Stages of Labor- Baby, It’s Go Time!

• The four stages of labor include dilation of the cervix, delivery of the baby, the placenta, and recovery.
• One would think the stages end with baby, but the baby is just part of the whole labor and delivery process. 
• Each stage differs from the next. Author, Hollie Dubroc, outlines the 4 stages below. 

With the process of labor, various stages take place from the onset of labor through the postpartum phase. Four stages occur during labor and developing an understanding of each, can provide a multitude of insight when caring for patients throughout the labor course.

Each stage of labor can be defined with an end result to acknowledge the next stage initiating or completion of labor. Each of the stages can also have their individual complexities and the length of each stage can differ between each individual patient you care for. 

First Stage– Dilation of the cervix 

Second Stage– Delivery of the baby 

Third Stage- Afterbirth 

Fourth Stage- Recovery 

The First Two Stages of Labor

First Stage

Focusing on the first stage, known as dilation of the cervix. The first stage is the most common process thought of when the term labor is discussed. The process of dilation of the cervix can vary from patient to patient on length of time it takes and methods utilized.  

Some patients need assistance to soften their cervix, enhance their effacement. Effacement refers to the thickness of the cervix and is typically provided in a percentage up to 100%. 

Descriptive terms may also be used including soft or thick. Medications to aide in the softening of the cervix and the multiple lists of “grandma’s” tips and tricks are out there as well.  

Once the cervix has softened, it will then gradually start to dilate. Both pharmacological and non-pharmacological methods could be utilized depending on each clinical scenario, to either augment or induce stage one.  

Another important component to stage one to consider is latent labor, and for some patients they may be in latent labor for several weeks prior to active labor. When this happens, it can be both confusing and frustrating for patients.

Simply waiting for contractions strong enough to cause cervical change. Once the patient has arrived at 10 centimeters, the second stage of labor can commence.

Second Stage

The second stage of labor will be the delivery of the newborn. Considerations should be made on the number of previous deliveries, maternal exhaustion, stage one complications, fetal presentation, or previous delivery complications.   

These considerations will help guide the amount and type of coaching to be done for the patient on various pushing and positioning techniques.

Always remember that each patient and each delivery can vary, so gaining understanding for each individual patient need will be critical to promote optimal patient care.  

The Last Two Stages of Labor

Third Stage

During the third stage of labor, expect a shift in concentration and focus on the room. There is now a new addition present, with two more stages of labor still to happen. The third stage of labor is known as the afterbirth, delivery of the placenta.  

The delivery of the placenta still plays a very intricate part of the labor process. Placenta delivery may happen on its own. Patients may need to push to deliver, or a manual extraction may need to be performed.

There are complications that can still occur during this stage including hemorrhage, retained placenta, placenta accrete, inversion of the uterus, or bleeding from cervical or vaginal lacerations.

Once the placenta is delivered, examination of the placenta can serve as a valuable resource for the health of the pregnancy and neonate status.  

Fourth and Final Stage

Within the last stage of labor, known as recovery, there are several important factors to keep in mind for the overall health of both patients. Typically, the length of stage four will last two hours. Initially the perineum will be assessed for lacerations, with repairs performed on those indicated.

For the maternal patient there will be frequent checks on vital signs, fundus/bleed assessments, and pain levels. These checks provide insight on monitoring for potential complications including postpartum hemorrhage, infection, and overall compensatory status.  

If the patient had an epidural, ensuring a return to baseline is happening. The time during this stage can serve as an excellent opportunity to perform patient education on both maternal health and newborn health. 

The Bottom Line

Labor is emotional and physically taxing, but knowing what to expect and when can help ease one’s mind throughout all four stages of delivery.Each labor and delivery experience are unqiue, but the staff involved do their best to provide optimal care while sticking to the patient’s birthing plan.

Nurses are acitively with patients throught all four stages of delivery to ensure Momma and baby are healthy. Continous monitoring is done until discharge to make sure that both Mom and baby can continue recovering safely from the comfort of their own home. 

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