When labor stalls, the question is which P has failed.
🚨 The moment that changes everything: ruptured membranes
The very first action after the water breaks is to check the fetal heart rate.
Rupture is when cord prolapse happens. FHR first - not the pad, not the time, not the color.
Then note TACO: Time · Amount · Colour ·
Odour. Fluid should be clear. Green = meconium. Foul = infection.
🖼️ Fetal heart rate decelerations.Swipe it sideways if it is cut off, or tap to open it full size.
🔴 Cord prolapse — act, do not investigate
1Call for help; press the emergency bell
2Gloved hand lifts the presenting part off the cord
3Knee-chest or Trendelenburg position
4Oxygen, stop oxytocin, prepare for immediate C-section
Never push the cord back in, and never leave the patient to go and call.
🖼️ Oxytocin, tachysystole and cesarean care.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Four stages: 1) dilation 0–10 cm · 2) full dilation to birth · 3) birth to placental delivery · 4) the first 1–4 hours of recovery.
Phases of stage 1 as she teaches them: latent up to ~5 cm, active ~6–7 cm, transition 8–10 cm. Her worked case: 6 cm / 100% effaced / 0 station = active phase of the first stage.
9 cm with strong frequent contractions = transition.Do not push until fully dilated — cervical trauma. Support her. Avoid analgesia this late: rapid progression and neonatal effects.
Crowning appears at about +4 station and means birth is imminent.
Fetal attitude: moderate flexion, chin to chest, arms and legs flexed = smallest presenting diameter, most favorable. Extension gives brow or face presentation.
Show 4 moreHide these 4
LOA = left occiput anterior = optimal.OP / LOP causes severe back pain with contractions, prolonged labor and slower descent → hands-and-knees or lateral positioning plus counterpressure. Not supine, not oxytocin, not straight to cesarean.
Precipitous labor = birth in under 3 hours.
Ruptured membranes with an unengaged fetal head = cord prolapse risk → assess FHR and reposition immediately.
Pain plus anxiety in active labor: patterned breathing and position changes first. Breath-holding raises tension and cuts oxygenation.
📕 From your ATI review book
Covered by ch. 11, 14 & 15.
Show 5 moreHide these 5
First action after ANY rupture of membranes is to check the fetal heart rate — you are ruling out cord prolapse. Color, odor and amount come second. Nitrazine turns blue at pH 6.5–7.5; ferning confirms.
Once membranes rupture, temperature goes from q4h to q2h. Rupture longer than 18–24 h is an infection risk and a GBS prophylaxis trigger.
True vs false labor: true contractions intensify with walking, start in the back and wrap forward, and change the cervix. False labor stays abdominal and quits with rest, hydration or repositioning.
Contraction intensity by palpation: nose = mild, chin = moderate, forehead = strong. Frequency is start-to-start.
Show 5 moreHide these 5
Red-flag pattern: duration over 90 sec, more than 5 contractions per 10 min, or under 30 sec of relaxation. All three cut placental perfusion.
Placental separation signs: a sudden gush of dark blood, the cord visibly lengthening, the fundus becoming firm and globular. Delayed cord clamping 30–60 sec is standard.
Fourth stage schedule: BP and pulse q15 min for 2 h; fundus and lochia q15 min the first hour then q30 min the second; temperature q4h.
Laceration degrees: 1st skin · 2nd into muscle · 3rd through the external anal sphincter · 4th into the rectal wall.
Elective induction requires at least 39 weeks, and Bishop ≥8 at term means a favorable cervix.
Show 3 moreHide these 3
Induction sequencing: oxytocin no sooner than 4 h after misoprostol, 6–12 h after dinoprostone. Remove any vaginal insert first. Run oxytocin as a secondary line on a pump, into the port closest to the client.
Amniotomy requires an engaged presenting part — the risk being prevented is cord prolapse.
TOLAC favors a prior LOW TRANSVERSE incision, one or two prior cesareans, 18–19 months between births, and immediate surgical backup.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 15 (labor and birth).
