increasing pain and focus
Transition
- Cervical dilation
- 8-10 cm
- Contractions
- every 1.5-2 min, 60-90 sec, strongest
- Patient behavior
- irritable, nauseated, urge to push
During — Monitoring
do not coach pushing before complete dilation HallmarkHold
Pushing at 9 cm risks cervical edema and prolonged labor despite transition urge to bear downcontinuous supportive presence in transition
Highest-priority comfort intervention when the client feels unable to copecontrolled breathing for premature urge to push
Prevents bearing down before full dilationposition change
Side-lying or hands-and-knees promotes comfort and fetal descent in transitionMonitor
fundal assessment every 15 minutes in Stage 4 Hallmark
Fundus should be firm and midline; boggy or displaced fundus needs immediate interventionlochia assessment every 15 minutes
Quantify blood loss during the highest-risk hemorrhage windowvital signs every 15 minutes for first hour
Detects early hemodynamic changes after deliverybladder distention check
A full bladder displaces the fundus and contributes to atonyTechnique
assess fundus for firmness and position
Stage 4 step 1: a boggy or displaced fundus requires immediate interventionestimate and document blood loss
Step 2: objective quantitative blood loss within first 15 minutesassess vital signs every 15 minutes for first hour
Step 3: highest-risk period for hemorrhageevaluate perineum for hematoma and repair integrity
Step 4: expanding hematomas cause hemodynamic instabilityassist initial breastfeeding during golden hour
Step 5: stimulates endogenous oxytocin to contract the uterus and reduce bleedingAfter — Complications
arrest of active phase
No cervical change >=2 hours despite adequate contractions (nulliparous)fetal heart rate deceleration during pushing
Stop pushing and breathe until FHR recovers; resume only after return to baselinesubgaleal hemorrhage after vacuum delivery
Potentially fatal; fluctuant scalp swelling crossing suture linescaput succedaneum
Scalp edema crossing suture lines after operative deliverycephalohematoma
Subperiosteal bleed that does not cross suture linesReport Nowescalate immediately
boggy uterine fundus Hallmark
Sign of uterine atony, the leading cause of Stage 4 postpartum hemorrhageexcessive lochia or blood gush
Stage 4 carries the highest hemorrhage risk; act before it becomes a crisisfetal heart rate drop to 90 bpm
Stop pushing, reposition, and intervene to restore uteroplacental perfusionexpanding perineal hematoma
Can cause concealed blood loss and hemodynamic instabilityno cervical change over 2+ hours in active labor
Labor arrest disorder requiring clinical decision-makingClinical Pearl
"1-2-3-4: dilate, push it out, placenta out the door, watch the bleeding on the floor." Stage 4's every-15-minute fundal and vital checks catch hemorrhage before it becomes a crisis.