Labor 1: Mechanics & Physiology
The stage of labor that begins with uterine contractions that cause cervical dilation and ends when the cervix is fully dilated.
What is the first stage of labor?
Tip: The first stage includes latent and active phases; active is where dilation accelerates.
This quick nursing measure is first for abrupt deep variable decelerations
What is reposition the mother, for example to the left lateral position?
Tip: Repositioning often improves cord blood flow and the fetal heart tracing.
This phase of the first stage of labor is when the cervix dilates from 0–3 cm, contractions are mild to moderate, and the mother is often talkative and excited.
What is the latent (early) phase of the first stage of labor?
By about 24 hours postpartum the fundus is typically located at this landmark relative to the umbilicus.
What is at or about the level of the umbilicus?
Tip: Expect the fundus to descend ~1 cm per day afterward.
Soaking one perineal pad every hour postpartum most likely indicates this and requires this immediate nursing action (two-word answer + one action).
What is possible hemorrhage; assess and notify provider?
Tip: Simultaneously fundal check, pad count, vitals, and start resuscitation per protocol if unstable.
This cardinal movement occurs when the fetal head rotates to align the longest diameter with the maternal pelvic outlet.
What is internal rotation?
Tip: Rotation helps the widest fetal head diameter negotiate the maternal pelvis.
Repetitive late decelerations on the fetal monitor most commonly indicate this underlying problem.
What is uteroplacental insufficiency?
Tip: Late decels are ominous — escalate assessment and interventions promptly.
This phase of the first stage of labor is characterized by rapid cervical dilation from 8–10 cm, strong contractions every 2–3 minutes, and intense maternal focus or irritability.
What is the transition phase of the first stage of labor?
The typical progression of lochia color from birth through the first weeks goes from this color to this color to this color (three-word sequence).
What is rubra → serosa → alba?
Tip: Rubra is bright red early, serosa pinkish-brown around day 3, alba creamy/white later.
A postpartum patient on day 5 reports fever, abdominal pain, and foul-smelling lochia; the nurse should suspect this type of infection.
What is endometritis; uterine infection?
The nurse performs a cervical check and finds that the patient is 1 cm dilated the cervix is long and thick. The fetus is engaged in the pelvis. This is the likely cervical assessment findings that the nurse would chart.
1/0 (or +1)/0
This fetal heart-rate change plus maternal fever should make you suspect chorioamnionitis or intraamniotic infection.
What is sustained fetal tachycardia greater than 160 beats per minute?
Tip: Maternal fever plus fetal tachycardia should prompt evaluation for infection and initiation of treatment per protocol.
This common physiologic side effect of epidural analgesia should be anticipated and managed; name the effect and one nursing intervention.
What is maternal hypotension, and one intervention is IV fluid bolus with uterine displacement and vasopressor per protocol?
Tip: Preload or bolus and vigilant blood-pressure monitoring reduce hypotension risk.
A common, expected breast change in the first 2–5 days postpartum that can cause firmness and tenderness as milk production increases.
What is breast engorgement?
Tip: Supportive measures include frequent breastfeeding or pumping, warm showers before feeding, cool packs after, and good latch technique.
Unilateral calf pain, redness, and swelling in the postpartum period raises concern for a condition that is diagnosed via this method
What is venous Doppler ultrasound?
In assessing fetal descent, station describes the relationship of the presenting part to this bony landmark.
What are the maternal ischial spines?
Tip: Station 0 equals at the spines; negative is above; positive is below.
Using a doppler, fetal heart tones can usually be detected by this gestational age
What is 10-12 weeks'?
Explain briefly why an epidural can lengthen the second stage and name one nursing strategy to help the patient deliver effectively despite this.
What is epidural analgesia can reduce the maternal urge to bear down and decrease pelvic floor sensation, which may prolong pushing; one strategy is active coaching of pushing with position changes and using open-glottis pushing or assisted delivery if indicated?
Tip: Pain control is valuable — combine coaching and positioning to restore effective expulsive efforts.
On BUBBLE-EE exam, the nurse notes breasts that are soft and non-tender, a firm uterus at the level of the umbilicus, clear yellow urine, lochia rubra that is light to moderate in amount, and intact perineal sutures. These are examples of this type of finding.
What are normal postpartum findings?
Postpartum day 4 headache of 10/10 with blurred vision warrants this treatment plan
Prompt evaluation through the ED
Name two physiologic reasons contractions become more effective in active labor, one uterine and one fetal/mechanical.
What are increased coordinated myometrial contractility (greater oxytocin responsiveness) and improved fetal engagement/descent (better mechanical alignment with the pelvis)?
Tip: Tie hormonal/receptor changes to mechanical alignment — both improve expulsive force.
This fetal heart tracing findings may result from fetal sleep, prematurity, or maternal medications (eg, opioids, magnesium), but can also signal early hypoxia
What is minimal variability, and the initial actions are check maternal medications/vitals, stimulate the fetus, reposition, give IV fluid bolus/oxygen, and notify the provider if persistent?
Tip: Distinguish benign causes (sleep, meds) from pathologic causes — if minimal variability persists or is paired with decels, act quickly.
A patient in labor has a contraindication to neuraxial analgesia/epidural (eg, significant maternal coagulopathy); appropriate alternative pain-management options may include
What are alternatives to neuraxial analgesia: judicious IV opioids, nitrous oxide if safe, and nonpharmacologic methods like continuous support, hydrotherapy, position changes, or TENS?
Tip: When neuraxial is contraindicated, combine safe pharmacologic choices with active nonpharmacologic coping techniques and close fetal monitoring.
On postpartum day 5, a nurse completes a BUBBLE-EE exam. The breasts are firm with milk production established, the fundus is palpable 3 cm below the umbilicus, lochia is serosa and scant, the perineum is well-approximated without hematoma, bowel and bladder function have returned, extremities show no edema or calf tenderness, and the patient demonstrates appropriate bonding and mood. These findings best represent this.
What are expected normal postpartum findings at approximately 5 days postpartum?
On a BUBBLE-EE exam, the nurse notes a firm uterus at the midline, lochia rubra saturating more than one pad per hour with foul odor, a swollen perineum with ecchymosis, and unilateral calf pain. These abnormal findings raise concern for this combination of complications.
What are postpartum hemorrhage, infection, hematoma, and deep vein thrombosis (DVT)?