The four Ps: passage, passenger, powers, and psyche. The fourth is the one students drop, and the book is explicit that psychological readiness shapes the course of labor.
Why labor starts is not fully known. The best explanation is an interplay of fetal and uterine factors amounting to progesterone withdrawal. "We do not fully know" is the accurate answer.
Presentation is the part that meets the cervix first; position is how that part relates to the pelvis. Different words, routinely swapped.
⚠️ Exam traps
She teaches active phase as both4–7 cm and 6–7 cm in the same rationale — traditional vs current ACOG. Expect 6 cm as the modern cut-off and read the stem carefully.
Transition is where students pick "encourage pushing." Not until fully dilated.
🧠 Mind maps 1
Built from this page's own content — the same four questions every time, so the shape is familiar before the topic is.
Labor & Birth
🎯 The four Ps
Passenger — fetal lie, presentation, position, attitude and size.
Passageway — the bony pelvis and the soft tissue.
Powers — contractions (involuntary) and pushing (voluntary).
Psyche — fear and tension raise catecholamines and genuinely slow labor.
👀 The stages
First — onset to full dilation. Latent 0–5 cm, active 6–10 cm.
Second — full dilation to birth. The pushing stage.
Third — birth to delivery of the placenta, usually within 30 minutes.
Fourth — the first 1–4 hours after; the highest-risk window for hemorrhage.
🧪 What you watch
Contraction frequency (start to start), duration, and intensity.
Cervical change is what defines labor — contractions without change are not labor.
Fetal heart rate between and during contractions.
Signs of placental separation: a gush of blood, a lengthening cord, a firm globular uterus.
🩺 What you do
Position changes and upright postures shorten labor; left lateral improves placental flow.
After rupture of membranes, check the fetal heart rate immediately — cord prolapse is the fear.
After birth: fundal massage, and a boggy uterus is the first sign of hemorrhage.
Assess the bladder — a full bladder displaces the uterus and prevents it contracting down.
🎥 Lecture recordings 2
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
ATI Active Learning Template — System DisorderProcesses of Labor and Birth
Filled from ATI chapter 11, row by row from that chapter’s own sections — 12 of 12 rows have content.
10 rows came from outside your ATI chapter — 3 cite a source, 7 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter explains the four stages of labor, premonitory signs preceding labor, and the five factors influencing labor and birth: fetal passenger, passageway, powers (contractions), maternal position, and psychological response.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Childbirth education lowers fear, and fear is what drives much of the pain.
Teach when to come in: contractions 5 minutes apart for 1 hour in a first labor, ruptured membranes, bleeding, or reduced fetal movement.
Encourage upright positions and walking in early labor — they shorten it.
Discuss the birth plan in advance, including what happens if it has to change.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Risks for a difficult labor — the 5 Ps: passenger, passageway, powers, position, psyche.
Malpresentation (breech, transverse, occiput posterior) and macrosomia.
Contracted or android pelvis; previous shoulder dystocia.
Grand multiparity, over-distended uterus, previous cesarean scar.
Maternal exhaustion, dehydration, and unmanaged fear all weaken the powers.
Assessment — Expected Findings
Not in your ATI chapter — filled from StatPearls, 2024.
True labor produces regular contractions plus objective cervical change, while false labor (Braxton Hicks) causes no cervical dilation or effacement.
In active labor, contractions typically occur every 2 to 5 minutes and require the woman's focused attention.
During the active phase, cervical dilation progresses from about 6 cm to full dilation at roughly 1 to 2 cm per hour.
The second stage, from full dilation to delivery, averages about 0.6 hours (roughly 36 minutes) without an epidural in first-time mothers.
The third stage, delivery of the baby to placental delivery, typically lasts 5 to 30 minutes.
StatPearls (NCBI Bookshelf) · Normal Labor: Physiology, Evaluation, and Management · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
CBC on admission — baseline hemoglobin before any blood loss.
