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Lesson 2: Stages of Labor and Nursing Care




As previously mentioned, the third stage of labor is the period from birth of the baby through delivery of the placenta. This is considered a dangerous time because of the possibility of hemorrhaging. Signs of the placental separation (see figure 2-9) are as follows:

a. The uterus becomes globular in shape and firmer.

b. The uterus rises in the abdomen.

c. The umbilical cord descends three (3) inches or more further out of the vagina.

d. Sudden gush of blood.

Figure 2-9. Placental separation and delivery.


a. Continue observation. Following delivery of the placenta, continue in your observation of the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.

b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.


Record the following information.

a. Time the placenta is delivered.

b. How delivered (spontaneously or manually removed by the physician).

c. Type, amount, time and route of administration of oxytocin. Oxytocin is never administered prior to delivery of the placenta because the strong uterine contractions could harm the fetus.

d. If the placenta is delivered complete and intact or in fragments.



2-1. Identify the definition and process of labor.

2-2. Identify the signs and symptoms of true labor and false labor.

2-3. Identify descriptive phrases that concern the four stages of labor.

2-4. Identify those factors that distinguish the three phases of the first stage of labor.

2-5. Identify the nursing care given the patient during the first stage of labor.

2-6. Select the signs of the second stage of labor.

2-7. Identify those parameters used to determine when the patient is taken to the delivery room.

2-8. Identify the nursing care given the patient while in the delivery room.

2-9. Identify signs of placental separation.

2-9. Select the nursing interventions used during the third stage of labor.

2-11. Select the goal of the fourth stage of labor.

2-12. Identify the nursing care given the patient during the fourth stage of labor.

2-13. Identify those factors which may extend or influence the duration of labor.


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