Normal labor

A. Labor is characterized by uterine contractions of sufficient frequency, intensity, and duration to result in effacement and dilatation of the cervix.

B. The first stage of labor starts with the onset of regular contractions and ends with complete dilatation (10 cm). This stage is further subdivided into the latent and an active phases.

1. The latent phase starts with the onset of regular uterine contractions and is characterized by slow cervical dilatation to 4 cm. The latent phase is variable in length.

2. The active phase follows and is characterized by more rapid dilatation to 10 cm. During the active phase of labor, the average rate of cervical dilatation is 1.5 cm/hour in the multipara and 1.2 cm/hour in the nullipara.

C. The second stage of labor begins with complete dilatation of the cervix and ends with delivery of the infant. It is characterized by voluntary and involuntary pushing. The average second stage of labor is one-half hour in a multipara and 1 hour in the primipara.

D. The third stage of labor begins with the delivery of the infant and ends with the delivery of the placenta.

E. Intravenous fluids. IV fluid during labor is usually Ringer's lactate or 0.45% normal saline with 5% dextrose. Intravenous fluid infused rapidly or given as a bolus should be dextrose-free because maternal hyperglycemia can occur.

F. Activity. Patients in the latent phase of labor are usually allowed to walk.

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