OB-GYN Review: Labor Stages, Fetal
Monitoring (VEAL CHOP), and
Postpartum Assessment
1. Stages of Labor
Labor is divided into three main stages, each with clear physiological events and
nursing considerations.
1.1 First Stage of Labor: Cervical Dilation
• Duration: Onset of regular contractions to full cervical dilation (10 cm)
• Phases:
1. Latent Phase:
▪ Cervix 0–3 cm dilated
▪ Contractions mild to moderate, 5–30 min apart
▪ Nursing focus: Educate, provide comfort, encourage ambulation
2. Active Phase:
▪ Cervix 4–7 cm dilated
▪ Contractions moderate to strong, 3–5 min apart
▪ Nursing focus: Monitor FHR, assess labor progress, provide
analgesia
3. Transition Phase:
▪ Cervix 8–10 cm dilated
▪ Contractions strong, 2–3 min apart, 60–90 sec
▪ Nursing focus: Emotional support, prepare for delivery, monitor
for complications
1.2 Second Stage of Labor: Expulsion
• Duration: Full dilation to birth of the baby
• Characteristics:
o Strong, frequent contractions
o Urge to push (Ferguson reflex)
, o Nursing focus: Encourage effective pushing, monitor FHR, maintain
maternal positioning
• Delivery: Vaginal birth of infant
1.3 Third Stage of Labor: Placental Delivery
• Duration: After birth of infant to delivery of placenta
• Signs of Placental Separation:
o Lengthening of the umbilical cord
o Gush of blood
o Uterus rises in abdomen
• Nursing focus: Assess for bleeding, fundal massage, administer oxytocin as
prescribed
1.4 Fourth Stage of Labor: Recovery
• Duration: 1–4 hours after birth
• Focus:
o Monitor maternal vital signs
o Assess for postpartum hemorrhage
o Encourage bonding and breastfeeding
2. Fetal Monitoring: VEAL CHOP
Fetal heart rate (FHR) monitoring is crucial to assess fetal well-being during labor.
Use the mnemonic VEAL CHOP:
FHR Pattern Meaning Nursing Intervention
Variable Cord Reposition mother, give oxygen,
decelerations compression amnioinfusion if ordered
Early Head Usually benign; continue to monitor,
decelerations compression supportive care
Okay /
Accelerations Normal, no intervention needed
Reassuring
, FHR Pattern Meaning Nursing Intervention
Late Placental Stop oxytocin, reposition mother, oxygen,
decelerations insufficiency notify provider, prepare for possible delivery
Key Points:
• Variable decelerations: “V” = “C” → cord compressed, abrupt drop in
FHR
• Early decelerations: Mirror contractions, usually not dangerous
• Accelerations: FHR rises above baseline, reassuring
• Late decelerations: Begin after contraction, ominous sign, requires
immediate action
3. Fetal Heart Rate Categories
Category FHR Pattern Clinical Significance
110–160 bpm baseline, moderate
Category I Normal, reassuring
variability, +/- accelerations
Indeterminate; minimal/absent
Category II Needs continued monitoring
variability, variable decels
Absent variability + recurrent Non-reassuring; immediate
Category III
late/variable decels or bradycardia intervention required
4. Postpartum Assessment
The “BUBBLE-HE” mnemonic helps structure postpartum assessment:
Letter Assessment Focus
B Breasts – check for engorgement, nipple cracks, lactation issues
U Uterus – fundal height, tone, midline position
B Bladder – urinary output, retention, infection
,Letter Assessment Focus
B Bowels – bowel sounds, constipation, flatus
L Lochia – amount, color, odor, consistency
E Episiotomy/Laceration – redness, swelling, drainage, approximation
H Homan’s sign / Hemorrhoids – DVT risk, anal comfort
E Emotional status – mood, bonding, postpartum depression signs
Vital Signs & Pain:
