Reference — Maternal-Newborn
Stages of Labor Reference
Labor is divided into four stages with distinct physiologic events, maternal changes, expected durations, and nursing priorities. This reference provides a concise summary of each stage for NCLEX preparation and clinical practice.
Educational use only. Duration of labor varies widely by parity, analgesia, and individual patient factors. Values reflect general guidelines. Always apply clinical judgment and follow provider orders and AWHONN standards. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Stages of Labor at a Glance
| Stage | Begins / Ends | Nulliparous | Multiparous |
|---|---|---|---|
| First — Latent | Onset to 6 cm | Up to 20 hours | Up to 14 hours |
| First — Active | 6 cm to 10 cm | ≥1 cm/hr; median ~6 hours | ≥1 cm/hr; shorter |
| Second | Complete dilation to birth | Up to 3 hours (+1 hr with epidural) | Up to 2 hours (+1 hr with epidural) |
| Third | Birth to placental delivery | 5–30 minutes (both) | |
| Fourth | Placenta to 1–2 hrs postpartum | 1–4 hours recovery (both) | |
First Stage
Latent Phase (0–6 cm):
- Mild contractions 5–20 min apart, 30–45 sec duration; irregular to regular pattern
- Cervix effaces and dilates slowly; bloody show may appear
- Mother talkative, anxious; able to walk and breathe through contractions
- Nursing: support comfort, ambulation encouraged, IV access, baseline FHR assessment, document contraction pattern
Active Phase (6–10 cm):
- Moderate to strong contractions 2–5 min apart, 45–60 sec duration
- Dilation at ≥1 cm/hour; fetal descent progresses
- Mother requires concentration; may request analgesia (epidural, IV opioids)
- Amniotomy (AROM) or spontaneous ROM may occur; color of amniotic fluid noted
- Nursing: continuous FHR monitoring, vital signs q1–2h, position changes, epidural care if applicable
Transition Phase (8–10 cm):
- Very strong contractions 2–3 min apart, 60–90 sec duration; minimal rest between
- Most intense phase; nausea, vomiting, shaking, irritability common
- Urge to push may occur before complete dilation — coach to breathe through until fully dilated
- Nursing: continuous support, do not leave patient, assess for complete dilation before pushing
Second Stage
Maternal changes:
- Bearing-down (Ferguson) reflex when fetal head presses on pelvic floor
- Perineum thins, bulges, and crowning occurs
- Cardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
Nursing considerations:
- Continuous FHR monitoring — report late decelerations or absent variability immediately
- Support open-glottis pushing; guide maternal effort with contractions
- Prepare delivery field, warm blankets, neonatal warmer; ensure resuscitation equipment ready
- Assess maternal vital signs every 5–15 minutes
- Document time of delivery; call APGAR scores at 1 and 5 minutes
Third Stage
Signs of placental separation:
- Gush or trickle of blood
- Cord lengthening at introitus
- Uterus rises and becomes globular (round, firm)
Nursing considerations:
- Active management of third stage (AMTSL): oxytocin immediately after delivery of anterior shoulder or after placenta
- Monitor blood loss; normal ≤500 mL vaginal delivery
- Inspect placenta for completeness — retained fragments increase PPH risk
- Never apply fundal pressure before signs of placental separation
- Retained placenta >30 minutes = obstetric emergency — notify provider
Fourth Stage (Recovery)
Assessment frequency:
- Every 15 minutes × 4, then every 30 minutes × 2, then hourly
Key assessments (BUBBLE-LE):
- Breasts: engorgement, colostrum, breastfeeding initiation
- Uterus: firm, midline, at or below umbilicus — boggy = atony → massage
- Bladder: distension displaces uterus; encourage voiding within 4–6 hours
- Bowel: first bowel movement expected within 1–3 days
- Lochia: rubra (days 1–3); amount ≤1 pad/hour is normal
- Episiotomy: REEDA — redness, edema, ecchymosis, discharge, approximation
- Emotional: bonding, mood, support system
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →