NCP LABOR: Stage I—Active Phase

As contractions increase to moderate intensity in the active phase, and as the cervix dilates from 4 to 8 cm, the client becomes more involved and focused on the labor process. The active phase lasts approximately 1–2 hr in the multipara and 3–4 hr in the nullipara. The fetus descends in the birth canal at approximately 2 cm/hr in the multipara and 1 cm/hr in the nullipara.

CLIENT ASSESSMENT DATA BASE

Activity/Rest

May show evidence of fatigue

Ego Integrity

May appear more serious and absorbed with labor process
Apprehensive about ability to control breathing and/or perform relaxation techniques

Pain/Discomfort

Contractions are moderate, occurring every 2.5–5 min and lasting 45–60 sec.

Safety

Fetal heart tones (FHTs) detected slightly below umbilicus in vertex position
FHR variability and periodic changes commonly noted in response to contractions, abdominal palpation, and fetal movement

Sexuality

Cervix dilates from approximately 4–8 cm (1.5 cm/hr multipara, 1.2 cm/hr nullipara).
Moderate amount of bloody show present.
Fetus descends to 11–12 cm below ischial spines.

NURSING PRIORITIES

1. Promote and facilitate normal progression of labor.
2. Support client’s/couple’s coping abilities.
3. Promote maternal and fetal well-being.