• Check every 15 min in first hour, then every 30–60 min
• Monitor for postpartum hemorrhage: >500 mL (vaginal) or >1000 mL
(cesarean)
Nursing Interventions:
• Encourage early ambulation to prevent DVT
• Promote breastfeeding support
• Educate mother about self-care and warning signs
5. Key Labor & Fetal Monitoring Tips for Students
• Contraction Timing: Note frequency, duration, intensity
• Document FHR: Before, during, after contraction
• Repositioning: Left lateral recumbent for fetal distress
• Oxygen: 8–10 L/min via face mask for non-reassuring FHR
• Communication: Notify provider immediately for Category III tracings
6. Quick Reference Table: Labor Stages &
Interventions
Stage Duration Key Signs Nursing Actions
Encourage ambulation,
1 – Latent 0–3 cm Mild contractions
education
, Stage Duration Key Signs Nursing Actions
1 – Active 4–7 cm Moderate contractions Monitor FHR, analgesia
1– Strong contractions, urge Emotional support, prepare
8–10 cm
Transition to push delivery
Full dilation to
2 Pushing, crowning Assist delivery, monitor FHR
birth
Cord lengthens, gush of Monitor bleeding, administer
3 Birth to placenta
blood oxytocin
Monitor vitals, fundus,
4 1–4 hr post-birth Recovery, bonding
lochia, pain
7. Common Labor Complications & Nursing
Management
Complication Signs/Symptoms Nursing Interventions
Cervix not progressing Monitor FHR, assess contractions,
Prolonged Labor >12 hr (primipara), >8 hr position changes, oxytocin as
(multipara) ordered, hydration
Encourage ambulation, hydration,
Dystocia / Weak or uncoordinated assist with ambulation, prepare for
Dysfunctional Labor contractions, fatigue interventions (forceps, vacuum,
cesarean)
Fetal Malposition Maternal position changes (hands-
Back labor pain, slow
(e.g., OP - occiput and-knees, lateral), monitor FHR,
descent
posterior) assist with epidural if ordered
Monitoring (VEAL CHOP), and
Postpartum Assessment
1. Stages of Labor
Labor is divided into three main stages, each with clear physiological events and
nursing considerations.
1.1 First Stage of Labor: Cervical Dilation
• Duration: Onset of regular contractions to full cervical dilation (10 cm)
• Phases:
1. Latent Phase:
▪ Cervix 0–3 cm dilated
▪ Contractions mild to moderate, 5–30 min apart
▪ Nursing focus: Educate, provide comfort, encourage ambulation
2. Active Phase:
▪ Cervix 4–7 cm dilated
▪ Contractions moderate to strong, 3–5 min apart
▪ Nursing focus: Monitor FHR, assess labor progress, provide
analgesia
3. Transition Phase:
▪ Cervix 8–10 cm dilated
▪ Contractions strong, 2–3 min apart, 60–90 sec
▪ Nursing focus: Emotional support, prepare for delivery, monitor
for complications
1.2 Second Stage of Labor: Expulsion
• Duration: Full dilation to birth of the baby
• Characteristics:
o Strong, frequent contractions
o Urge to push (Ferguson reflex)
, o Nursing focus: Encourage effective pushing, monitor FHR, maintain
maternal positioning
• Delivery: Vaginal birth of infant
1.3 Third Stage of Labor: Placental Delivery
• Duration: After birth of infant to delivery of placenta
• Signs of Placental Separation:
o Lengthening of the umbilical cord
o Gush of blood
o Uterus rises in abdomen
• Nursing focus: Assess for bleeding, fundal massage, administer oxytocin as
prescribed
1.4 Fourth Stage of Labor: Recovery
• Duration: 1–4 hours after birth
• Focus:
o Monitor maternal vital signs
o Assess for postpartum hemorrhage
o Encourage bonding and breastfeeding
2. Fetal Monitoring: VEAL CHOP
Fetal heart rate (FHR) monitoring is crucial to assess fetal well-being during labor.