Blood type and screen, in case transfusion is needed.
GBS status from the 36 0/7–37 6/7 culture — positive means intrapartum antibiotics.
Urinalysis for protein and glucose.
Nitrazine or fern test to confirm ruptured membranes — amniotic fluid turns nitrazine paper blue.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Vaginal examination for dilation, effacement, station, presentation and position.
Leopold maneuvers before the exam — they establish lie and presentation and locate the back for auscultation.
Continuous or intermittent electronic fetal monitoring.
Ultrasound to confirm presentation when it is uncertain.
No vaginal exam if there is bright red painless bleeding — placenta praevia must be excluded first.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Leopold maneuvers, tocotransducer, and EFM assess fetal position and track contractions/FHR externally
Obtain group B strep culture if none on file from 36 0/7-37 6/7 weeks; give IV prophylactic antibiotic if positive
Check maternal temperature every 2 hr once membranes are ruptured
Grade contraction intensity by palpation: mild (like nose tip), moderate (chin), strong (forehead)
Contractions longer than 90 sec, or more than 5 in 10 min, with under 30 sec rest between, risk fetal hypoxia
Vaginal exam checks dilation, effacement, fetal station, position, and membrane status
Fourth stage: check BP/pulse/respirations every 15 min for the first 2 hr; temperature every 4 hr
Assess fundus and lochia every 15 min during the first hour after birth
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Oxytocin for augmentation — titrated, always on a pump, with continuous monitoring.
Penicillin G for GBS-positive clients, ideally ≥4 hours before birth.
Analgesia and anesthesia per the pain chapter.
Antiemetics as needed.
Never leave oxytocin running through a period of tachysystole or a non-reassuring tracing — stop it, reposition, oxygen, call.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Amniotomy — check fetal position and station first, and the fetal heart rate immediately after, because of cord prolapse risk.
Membrane sweeping and cervical ripening agents to start labor.
Amnioinfusion for variable decelerations from cord compression.
Position changes, birthing ball, hydrotherapy.
Episiotomy is no longer routine and is used only for specific indications.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from StatPearls, 2024.
Teach patients that true labor contractions come at regular intervals and intensify, unlike irregular Braxton Hicks contractions.
Advise patients that contractions occurring every 2 to 5 minutes generally signal it is time to go to the hospital.
Explain that Braxton Hicks contractions may be uncomfortable but do not cause the cervix to dilate or efface.
StatPearls (NCBI Bookshelf) · Normal Labor: Physiology, Evaluation, and Management · open the source →
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Obstetric provider or midwife; anesthesia for regional analgesia.
Neonatal team at the birth for any anticipated complication.
Doula or support person — continuous labor support measurably shortens labor and reduces intervention.
Interpreter where needed; consent in labor must be genuine.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
A third stage lasting longer than 30 minutes for placental delivery increases the risk of postpartum hemorrhage.
Most third stages conclude within 10 to 20 minutes after delivery; placental retention beyond 30 minutes is considered abnormal and needs intervention.
StatPearls (NCBI Bookshelf) · Normal Labor: Physiology, Evaluation, and Management; Abnormal Labor in Obstetrics: Recognition and Management (Nursing) · open the source →
ATI Active Learning Template — System DisorderNursing Care During Stages of Labor
Filled from ATI chapter 14, row by row from that chapter’s own sections — 12 of 12 rows have content.
10 rows came from outside your ATI chapter — 3 cite a source, 7 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Outlines nurse responsibilities across the four stages of labor: admission and ongoing maternal/fetal assessment, supporting comfort and effective pushing, and monitoring recovery and bonding after delivery of the placenta.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Encourage upright and mobile positions in the first stage.
Offer clear fluids and ice per policy; dehydration slows labor.
Encourage voiding every 2 hours — a full bladder impedes descent and causes uterine atony afterwards.
