Maternity - L&D, part 3: Stages of Labor, Effacement vs. Dilation
This article discusses the stages of labor, as well as the difference between effacement and dilation. The Maternity Nursing series follows along with our Maternity Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Stages of labor
There are four stages of labor, conveniently named stages one, two, three, and four, or first, second, third, and fourth stage.
First stage of labor
The first stage of labor is divided into three phases, the latent phase, the active phase, and the transition phase. These commence at the onset of labor and last until the cervix is fully dilated (10 cm).
In the latent phase, the cervix is dilated 0 – 3 cm, and the patient experiences mild to moderate contractions around 5 minutes apart. Pain is probably not an issue yet.
During this phase, Mom is excited and talkative: “Oh my god, the baby’s actually coming. I can’t believe it’s time.”
In the active phase, the cervix is dilated 4 – 7 cm, and the contractions are growing stronger and occurring 2 – 5 minutes apart.
During active labor, Mom may become more apprehensive, intense, and inwardly focused: “This is starting to hurt a lot. I’m getting a little bit nervous about it."
In the transition phase, the cervix is dilated 8 – 10 cm (full dilation), and contractions are strong to very strong, occurring 1.5 – 2 minutes apart.
The hallmark signs of the transition phase of labor are if Mom feels a very strong urge to push or says, “I need to have a bowel movement,” which is probably due to rectal pressure from the baby being so far into the pelvis.
Another sign is if Mom starts verbalizing fear or apprehension like, “I can't do this,” or, “I don't want to do this anymore,” or, “I don’t think I can take it much longer.” At this point, it is important to give Mom emotional support and reassurance: “You’re doing so great. You’re so close to the finish line. I need you to take a couple of deep breaths and we’re going to get through this together.”
Second stage of labor
The second stage of labor is the time from complete dilation of the cervix (10 cm) until the delivery of the baby. During this stage, Mom feels an overwhelming urge to push.
Third stage of labor
The third stage of labor is from when the baby is born until the placenta is delivered.
Fourth stage of labor
The fourth and final stage of labor is from the time the placenta is delivered until the time that Mom has been stabilized, that is, back to the pre-labor baseline.
Effacement vs. dilation
During labor, you may hear things like a patient is “100% effaced and 6 centimeters dilated.” This is a description of the progression of the cervix during labor — how thick or thin it is, and how wide it is opening.
Effacement has to do with the thinning of the cervix.
The cervix starts out thick and closed. With the beginning of strong contractions, the cervix starts to get thinner. This is because it is stretching upward as contractions occur.
Effacement is referred to in percentages from zero to 100%.
Dilation has to do with how wide the cervix is getting (opening) and is measured in centimeters.
On the flashcards, you’ll see a set of diagrams that visualize this process. At the start, the cervix is zero percent effaced with no dilation. Then it transitions to 50% effacement with no dilation as the baby begins to move down. Next, as the baby moves further down, the cervix is fully effaced and 5 centimeters dilated (labor is well underway!). Finally, at birth, the cervix is fully effaced and dilated to 10 cm (here comes the baby!).
Hi, I'm Meris, and in this video I'm going to be talking to you about the stages of labor along with the difference between effacement and dilation. I'm going to be following along using our maternity flashcards. These are available on our website, LevelUpRN.com, if you want to grab a set for yourself. And if you already have a set, I would invite you to follow along with me. Okay, let's get started.
First up, we are talking about the different stages of labor. There are four stages, and thankfully they are named stage one, two, three, and four, or first stage, second stage, third, and fourth, so on and so forth. Let's start by talking about the first stage.
The first stage is going to be broken up into three phases, so this is going to be the latent phase, the active phase, and the transition phase. This is going to be from the onset of labor until the cervix is fully dilated. That's what the whole first stage is, but we break it down into three phases.
So the latent stage, this is going to be--mom is really excited and talkative. "Oh my god, baby's actually coming. I can't believe it's time," that sort of thing. Pain probably isn't too bad yet, and we are zero to three centimeters dilated, so we're talking just a little bit dilated, not a huge change there.
Then we get to the active phase of labor. So when you hear active labor, this is what we're talking about. This is going to be from four to seven centimeters, so we're getting more like here. We're getting to be much more dilated, and this is where we're getting stronger contractions. Mom is probably getting a little apprehensive. "Oh gosh, this is starting to hurt a lot. I'm getting a little bit nervous about it," and that kind of a feeling.
Then we get to the transition phase. This is going to be eight to ten centimeters, so from eight centimeters to full dilation. Now when we talk about full dilation, I mean, we're talking 10 centimeters here--very dilated, big enough for the baby to come through. The hallmark sign of transition phase of labor is going to be if mom feels the very strong urge to push or says, "I need to have a bowel movement," that is probably rectal pressure from the baby being so far into the pelvis. Another thing is if mom starts verbalizing any sort of fear or apprehension like, "I can't do this," or, "I don't want to do this anymore," or, "I don't think I can take it much longer." Anything like that should signal to us that we're in the transition phase, and this is a really important time for emotional support and reassurance and, "You're doing so great. You're so close to the finish line. I need you to take a couple of deep breaths and we're going to get through this together," that sort of a thing.
Now I'm fully dilated. We've made it all ten centimeters. So from this point until the baby is born, this is going to be called the second stage of labor.
Now the baby is born. Baby is here on the outside. From that point until the placenta is delivered is going to be the third stage of labor.
And then from the time that the placenta is delivered, until the time that the mom has been stabilized, until the time that we have normalized - gone back to that pre-labor baseline - that's going to be the fourth stage of labor. So very important to focus on: what am I paying attention to in each stage of labor? And that can help you think about your nursing interventions.
Okay, moving on to what is maybe my favorite illustration in this whole deck.
We're going to talk about the difference between effacement and dilation, so you may hear things like a patient is 100% effaced and six centimeters dilated. What does that mean?
Well, effacement has to do with the thinning of the cervix, so the cervix starts out--it is thick and it is closed. And then as we start having those strong contractions, as we have that, we're going to thin that cervix out, so it's actually going to get thinner because it's stretching upwards as we have those strong contractions. Effacement is referred to in percentages from zero to 100%.
Dilation has to do with how big is the cervix getting, in terms of, how wide is the opening to the cervix? This is measured in centimeters, so you will see that--you'll hear someone say that they're this percent effaced and this many centimeters dilated. So this illustration here, I think it is such a great visual at helping you understand the difference. So that you can see, we've highlighted here what the cervix is, in red, and you can see how it gets thin, and then you can also see how it opens. I just think it's such a beautiful way of really conceptualizing these difficult concepts, because it does get a little bit tricky.
I hope that review was helpful. if it was, please like this video so that I know, and I really would love to hear if you have a great way to remember any of these things. Please leave me a comment so that I can see, because I know that there's definitely better ways to remember things than we have thought of, and I want to hear all of them. Thank you so much for watching this video, and I hope I'll see you in the next one. Happy studying.
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