If you are reading this article in preparation for the birth of your baby, congratulations! During the days leading up to your labor and birth, so many important preparations are happening for you and your baby, getting the two of you ready for the important and joyful journey you are about to begin together. Hopefully, you and your birthing partner have attended childbirth preparation classes, and perhaps you have also hired a labor doula to be with you as you labor and birth.
The following explanation of the stages of labor will hopefully guide you as you enter in the final hours before you see your newborn, and start your journey of life together.
The Preparation Stage:
Many women experience the ‘practice contractions’, also know as Braxton Hicks contractions, for weeks leading up to their time of labor. These periods of time when the uterus tightens and loosens may be hardly noticeable, or bothersome and uncomfortable. The job of these practice contractions is to start the process of thinning out the thick cervix so that it may eventually dilate, gently push the baby’s head further down into the pelvis, bring your uterus into a forward tilt. During this stage, you may experience an increase in your vaginal discharge, lower back pain, a feeling of looseness in the pelvis and may find yourself going to the bathroom even more than before. For some women, this part of early labor can be very subtle, or very uncomfortable. Talk with your midwife or doctor if you are unsure about the beginning of real labor, or if you need reassurance about what is going on.
The First Stage of Labor:
Dilation Phase
Eventually, the contractions, or rushes, will settle into a more predictable pattern, perhaps every 15-20 minutes for a few hours. Some women even bypass this part of the first stage of labor and go right to a predictable pattern of contractions every 5 minutes. Contractions during this time will last anywhere from 15 seconds to 90 seconds. The longer they last, the more likely they are to be uncomfortable. You may feel more pressure at this point as the baby’s head comes lower and lower into your pelvis.
This period of time when the uterus is settling into a pattern is known as the latent phase of labor. For some women, this part of labor can last a few hours, or a couple of days. The most important things that a woman can do in this part of labor is rest as much as possible between the contractions, surround herself with people who love and support her, drink plenty of healthy fluids, eat to appetite, experiment with lots of different positions (mobility is the key to helping the baby come down into the pelvis), shower, bathe in relaxing water, and rest some more. We often tell women who are starting a regular contraction pattern to go back to sleep if it is the middle of the night and the baby is moving well. This phase of labor is over when a women’s cervix reaches 4 centimeters of dilation and is thinned out 100% (fully effaced).
In a healthy pregnancy, these first hours of labor are best spent at home where a woman may rest and be surrounded by those who love and support her.
Active labor is the period of time when the cervix is opening from 4 centimeters dilated to 10 centimeters of dilation. During these hours, the baby’s heartbeat is checked for normal reactions to contractions. During the last part of the active phase of labor, sometimes known as the transition phase, contractions may increase in frequency to every two to three minutes, and will increase in length. Women will feel an increase in pressure, back pain, may shake and vomit, and may feel a strong urge to push because of the pressure of the baby’s head on the rectum. Strong emotions can surface during this part of labor, especially doubt in the ability to birth and fear of the unknown.
The Second Stage of Labor:
Dilation Phase
Once a woman’s cervix is dilated to 10 centimeters, she enters what is known as the pushing phase of labor. Remember that just because a woman is ‘fully dilated’ does not mean that she will have a strong urge to push her baby out. Women sometimes fall asleep for a while after reaching full dilation just to recuperate their strength for the pushing part of birth. As long as mother and baby are fine, there is no need to intervene. Some women don’t feel an urge to push for several minutes and providers can actually interfere with important communication between mother and baby by telling a woman to push before she feels the urge to do so.
There are many positions in which to push. Women laboring in water and intending water birth push while submerged. Women may choose to push standing up, on hands and knees, squatting, or on their left sides. Few women will get on to their backs with their legs extended up unless told to do so – they seem to instinctually know this is not the best position in which to birth.
As long as mother and baby are fine, there should be no stringent time rules on the time it takes to push a baby out. Big babies weighing over 8 lbs. take longer to push out – this is only logical! Once the baby’s head starts to emerge, and any umbilical cords around the neck are lifted off, and the shoulders are born, this is a great opportunity for the new mother to reach down and lift her own baby out from her body with assistance from her partner.
The Third Stage of Labor:
Delivery of Placenta
After the baby is born, the baby continues to receive important blood from the mother though the umbilical cord. She usually feels a cramping in her uterus after a few minutes, signaling the readiness for the expulsion of the placenta, or afterbirth. For most women, this occurs between 10 and 30 minutes after the baby. This stage of labor progresses most smoothly when a mother pushes out her placenta with very gentle traction, or gets into a squatting position and delivers the placenta from an upright angle. After the placenta comes, her uterus is gently massaged. During this time, her midwife or doctor will also inspect her vagina and perineum carefully to see if there is any need for repair.
The Fourth Stage of Labor:
Postpartum Recovery
The postpartum period is when you body starts its long process back to pre-pregnancy reality, and when you start the incredibly joyful and exhausting work of becoming a parent, is generally called the fourth stage of labor.
During all the preparation stages, the work of labor, the joy of birth, and the challenges of parenting, remember that your body was designed to birth, and that your baby knows how to be born. Allow as many of the processes of natural labor and birth to occur as you can, and your rewards will be many. Seek help from health care providers who believe that pregnancy and birth are normal, natural processes and not pathological in nature, and surround yourself with loved ones who believe in you and your ability to move through the stages of pregnancy, labor, and birth as the empowered woman you are!