Support non-pharmacological comfort first: breathing, counter-pressure, position, water, massage.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Precipitous labor — under 3 hours — risks laceration, hemorrhage and an unattended birth.
Prolonged labor risks infection, exhaustion and atony.
Prolonged rupture of membranes over 18–24 hours raises infection risk.
Frequent vaginal examinations raise infection risk — do them for a reason, not a routine.
Full bladder, epidural, and supine position all slow descent.
Assessment — Expected Findings
Not in your ATI chapter — filled from StatPearls, 2024.
Maternal vital signs and fetal heart rate should be obtained and assessed for abnormalities on arrival to labor and delivery.
Ongoing labor assessment periodically reviews vital signs, urine output, pain level, and oral intake as labor progresses.
StatPearls (NCBI Bookshelf) · Normal Labor: Physiology, Evaluation, and Management · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from StatPearls, 2024.
A complete blood count and blood type and screen are commonly obtained on admission to labor and delivery.
Additional sexually transmitted infection testing is often added on admission for patients considered high risk.
StatPearls (NCBI Bookshelf) · Normal Labor: Physiology, Evaluation, and Management · open the source →
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Vaginal examination timed to a decision, not the clock.
Continuous EFM or intermittent auscultation depending on risk.
Fetal scalp stimulation to assess for acceleration when the tracing is unclear.
Assess the amniotic fluid at rupture: color, odor, amount and time. Meconium-stained or foul-smelling fluid is reported immediately.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Teach relaxation strategies for labor: paced breathing, effleurage, and focal-point imagery.
Support comfort with position changes, ambulation, warm/cold packs, or hydrotherapy if not contraindicated.
Encourage frequent voiding throughout labor to prevent bladder distention.
Help position the client and coach bearing down once the cervix is fully dilated.
Promote rest between contractions during active pushing.
Prepare for a possible episiotomy and have a neonatal-resuscitation-trained nurse ready at birth.
Preheat the radiant warmer ahead of delivery.
Have the client push once signs of placental separation are seen.
Give prescribed oxytocics after the placenta delivers to contract the uterus and prevent hemorrhage.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Oxytocin for augmentation; oxytocin again after delivery of the placenta to contract the uterus.
Analgesia and epidural per the pain chapter — preload with IV fluid and monitor for hypotension.
GBS prophylaxis if indicated.
Rho(D) immune globulin postpartum for an Rh-negative mother with an Rh-positive newborn.
Ophthalmic erythromycin and vitamin K for the newborn.
Therapeutic Procedures
Not in your ATI chapter — filled from AWHONN Position Statement.
For low-risk patients in the active phase of labor, AWHONN recommends auscultating the fetal heart rate every 15 to 30 minutes.
During the passive second stage, before active pushing, fetal heart rate should be auscultated about every 15 minutes.
Once a low-risk patient begins active pushing, auscultation frequency increases to every 5 to 15 minutes.
These intervals are minimums; more frequent assessment is needed whenever maternal or fetal status changes.
AWHONN · Fetal Heart Monitoring (Position Statement, Table 1: Intermittent Auscultation Frequency) · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain each stage as it happens — understanding what is happening reduces the pain of it.
Do not push until fully dilated, however strong the urge, or the cervix swells.
Open-glottis pushing with the contraction; rest between.
Explain that the urge to push may be blunted by an epidural, so coaching matters more.
Prepare her for what the first hour after birth involves: skin-to-skin, the placenta, fundal checks that hurt.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Provider or midwife, anesthesia, and the neonatal resuscitation team.
Charge nurse early — obstetric emergencies need people in the room fast.
Blood bank for type and crossmatch when hemorrhage risk is high.
Lactation support within the first hour if she is breastfeeding.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Cord prolapse — call for help, relieve pressure off the cord with a gloved hand, knee-chest or Trendelenburg, oxygen, prepare for immediate cesarean. Never push the cord back in.
Uterine tachysystole — more than 5 contractions in 10 minutes. Stop oxytocin, reposition left, IV fluid, oxygen.