Use the mnemonic VEAL CHOP:
FHR Pattern Meaning Nursing Intervention
Variable Cord Reposition mother, give oxygen,
decelerations compression amnioinfusion if ordered
Early Head Usually benign; continue to monitor,
decelerations compression supportive care
Okay /
Accelerations Normal, no intervention needed
Reassuring
, FHR Pattern Meaning Nursing Intervention
Late Placental Stop oxytocin, reposition mother, oxygen,
decelerations insufficiency notify provider, prepare for possible delivery
Key Points:
• Variable decelerations: “V” = “C” → cord compressed, abrupt drop in
FHR
• Early decelerations: Mirror contractions, usually not dangerous
• Accelerations: FHR rises above baseline, reassuring
• Late decelerations: Begin after contraction, ominous sign, requires
immediate action
3. Fetal Heart Rate Categories
Category FHR Pattern Clinical Significance
110–160 bpm baseline, moderate
Category I Normal, reassuring
variability, +/- accelerations
Indeterminate; minimal/absent
Category II Needs continued monitoring
variability, variable decels
Absent variability + recurrent Non-reassuring; immediate
Category III
late/variable decels or bradycardia intervention required
4. Postpartum Assessment
The “BUBBLE-HE” mnemonic helps structure postpartum assessment:
Letter Assessment Focus
B Breasts – check for engorgement, nipple cracks, lactation issues
U Uterus – fundal height, tone, midline position
B Bladder – urinary output, retention, infection
,Letter Assessment Focus
B Bowels – bowel sounds, constipation, flatus
L Lochia – amount, color, odor, consistency
E Episiotomy/Laceration – redness, swelling, drainage, approximation
H Homan’s sign / Hemorrhoids – DVT risk, anal comfort
E Emotional status – mood, bonding, postpartum depression signs
Vital Signs & Pain:
• Check every 15 min in first hour, then every 30–60 min
• Monitor for postpartum hemorrhage: >500 mL (vaginal) or >1000 mL
(cesarean)
Nursing Interventions:
• Encourage early ambulation to prevent DVT
• Promote breastfeeding support
• Educate mother about self-care and warning signs
5. Key Labor & Fetal Monitoring Tips for Students
• Contraction Timing: Note frequency, duration, intensity
• Document FHR: Before, during, after contraction
• Repositioning: Left lateral recumbent for fetal distress
• Oxygen: 8–10 L/min via face mask for non-reassuring FHR
• Communication: Notify provider immediately for Category III tracings
6. Quick Reference Table: Labor Stages &
Interventions
Stage Duration Key Signs Nursing Actions
Encourage ambulation,
1 – Latent 0–3 cm Mild contractions
education
, Stage Duration Key Signs Nursing Actions
1 – Active 4–7 cm Moderate contractions Monitor FHR, analgesia
1– Strong contractions, urge Emotional support, prepare
8–10 cm
Transition to push delivery
Full dilation to
2 Pushing, crowning Assist delivery, monitor FHR
birth
Cord lengthens, gush of Monitor bleeding, administer
3 Birth to placenta
blood oxytocin
Monitor vitals, fundus,
4 1–4 hr post-birth Recovery, bonding
lochia, pain
7. Common Labor Complications & Nursing
Management
Complication Signs/Symptoms Nursing Interventions
Cervix not progressing Monitor FHR, assess contractions,
Prolonged Labor >12 hr (primipara), >8 hr position changes, oxytocin as
(multipara) ordered, hydration
Encourage ambulation, hydration,
Dystocia / Weak or uncoordinated assist with ambulation, prepare for
Dysfunctional Labor contractions, fatigue interventions (forceps, vacuum,
cesarean)
Fetal Malposition Maternal position changes (hands-
Back labor pain, slow
(e.g., OP - occiput and-knees, lateral), monitor FHR,
descent
posterior) assist with epidural if ordered
