Ld

First Stage of Labor

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First Stage of Labor, Stage One of Labor, Labor Stages, Friedman Curve, Latent Phase of Labor, Active Phase of Labor

  • Background
  1. Stage 1 of Labor is divided into two phases
    1. Latent Phase
    2. Active Phase
  2. Expected progress is based on Friedman Curve
  3. Assumes regular, frequent palpable contractions
  • Phase
  • Latent
  1. Definition
    1. Cervical dilation <4 cm and
    2. Regular contractions
  2. Normal Progress
    1. Nulliparous women
      1. Mean duration: 8.6 hours
      2. Maximum normal duration: 20 hours
    2. Multiparous women
      1. Maximum normal duration: 14 hours
  3. Management
    1. Avoid hospitalization in latent labor
    2. Maximize hydration
    3. Facilitate rest and supportive environment
    4. Consider latent phase sedation (e.g. Hydroxyzine)
    5. See Non-Pharmacologic Pain Control in Labor
  • Phase
  • Active
  1. Definition
    1. Cervical dilation >4 cm and
    2. Regular contractions
  2. Normal Progress
    1. Nulliparous women
      1. Cervical Dilation: >1.2 cm/hour
      2. Fetal Descent: >1 cm/hour
    2. Multiparous women
      1. Cervical Dilation: >1.5 cm/hour
      2. Fetal Descent: >2 cm/hour
  3. Management
    1. See Labor Dystocia
    2. Consider Active Management of Labor
      1. Oxytocin Augmentation
    3. Consider amniotomy
    4. See Fetal Heart Tracing
    5. See Active Labor Anesthesia