Shoulder dystocia — McRoberts position and suprapubic pressure first. Never apply fundal pressure.
Amniotic fluid embolism — sudden dyspnea, hypotension and DIC. Rare and catastrophic.
Postpartum hemorrhage — the boggy uterus is massaged first, before anything else.
📋 Therapeutic Procedures for Labor and Birth6 parts
ATI Active Learning Template — System DisorderTherapeutic Procedures for Labor and Birth
Filled from ATI chapter 15, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 4 cite a source, 5 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Surveys procedures used to assist labor and birth: version to turn a breech fetus, cervical-readiness scoring, ripening agents, oxytocin induction/augmentation, artificial rupture of membranes, fluid infusion for cord compression, vacuum or forceps delivery, perineal incision, cesarean surgery, and trial of labor after a prior cesarean.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain why an intervention is being offered and what happens without it — consent in labor is easily assumed rather than obtained.
A Bishop score guides whether induction is likely to succeed; a favorable cervix scores higher.
Elective induction before 39 weeks is not recommended without a medical indication.
Discuss the possibility of cesarean in advance, so it is not the first time she hears it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2024.
Common indications for labor induction include oligohydramnios, fetal growth restriction, hypertensive disorders, and post-term pregnancy.
Absolute contraindications to induction include vasa previa, placenta previa, transverse fetal lie, and umbilical cord prolapse.
A prior classical cesarean incision is a contraindication to labor induction due to uterine rupture risk.
Operative vaginal delivery (vacuum or forceps) is considered for maternal exhaustion, a nonreassuring fetal heart rate tracing, or a prolonged second stage.
StatPearls (NCBI Bookshelf) · Induction of Labor; Vacuum Extraction · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
After amniotomy: fluid clear, and the fetal heart rate unchanged.
After a ripening agent: gradual cervical change without tachysystole.
On oxytocin, an adequate pattern is contractions about 2–3 minutes apart lasting 60–90 seconds, with the uterus relaxing fully in between.
After a vacuum or forceps birth: expect a caput or bruising on the newborn.
A uterus that does not relax between contractions is not an expected finding — the fetus is only perfused during the rest.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Type and screen or crossmatch before cesarean.
CBC before an operative birth.
Coagulation studies where hemorrhage or abruption is suspected.
Cord blood gases after an operative birth for a non-reassuring tracing.
Diagnostic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
A Bishop score of 8 or higher predicts a favorable cervix and a likely successful vaginal delivery after induction.
A Bishop score of 3 or lower predicts a low chance of successful induction, favoring cervical ripening first.
StatPearls (NCBI Bookshelf) · Induction of Labor · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Monitor FHR continuously during external cephalic version and for 1 hr afterward for bradycardia or variable decels.
Give Rh-negative clients Rho(D) immune globulin after version unless birth is expected within 72 hr.
Bishop score of 8 or higher at term means the cervix is favorable for induction.
Bishop scoring rates 5 cervical/station factors, each scored 0 to 3 points.
Misoprostol (prostaglandin E1) and dinoprostone (prostaglandin E2) are used to ripen the cervix.
After a vaginal ripening insert, keep client side-lying for 30 min to 2 hr.
Remove any vaginal ripening insert before starting oxytocin.
Watch for ripening-agent adverse effects: nausea, vomiting, diarrhea, fever, or tachysystole.
Use cervical ripening agents cautiously with glaucoma, asthma, or cardiovascular/renal disease.
Medications
Not in your ATI chapter — filled from StatPearls, 2024.
IV oxytocin for induction is titrated to produce contractions about 2 to 3 minutes apart to achieve cervical dilation.
Misoprostol for cervical ripening is typically dosed between 25 and 50 micrograms.
Uterine tachysystole, more than five contractions inside a 10-minute window, is a recognized risk of pharmacologic induction.
StatPearls (NCBI Bookshelf) · Induction of Labor · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
Vacuum extraction requires a fully dilated cervix, ruptured membranes, an engaged fetal head, and a known fetal head position.
