Maternal-Newborn Nursing · Nursing Care and Interventions During Labor and Birth
Nursing Care During the First Stage of Labor
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In 30 seconds
The First stage of labor Onset of regular contractions until full cervical dilation Full entry → is the longest: it begins with the onset of regular uterine contractions and ends when the cervix is fully dilated. It is divided into the latent (early) phase, the Active phase Stronger, closer contractions with more rapid cervical change Full entry →, and — in many frameworks — the intense final portion called Transition Final intense portion of the first stage Full entry →. During these hours the nurse is the continuous presence: assessing the pregnant person and the fetus, supporting comfort and coping, helping labor progress, and catching the small changes that, left unnoticed, become large problems.
Nursing care in the first stage is a repeating cycle rather than a single task: assess — intervene — reassess — document, over and over, at intervals set by institutional policy and the person's condition. The assessment is deliberately layered. On the maternal side: vital signs, uterine activity (frequency, duration, intensity, and Resting tone Uterine softness between contractions Full entry → of contractions), cervical progress (Dilation How far the cervix is open, in centimeters Full entry →, Effacement How thin the cervix has become, as a percentage Full entry →, Station Level of the fetal presenting part relative to the ischial spines Full entry →), bladder, pain and coping, and general well-being. On the fetal side: heart rate pattern, whether the tracing is reassuring, and how the fetus responds to contractions. Around both: the person's emotional state, support system, birth preferences, and communication needs.
The first stage is also where the nurse builds the relationship that carries through birth. People remember how they were treated during labor as clearly as they remember the birth itself. A nurse who explains what is happening, offers options, and stays present transforms an intimidating process into one the person can participate in. That combination — technical vigilance and human presence — defines intrapartum nursing.
Why this matters
Most of the emergencies of labor are preceded by subtle changes: a fever that climbs, a fetal tracing that slowly becomes less reassuring, contractions that stop relaxing between peaks, a person who suddenly can't cope. The first stage is long — often many hours — and it is the nurse's surveillance during that time that catches these changes early, when they are still reversible. Early recognition is the difference between a problem that is corrected and a crisis that is not.
This topic also carries heavy exam weight: the phases of the first stage and their characteristics, what the admission assessment includes, how uterine activity and cervical progress are assessed, and which findings are reportable. In practice, first-stage care is the core of the labor nurse's job — the skills learned here (Leopold's maneuvers Systematic abdominal palpation of fetal lie, presentation, position Full entry →, timing contractions, interpreting fetal monitoring from Chapter 16, applying comfort measures from Chapter 17) all converge in the bedside cycle of assessment and support. Finally, patient experience matters: evidence shows that continuous support, communication, and respectful care during the first stage improve outcomes and satisfaction.
The college version
Core Concepts
The phases of the first stage
- Latent (early) phase: contractions are mild, irregular, and often felt as backache or menstrual-like cramping; cervical change is slow. Many people spend much of this phase at home. Nursing care focuses on education (when to come in, comfort measures), rest, hydration, and support.
- Active phase: contractions become stronger, longer, and closer together; cervical dilation and descent progress more rapidly. This is the phase of intense labor nursing: more frequent assessment, active comfort measures, and decisions about analgesia.
- Transition: the final, most intense portion of the first stage — strong contractions with minimal rest between them, often accompanied by nausea, trembling, irritability, and the feeling of "I can't do this." Transition is progress, not pathology: the nurse normalizes it, keeps the person focused, and prepares for the second stage.
The dilation thresholds that separate these phases vary somewhat across guidelines and institutions, so students should describe the characteristics of each phase and follow the framework used in their program.
The admission assessment
Admission to the labor unit begins with a systematic assessment: the prenatal record and history (obstetric history, medical and surgical history, allergies, medications, substance use, psychosocial situation), the person's story (contractions, membrane status, bleeding, fetal movement), and vital signs. The fetal assessment includes the heart rate pattern and uterine activity; the nurse may use Leopold's maneuvers (systematic abdominal palpation) to determine fetal lie, presentation, and position. A vaginal exam per policy evaluates cervical dilation (how open the cervix is, in centimeters), effacement (how thin it is, as a percentage), and station (the fetal presenting part's level relative to the ischial spines). Testing for ruptured membranes and lab work are done per order and policy. Throughout, the nurse assesses the person's pain, coping, support system, and birth preferences.
Ongoing maternal assessment
Once admitted, the nurse reassesses at intervals set by policy and clinical need:
- Vital signs, including temperature — a rising temperature is reportable.
