NCLEX Review Guide: Process of Labor

First Stage of Labor

• Latent Phase (0-3 cm dilation): Contractions are mild to moderate, lasting 30-45 seconds every 5-30 minutes. Client may experience excitement and anxiety.
• Active Phase (4-7 cm dilation): Contractions become stronger, lasting 45-60 seconds every 3-5 minutes. Client becomes more focused and serious.
• Transition Phase (8-10 cm dilation): Most intense contractions lasting 60-90 seconds every 2-3 minutes. Client may feel overwhelmed and lose control.

Second Stage of Labor

• Complete cervical dilation (10 cm) to birth of baby. Client experiences urge to push with contractions every 2-3 minutes.
• Averages 20 minutes for multiparas and 50 minutes for primigravidas. Do not exceed 3 hours for primigravidas or 2 hours for multiparas.

Third and Fourth Stages

• Third Stage: Delivery of placenta within 30 minutes of birth. Watch for signs of placental separation (gush of blood, cord lengthening, uterus becomes globular).
• Fourth Stage: First 1-4 hours postpartum. Critical period for hemorrhage monitoring.

1. Assess fundus every 15 minutes for first hour
2. Monitor vital signs every 15 minutes
3. Evaluate lochia amount and color
4. Check perineum for swelling or hematoma

Cardinal Movements

1. Engagement: Fetal presenting part enters true pelvis
2. Descent: Continuous movement through birth canal
3. Flexion: Fetal chin moves toward chest
4. Internal Rotation: Fetal head rotates to accommodate pelvis
5. Extension: Fetal head extends under symphysis pubis
6. External Rotation: Head rotates to align with shoulders
7. Expulsion: Birth of entire body

Quick Assessment Checks