First stage of labor

Take a complete history and perform a complete physical examination. The physical should include a vaginal examination to assess the cervix.

Access and monitor fetal and maternal vital signs. -latent phase: dilation of cervix to 3-4cm -active phase: dilation continues 3-4 to 7cm -transition phase: cervix dilates to 8-10cm

Second stage of labor

Follow and chart fetal station as the neonate descends in the pelvis. Assess fetal position by palpation or by inspection (as the head becomes visible). Monitor fetal and maternal vital signs closely. Delivery is imminent at crowning Crowning occurs when the fetal head bulges the perineum as the head moves through the birth canal. -Descent of the neonate through the pelvis -Flexion of the head, putting the occiput in presenting position -Internal rotation of the vertex to maneuver past the lateral ischial spines -Extension of the head to pass beneath the maternal symphysis -External rotation of the head after delivery to facilitate shoulder delivery -Expulsion

Guide the newborns body as it is delivered. Suction the nares again and perform an initial assessment of the newborn. Clamp the umbilical cord in 2 locations, several centimeters apart. The clinician or the mothers partner can cut the cord between the clamps.

AFTER DELIVERY:
Clean the newborn or place directly with the mother, assuming a normal appearance and Apgar evaluation. If the newborn is given directly to the mother, wrap the newborn and place on the mothers bare chest; the newborn's wet skin or the mothers wet clothes, combined with exposure to ambient air, lead to significant heat loss. Continue to monitor the mother as she progresses to the third stage of labor.

Third stage of labor

Placental separation is evidenced by the following:

-Lengthening of the cord, sudden gush of blood, abdomen globular

The clinician can facilitate placental delivery. o Apply gentle horizontal traction on the umbilical cord with one hand. o Apply vertical pressure just superior to the pubic symphysis with the other

hand to prevent inversion of the uterus. o Administer intravenous oxytocin to expedite the third stage of labor. Oxytocin should be started at delivery of the anterior shoulder.

 Inspect the placenta after delivery. o Manually explore the uterus if the placenta is not intact. o Retained placenta fragments increase the risk of postpartum hemorrhage.

Fourth stage (recovery and bonding

This stage last from 1 to 4 hours after birth.

Leopolds manuever A. First Maneuver (Upper pole) 1. Examiner faces woman's head 2. Palpate uterine fundus 3. Determine what fetal part is at uterine fundus B. Second Maneuver (Sides of maternal abdomen) 1. Examiner faces woman's head 2. Palpate with one hand on each side of abdomen 3. Palpate fetus between two hands 4. Assess which side is spine and which extremities C. Third Maneuver (Lower pole) 1. Examiner faces woman's feet 2. Palpate just above symphysis pubis 3. Palpate fetal presenting part between two hands 4. Assess for Fetal Descent D. Fourth Maneuver (Presenting part evaluation) 1. Examiner faces woman's head 2. Apply downward pressure on uterine fundus 3. Hold presenting part between index finger and thumb Assess for cephalic versus Breech Presentation