MCN
lasting 60-70 seconds
Stages of Labor and Delivery
Primigravida - 12-18 hours
Multigravida - 6-8 hours
First Stage
➔ Takes about 12 hours to complete
➔ Has 3 segments
◆ Latent Phase
◆ Active Phase
◆ Transition Phase
➔ Latent Stage
◆ Begins at the onset of regularly
perceived uterine contractions and
ends when rapid cervical dilation
begins
◆ Mild contractions lasting 20-40
seconds
◆ Cervical effacement occurs and the
cervix dilates minimally
◆ A multiparous woman usually
progresses more quickly than a
nulliparous
◆ Longer latent phase for a woman who
enters with a “nonripe” cervix
◆ Anesthesia given too early in labor is a
factor that tends to prolong this stage
◆ Contractions generate minimal
discomfort and can be managed by
controlled breathing if the woman is
psychologically prepared and does not
tense at each tightening sensation in
her abdomen
➔ Active Phase
◆ Cervical dilation occurs more rapidly
◆ Stronger contractions lasting 40-60
seconds
◆ Contractions occur every 3-5 minutes
◆ Show and perhaps spontaneous
rupture of membranes may occur
➔ Transition Phase
◆ Contractions reach their peak of
intensity
◆ Contractions occur every 2-3 minutes
◆ Has a maximum dilation of 8-10 cm
◆ If show has not previously occurred,
show will occur as the last of the
mucus plug is released from the cervix
◆ If the membranes has not previously
ruptured, it usually ruptures at full
dilation (10 cm)
◆ By the end of this phase, full dilation
and complete cervical effacement
have occurred
◆ Woman may experience intense
discomfort accompanied by nausea
and vomiting
◆ Woman may also experience a feeling
of loss of control, anxiety, panic,
and/or irritability
◆ At the end of this stage at 10 cm
dilation, unless she has been
administered epidural anesthesia, the
irresistible urge to push usually begins
Second Stage
➔ Time span from full dilation and cervical
effacement to the birth of the infant
➔ Woman typically feels contractions change
from the crescendo-decrescendo pattern to
an uncontrollable urge to push with each
contraction
➔ May experience momentary nausea or
vomiting because pressure is no longer
exerted on her stomach as the fetus descends
into the pelvis
➔ Fetus begins to descend
➔ As the fetal head touches the internal
perineum to begin internal rotation, the
woman’s perineum begins to bulge and appear
tense
➔ The anus may become everted and stool may
be expelled
➔ Crowning occurs
Third Stage
➔ Placental stage
➔ Begins with the birth of the infant and ends
with the delivery of the placenta
➔ Two phases
 ◆ Placental separation
◆ Placental expulsion
➔ Uterus can be palpated as a firm, round mass
just below the level of the umbilicus
➔ Uterine contractions begin after a few minutes
of rest
➔ Organ assumes a discoid shape and retains
this shape until the placenta has separated
➔ Approximately 5 minutes after the birth of the
infant
➔ Placental Separation
◆ Occurs as the uterus contracts down
on an almost empty interior
◆ Active bleeding on the maternal
surface of the placenta begins
◆ The placenta sinks to the lower uterine
segment or the upper vagina
◆ Loose and ready to deliver:
● Lengthening of the umbilical
cord
● Sudden gush of vaginal blood
● Placenta is visible at the
vaginal opening
● Uterus contracts and feels firm
again
◆ Fetal surface is evident when the
placenta separates first at its center
then on the edges and folds on itself
like an umbrella
● 80% of placentas separate
and present in this way
◆ Maternal surface is evident when the
placenta separates first at its edges
and slides along the uterine surface
◆ Schultze - shiny and glistening
◆ Duncan - raw, red and irregular with
cotyledons
◆ Can take anywhere from 1-30 minutes
◆ There is a blood loss of about
300-500 mL
➔ Placental Expulsion
◆ Placenta delivers either by natural
bearing-down effort of the mother or
by gentle pressure on the contracted
uterine fundus (Crede Manuever)
◆ Pressure should never be applied on a
uterus in a noncontracted state to
avoid the uterus to evert accompanied
by massive hemorrhage
◆ If the placenta does not deliver
spontaneously, it can be removed
manually
◆ Needs to be inspected after delivery to
certain it is intact and no part was
retained (could prevent the uterus
from fully contracting and lead to
postpartal hemorrhage)
7 Cardinal Movements
➔ Engagement
◆ This is the start of the birthing process
and the baby getting themselves into
the position for birth.
