Stages of Labor
Having a baby is one of the most exciting experiences of your life. It can also be quite stressful if you do not know what to expect. One of the most important items on your list of things to do should be taking a childbirth education class. Childbirth education classes will help you prepare for the birth of your baby by providing an overview of what you can expect from your body, your health care service providers and from your baby during this time. You will learn about options to increase your comfort and reduce anxiety, such as using a labor doula. Knowing your options and being prepared will result in a birth that is more productive, more comfortable, and faster.
One of the first items addressed in childbirth education classes is what to expect during the different stages of labor. Labor occurs in three stages. The first stage of labor is divided into three separate phases: the early phase, active phase, and the transitional phase. The second stage is pushing and delivering the baby, and the third stage is the delivery of the placenta.
In the first stage of labor during the early phase, you may begin to experience back ache and mild labor pains that are irregular at first. You will lose your mucous plug, which will lead to an increase in vaginal discharge with bloody streaks; that is called "show" and results from small capillaries opening from the stretching and thinning out of the bottom of the uterus, the cervix. For most women, this stage is fifteen to twenty hours long with a first birth. The cervix will soften and efface (or thin out) and dilate (or open). The best way to imagine this process is to think of popping a lifesaver into your mouth. Feel with your tongue how thick the middle is and how small the center opening. If you felt that lifesaver ten minutes later, the middle would be very thin and the opening much wider. The same thinning and opening occurs at the cervix. You may also have loose stools and menstrual-like cramping.
However, very little intervention is needed at this time, just rest and hydration. You can stay at home or wherever you are most comfortable in the early phase, when you may feel excited and very sociable. Do remember to empty your bladder frequently though, because a full bladder makes it more difficult for your uterus to do its job, and an empty bladder gives more room for the baby's passage out. If your contractions begin earlier than the thirty-seventh week of your pregnancy (or three weeks prior to your due date), it is important to call your health care service provider, rest, hydrate and keep your bladder empty. If you have an increase in your bleeding, if you have constant abdominal pain or if your membranes rupture, in each case, you should call your health care service provider and go to the hospital.
Gradually, the backache and cramping will become stronger and last longer. Generally, healthcare providers agree that when the contractions occur every five minutes and last sixty seconds, it is time for you to leave for the hospital. Be sure to ask your own doctor or healthcare provider when he or she believes the contractions are coming fast enough to warrant going to the hospital.
By this point, you will be in active labor. In active labor, there will be an increase in "show" and an increase in the strength and duration of the contractions. In the early phase, your cervix dilates from zero to three centimeters ("cm"). In the active phase, the effacement continues, and you progress from four to eight cm. The contractions are now closer together, about every two-and-one-half to four minutes, and stronger in intensity. They can last forty-five to sixty seconds or longer. When the contraction occurs, you become more inward and less talkative because you need to concentrate on the work at hand. Now you will begin to use the skills you have learned in classes, including position changes, slow deep breathing, concentration, and relaxation. Warm showers and the birth ball may offer comfort (providing you don't have any medical or obstetric complications), along with music and massage. Ice packs or cold packs, or a combination of both, can be soothing. It is important to stay as relaxed as possible both to conserve energy and to help your body do what it needs to do. Nausea and vomiting can occur at this time, and your nurse and caregiver can provide you with medication if you wish. This phase of labor can last as little as three hours and as long as eight hours.
The next phase of labor is transition, which is the most difficult but the shortest phase of labor. During transition, the cervix dilates to ten cm. Your contractions come one right after the other and are very strong; sometimes having two peaks. You may feel hot one minute and cold the next, and you may feel irritable and overwhelmed. The massage and touching that were so welcome in the last phase can now be very irritating to you; however, having your feet rubbed or your hands massaged can bring some relief. Cool wash clothes can be very helpful at this time as well. Transition can last from fifteen minutes to three hours. You have the option of medication for pain, and the nurses will assess you frequently to see to your needs. At the end of this stage of labor, some women experience a resting phase prior to the onset of the pushing stage.
The pushing stage starts when you are ten cm. dilated. Your caregiver or nurse does a vaginal exam at this time to make sure that it is safe for you to push. Pushing too early may cause swelling and a longer labor. Most women feel an overwhelming urge to push, but some do not. Your caregiver guides you if you do not feel the urge. Pushing while letting out a small amount of air can be very effective. To use this method, imagine you have a candle at arms length. Blow just hard enough to make the flame flicker, but don't blow it out.
During the pushing stage, you may be able to push two to three times per contraction. Now is a good time to ask for a mirror because it helps you know which muscles to use during pushing. During the resting period between each push, you may feel the baby slip back slightly, which is normal. It's like a car trying to get out of an icy spot: your car slips back a little with each attempt to move forward, but overall each time you try to move, you make more headway. As in labor, a variety of positions can benefit the pushing phase. This stage may be complete in as little as three pushes, but can last up to three hours. You feel a lot of pressure, including considerable rectal pressure as the baby's head pushes down on your rectum. Your perineum, the area between the bottom of the vaginal opening and your rectum, begins to stretch, which causes a burning or stinging sensation.
When the baby's head starts to emerge, the staff encourages you to give slow small pushes to avoid tearing your vaginal opening. Once your baby's head emerges, the doctor asks you to stop pushing so that he/she can suction out the baby's nose and mouth. The baby's shoulders come next, quickly followed by the rest of his/her body, at which point you feel an overwhelming sense of relief and happiness.
Once the baby is born, the cord is cut; that does not hurt you or the baby as there are no nerve endings in the cord. The baby is placed on your abdomen or under a warmer and is simultaneously stimulated to cry and dried by the nurse. If you are going to breast feed, this is the best time while your baby is in the quiet and alert stage just after birth.
The last stage of labor is the delivery of the placenta, which sometimes takes from five minutes to a half hour after the birth. The contraction is mild, and after delivery, your care giver checks the placenta to make sure that it appears healthy and intact. If you need any repair of tears, the doctor gives you a local anesthetic for pain.
Once you deliver the placenta, the birth is over. And now your life really begins! I always tell my patients that they do not know alive until someone puts that baby into their arms. It is a beautiful, wondrous, and magical time.