- Uterine activity by palpation (or intrauterine pressure catheter if used): the frequency (start of one contraction to start of the next), duration (how long each contraction lasts), intensity (mild/moderate/strong), and — critically — the resting tone between contractions, which should be soft.
- Cervical progress with exams per policy; exams are not performed casually.
- Bladder and elimination: a full bladder can impede descent and increase discomfort; the nurse encourages voiding regularly or monitors output per policy.
- Pain and coping: assessed continually, using words, behavior, and the person's own report.
- Vaginal discharge and membranes: color and amount of fluid, presence of bleeding, and any changes.
Ongoing fetal assessment
Fetal status is assessed by intermittent auscultation or electronic fetal monitoring (Chapter 16), depending on policy and risk status. The nurse evaluates the baseline rate, variability, accelerations, and decelerations, and — just as important — how the tracing responds to interventions. A reassuring pattern is documented and watched; a non-reassuring pattern triggers the assessment and response cycle, including intrauterine resuscitation measures (Chapter 16) and provider notification.
Comfort, positioning, and physical care
First-stage comfort care applies everything from Chapter 17: position changes (upright, side-lying, hands-and-knees, birth ball), movement, hydrotherapy per policy, massage and counterpressure, breathing and relaxation guidance, and continuous support. Physical care includes oral intake per policy (often clear liquids or ice chips, depending on the institution and anesthesia plans), oral hygiene, skin care, and keeping the person dry and comfortable. Position changes also serve the fetus: side-lying supports circulation, and upright positions use gravity.
Psychosocial and family care
The nurse communicates what is happening in plain language, honors the person's birth preferences, and includes support persons — teaching the partner how to help (where to apply counterpressure, what to say). Cultural humility, privacy, and informed consent are continuous threads. Anxiety is treated as a clinical finding: it worsens pain (the fear–tension–pain cycle) and deserves the same attention as a vital sign.
Documentation, communication, and escalation
Everything is documented: assessments, interventions, responses, education, and communication with the provider. Handoffs use structured communication (SBAR). Reportable findings include fever, abnormal vital signs, non-reassuring fetal patterns, vaginal bleeding, ruptured membranes with concerning fluid, a prolapsed cord, signs of uterine rupture in at-risk situations, and a sudden change in pain or coping. Exactly what to report, when, and by what mechanism is set by institutional policy — the nurse learns the unit's red-flag list. Scope note: assessment frequency, cervical-exam policies, oral-intake rules, and reporting parameters vary by institution and state practice act.
Common Confusions
| Do Not Confuse | With | Difference |
|---|---|---|
| Latent phase | Active phase | Latent = mild, irregular, slow change; active = strong, regular, rapid change — different care intensity and decisions |
| Dilation | Effacement | Dilation = how open (cm); effacement = how thin (%) — both measure progress, neither substitutes for the other |
| Contraction frequency | Contraction duration | Frequency = start-to-start interval; duration = how long each contraction lasts — both are assessed together with intensity and resting tone |
| "Pain means it's working" | Pain is assessed and managed | Pain is expected, but it is still assessed and treated; severe, out-of-pattern pain is reportable |
| Any contraction pattern is fine if the tracing looks okay | Uterus must relax between contractions | Resting tone that stays firm is a warning sign of a non-relaxing uterus — report it |
| One admission assessment is enough | Assessment is continuous | The first-stage cycle repeats at policy-set intervals; the person's condition changes hour to hour |
| "The monitor watches the baby" | The nurse interprets the tracing | Monitoring is only data; interpretation and action are nursing judgment |
| "I can't do this" = something is wrong | "I can't do this" = transition | The intense symptoms of transition are signs of progress; normalize and support (unless accompanied by objective findings) |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Labor is a long race, and the first stage is the beginning — the uterus squeezes and squeezes until the doorway (the cervix) is fully open. The nurse is like a coach who watches the clock, checks how the runner is doing, and gives tips: change position, breathe slowly, sip water, rest between laps. The nurse also listens to the baby's heartbeat the whole time, because the baby is running the race too, and the coach has to make sure both runners are okay.
Worked example
Consider a first-time parent who arrives at triage with contractions every six to eight minutes, mild in intensity, and a cervical exam showing early dilation with 50% effacement — the latent phase. The nurse completes the admission assessment: history and prenatal record, vital signs, Leopold's maneuvers (the baby is head-down), an initial fetal tracing, and a discussion of the person's birth preferences and support plan. Rather than admitting to the unit immediately, the nurse explains the option to labor at home a while longer, and the person goes home with clear education: when to return, what to do for comfort, and what to watch for.