Emptying the bladder and obtaining informed consent are also prerequisites before attempting operative vaginal delivery.
A cervical ripening Foley balloon is inflated with 30 to 80 mL of saline and generally removed once the cervix dilates 3 to 4 cm.
Vacuum cup traction is applied only during contractions and maternal pushing, limited to two to three attempts.
Clinicians are advised to keep the whole vacuum procedure under roughly 20 to 30 minutes from start to finish.
StatPearls (NCBI Bookshelf) · Vacuum Extraction; Induction of Labor · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain what she will feel with each procedure — pressure, not usually pain, with a vacuum.
After cesarean: splinting the incision to cough, early ambulation, incision care, and what to report.
Report to the provider: fever, foul discharge, a wound that opens or drains, calf pain, heavy bleeding.
Explain that a vacuum or forceps birth does not mean the next birth will need one.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Anesthesia for regional or general; surgical team for cesarean.
Neonatal team present for every operative birth.
Blood bank on standby where hemorrhage risk is raised.
Physiotherapy for recovery after cesarean where mobility is slow.
⚠️ What goes wrongComplications
Complications
Stop oxytocin for tachysystole: more than 5 contractions per 10 min, duration over 90 seconds, or resting tone over 15 mmHg.
Target oxytocin contraction pattern: every 2 to 3 min, lasting 40-70 seconds, with FHR staying 110-160/min.
For tachysystole with nonreassuring FHR, give terbutaline0.25 mg subcutaneously.
Elective induction should wait until at least 39 weeks gestation to limit infection, preterm birth, and cesarean risk.
Amniotomy raises risk of cord prolapse and infection; labor usually starts within 12 hr of rupture.
Amnioinfusion (saline or lactated Ringer's) eases variable decelerations caused by cord compression.
Vacuum-assisted birth risks include neonatal scalp laceration, cephalohematoma, or subdural hematoma.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Four stages: 1) dilation 0–10 cm · 2) full dilation to birth · 3) birth to placental delivery · 4) the first 1–4 hours of recovery.
Phases of stage 1 as she teaches them: latent up to ~5 cm, active ~6–7 cm, transition 8–10 cm. Her worked case: 6 cm / 100% effaced / 0 station = active phase of the first stage.
9 cm with strong frequent contractions = transition.Do not push until fully dilated — cervical trauma. Support her. Avoid analgesia this late: rapid progression and neonatal effects.
Crowning appears at about +4 station and means birth is imminent.
Precipitous labor = birth in under 3 hours.
Pain plus anxiety in active labor: patterned breathing and position changes first. Breath-holding raises tension and cuts oxygenation.
First action after ANY rupture of membranes is to check the fetal heart rate — you are ruling out cord prolapse. Color, odor and amount come second. Nitrazine turns blue at pH 6.5–7.5; ferning confirms.
Once membranes rupture, temperature goes from q4h to q2h. Rupture longer than 18–24 h is an infection risk and a GBS prophylaxis trigger.
Red-flag pattern: duration over 90 sec, more than 5 contractions per 10 min, or under 30 sec of relaxation. All three cut placental perfusion.
Placental separation signs: a sudden gush of dark blood, the cord visibly lengthening, the fundus becoming firm and globular. Delayed cord clamping 30–60 sec is standard.
Fourth stage schedule: BP and pulse q15 min for 2 h; fundus and lochia q15 min the first hour then q30 min the second; temperature q4h.
Laceration degrees: 1st skin · 2nd into muscle · 3rd through the external anal sphincter · 4th into the rectal wall.
Elective induction requires at least 39 weeks, and Bishop ≥8 at term means a favorable cervix.
Induction sequencing: oxytocin no sooner than 4 h after misoprostol, 6–12 h after dinoprostone. Remove any vaginal insert first. Run oxytocin as a secondary line on a pump, into the port closest to the client.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
