Medical textbooks divide labor into three distinct stages. In stage one, the cervix dilates (opens) and effaces (thins), allowing the descent of the baby toward birth. During labor's second stage, the baby passes through the birth canal and is born. The third stage involves the delivery of the placenta. Clearly these stages are not equal in time or intensity and every birth will follow its own pattern-one not necessarily found in a textbook.
The first stage of labor rarely begins with a dramatic flourish. Over the last few weeks of pregnancy, the cervix has been gradually ripening and softening. Uterine contractions are occurring during this time. Some may be strong, some barely noticeable, but each is preparing your body for the actual onset of labor.
In the first stage of labor, the cervix will dilate from closed, which is its normal state, to fully open at ten centimeters in diameter. To help you envision this opening, one centimeter is about the diameter of a single Cheerio. Three centimeters is the diameter of a banana. Five centimeters is the diameter of a small apple and ten centimeters is the diameter of a bagel.
Stage one can be divided into early labor (dilation up to 4 cms.) and active labor (4 cms. to 8 cms.). Contractions in early labor become regular in their occurrence-from 10 to 20 minutes apart and lasting 30-60 seconds. Contractions are measured from the beginning of one to the beginning of the next. During this early phase of labor, you may feel excited and nervous now that the moment that you have been waiting for has finally come. You may want to rest, walk, shower, or eat lightly. It is very important to keep hydrated by drinking lots of water and juice. You may experience leaking of amniotic fluid or "show", the expulsion of the plug-which may be stained with blood-that has kept the cervix sealed.
You will know that you are in active labor when your contractions become regular and form a pattern of increasing frequency. They will not stop with change of movement or position and they become progressively stronger. You may handle these contractions with simple, regular breathing patterns. As these things begin to happen, you will want to contact your caregiver and decide when to go to the hospital, where you will probably spend the active phase of the first stage of labor.
In this active phase, your cervix will continue to dilate from 4 cm. to about 8 cm. There is no certain time frame for this progression, although early labor may last about 8 hours in a first-time mother. Active labor is usually shorter, but more intense. Its contractions will be about 3 minutes apart and will last 45-60 seconds. It is during this phase that some women request pain relief. You may want to discuss your options with your caregiver before you are in labor. Discomfort can often be helped by body positions that allow gravity to speed dilation, such as walking, squatting, kneeling forward on a chair or birth ball, or lying on your side. The continuous support and encouragement of a partner or doula can be of enormous importance during this time.
Though labor may be difficult at this point, you are getting close to the birth of your baby as you enter that final phase of stage one, known as transition. During this time your cervix will dilate from 8 cm. to 10 cm., often quickly. Your contractions will be about 2 to 3 minutes apart and last 60-90 seconds. This is your body's last effort to open the cervix fully to allow for birth. You may be irritable and feel shaky or nauseated. Your hormones are working with your baby's at full speed to prepare for delivery.
You have finally arrived at the second stage of labor-the birth. Your body will feel the urge to push the baby out and you will bear down in order to bring your baby into the world. The baby's head will appear as the baby is "crowning" and your medical attendants will guide you through the last few pushes to deliver your child.
Anywhere from 5 minutes to 1 hour after your baby is born, you will complete the third stage of labor by delivering the placenta and membranes that have nourished and contained your baby throughout your pregnancy. These contractions are milder and occur as you are marveling at your child and feeling the support of your loved ones and caregivers.
However these stages progress, your experience will be unique to you and your child and will be the beginning of a beautiful new stage in the life of your family.