Hours later the person returns in the active phase: contractions every three to four minutes, moderate to strong, with the cervix further dilated. Now the full cycle runs. The nurse checks vital signs and the fetal tracing, times the contractions (noting that the uterus relaxes fully between them), encourages voiding, and suggests position changes and the birth ball. The person's partner learns where to apply counterpressure. A few hours on, the person becomes nauseated, trembles, and says, "I can't do this anymore." The nurse recognizes transition, normalizes it, and keeps the person focused through each contraction. A cervical exam confirms near-full dilation. The nurse updates the provider, documents the assessment and interventions, and begins preparing for the second stage. The whole shift was the same cycle — assess, support, reassess, document — applied with different intensity at each phase.
Key takeaways
- First stage = onset of regular contractions to full dilation, with latent, active, and transition phases — each with different characteristics and nursing focus.
- The admission assessment covers history, vital signs, uterine activity, fetal status, cervical exam (dilation/effacement/station per policy), membranes, and psychosocial context.
- Uterine activity is assessed as frequency, duration, intensity, and resting tone — resting tone must be soft between contractions.
- Fetal status is assessed continuously (EFM) or intermittently (auscultation) per policy — patterns are interpreted in context and acted on (Chapter 16).
- A full bladder can impede descent — regular voiding or bladder monitoring is part of first-stage care.
- Comfort care (positioning, water, counterpressure, breathing, support) is nursing intervention, not optional extras.
- Transition symptoms (nausea, trembling, "I can't do this") are signs of progress, not pathology — normalize and support.
- Reportable findings follow the unit's list and SBAR communication; assessment frequency follows policy.
Check yourself
6 review questions from the chapter. Try each one, then open the answer.
What are the three phases of the first stage of labor, and what characterizes each?
Show answer
Latent: mild, irregular contractions with slow cervical change — focus on education, rest, and comfort. Active: stronger, closer contractions with more rapid dilation — intense assessment and comfort care. Transition: the final intense portion with strong contractions and minimal rest — normalize the symptoms and prepare for the second stage.
What does the admission assessment include?
Show answer
History and prenatal record (obstetric, medical, surgical, allergies, medications, psychosocial), vital signs, uterine activity, fetal heart rate assessment (Leopold's maneuvers, auscultation or EFM), cervical exam per policy (dilation, effacement, station), membrane status, and the person's pain, coping, support system, and birth preferences.
How is uterine activity assessed, and why is resting tone important?
Show answer
By palpation (or IUPC if used): frequency (start-to-start), duration (length of each contraction), intensity (mild/moderate/strong), and resting tone between contractions. Resting tone should be soft — a uterus that stays firm between contractions deprives the fetus of recovery time and is reportable.
Why does the nurse encourage regular voiding during the first stage?
Show answer
A full bladder can impede fetal descent and increase discomfort, and it can be a source of distress that mimics or worsens labor pain. Regular voiding (or bladder monitoring per policy) supports progress and comfort.
A laboring person in transition becomes nauseated, trembling, and says, "I can't do this." What should the nurse do?
Show answer
Recognize and normalize transition — nausea, trembling, and "I can't do this" are classic transition symptoms and signs of progress. Keep the person focused through each contraction with breathing guidance, reposition, provide support, and reassure; then confirm progress with the provider and prepare for the second stage.
List three reportable findings from the first stage that require provider notification per policy.
Show answer
Any three, per the unit's policy: fever or abnormal vital signs, non-reassuring fetal heart rate patterns, vaginal bleeding, ruptured membranes with concerning fluid, signs of cord prolapse, a uterus that fails to relax (rising resting tone), or a sudden change in pain or coping. Report using structured communication (SBAR).
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- First stage of labor
- Onset of regular contractions until full cervical dilation
- Latent phase
- Early, mild, irregular contractions with slow cervical change
- Active phase
- Stronger, closer contractions with more rapid cervical change
- Transition
- Final intense portion of the first stage
- Dilation
- How far the cervix is open, in centimeters
- Effacement
- How thin the cervix has become, as a percentage
- Station
- Level of the fetal presenting part relative to the ischial spines
- Leopold's maneuvers
- Systematic abdominal palpation of fetal lie, presentation, position
- Resting tone
- Uterine softness between contractions
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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