Stages of Labor on the NCLEX
The four stages of labor, the three phases of stage 1, and nursing care for each.
NCLEX tests the stage boundaries by the numbers and the nursing priority inside each one.
Stage 1: onset to full dilation
Latent (0-3 cm): mild contractions every 5-30 min. Mother talkative. Encourage ambulation, teach breathing. Active (4-7 cm): contractions every 3-5 min, stronger. Pain management, encourage voiding every 2 hours (a full bladder impedes descent). Transition (8-10 cm): contractions every 2-3 min, intense. Mother irritable, may say she cannot go on. Urge to push before full dilation → pant or blow, do not push (risk of cervical edema).
Stage 2: full dilation to birth
Pushing stage. Support open-glottis pushing with contractions, rest between. Monitor FHR with every contraction or per protocol. Watch for crowning and support the perineum.
Stage 3: birth to placenta
Usually 5-30 minutes. Signs of separation: gush of dark blood, lengthening cord, uterus rises and becomes globular. Do not pull the cord. Oxytocin is typically given after delivery of the placenta to contract the uterus.
Stage 4: the first hours after delivery
The highest-risk window for postpartum hemorrhage. Fundus and lochia every 15 minutes for the first hour per protocol. Fundus should be firm, midline, at or below the umbilicus. Boggy fundus → massage first.
Frequently asked
How do I tell true labor from false labor?
True labor produces cervical change. Contractions get stronger, closer, and regular, and walking intensifies them. Braxton Hicks are irregular and ease with rest or hydration.
Why no pushing before 10 cm?
Pushing against a partially dilated cervix causes cervical edema and can tear the cervix, which slows labor. Coach panting through the urge.
When is the fetal monitoring frequency highest?
Second stage. Assessment frequency increases with each stage; follow facility protocol for exact intervals.
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