➔ Descent
◆ Is the downward movement of three
biparietal diameter of the fetal heard
within the pelvic inlet and is caused by
pressure placed on the fetus by the
uterine fundus.
◆ This is aided by a woman contracting
her abdominal muscles with pushing.
➔ Flexion
◆ The head bends forward onto the
chest, making the
suboccipitobregmatic diameter
present to the birth canal.
◆ This is also aided by the abdominal
muscle contraction.
➔ Internal Rotation
◆ As the baby descends, the occiput
rotates so that the anteroposterior
diameter is in the anteroposterior
plane of the pelvis, which is considered
as the best relationship of the occiput
to the outlet of the pelvis.
◆ The shoulders are then brought into
the optimal position to enter the inlet.
➔ Extension
◆ The back of the neck stops beneath
the pubic arch as the occiput is born
 and acts as a pivot for the rest of the
head.
◆ The head extends, and the face and
chin are born.
➔ External Rotation
◆ The head rotates one final time back to
the diagonal or transverse position of
the early part of labor, which brings the
shoulders into an anteroposterior
position, which is the optimal position
for entering the inlet.
◆ The anterior shoulder is born first and
is perhaps assisted by downward
flexion of the infant’s head.
➔ Expulsion
◆ Following the birth of the shoulders,
the rest of the baby is born easily
because of its relatively smaller size.
◆ Is the end of the pelvic division of
labor
Leopold’s Maneuver
➔ 1st Maneuver
◆ Also known as the fundal grip
◆ This is done by standing at the foot of
the woman, facing her, and placing
both hands flat on the abdomen.
Following that, this maneuver is done
by palpating the superior surface of
the fundus to determine the
consistency, shape, and mobility.
◆ Determines whether the fetal head or
breech is in the fundus
◆ A head feels more firm than a breech,
is round and hard and moves
independently of the body.
◆ A breech feels softer and moves only
in conjunction with the body.
➔ 2nd Maneuver
◆ Also known as the umbilical grip
◆ This is done by facing the woman,
holding the left hand stationary on the
left side of the uterus while using the
right hand to palpate the opposite side
of the uterus from top to bottom. This
is then repeated on the other side
◆ This maneuver locates the back of the
fetus. The fetal back feels like a
smooth, hard, and resistant surface
◆ The fetal small parts on the opposite
side feel more like a number of angular
bumps and nodules
➔ 3rd Maneuver
◆ Also known as Pawlik’s grip
◆ This is done by gently grasping the
lower portion of the abdomen just
abdomen just above the symphysis
pubis between the thumb and fingers
and then pressing them together.
◆ This maneuver determines which part
of the fetus is at the inlet along with its
mobility. If the presenting part moves,
it is not engaged. If the part is firm, it is
the head. If soft, it is breech.
➔ 4th Maneuver
◆ Also known as pelvic grip
◆ This is done by placing fingers on both
sides of the uterus approximately
2inches above the inguinal ligaments,
pressing downward and inward in the
direction of the birth canal, while
allowing fingers to be carried
downward.
◆ This maneuver is done only if the fetus
is in a cephalic presentation as it
determines fetal attitude and degree
of fetal extension into the pelvis.
◆ The fingers of one hand will slide
along the uterine contour and meet no
obstruction, indicating the back of the
fetal neck while the other will meet an
obstruction, indicating the fetal brow
◆ If the fetus is in a poor attitude, the
examining ginders will meet an
obstruction on the same side as the
fetal back, indicating a hyperextension
◆ If the brow is very easily palpated, the
fetus is probably in a posterior
position.