Stages Of Labor
|Introduction To Labor
Scientists still do not really know what triggers labor, but it probably begins with hormones being emitted from the baby, which kicks off a chain reaction in the mother's body. Recognizing the signs of true labor and false labor are important for determining when you go to hospital (or when you call the midwife for those planning home births). Sometimes labor begins with the water breaking, this is when the sac protecting the fetus filled with amniotic fluid bursts. However in 75 percent of cases, this does not happen until the later stages of labor. Labor usually starts with mild contractions as the cervix begins to efface and dilate. Contractions become longer and closer together as labor progresses and cervix dilation increases. Finally the baby moves down into position for birth.
There are three stages of labor, and for a first-time mother, the three stages can last a total of 12 to 18 hours on average. It may be a little shorter for subsequent pregnancies (7 hours).
First Stage Labor: Active labor, where increasing contractions and dilation of the cervix take place and the baby moves into the birth canal in preparation for delivery.
The first stage of labor is the longest of the 3 stages. In fact, it is so long, experts divide it into 3 more phases! All women who have a natural vaginal birth go through these 3 phases, and the only time it is cut short, is when a C-section delivery is performed. As a pregnant woman proceeds through the phases, contractions become faster and longer, the cervix dilates until it is finally fully dilated at 10cm and the baby moves into the birth canal ready for birth.
Phase 1. Early Labor: Effacement and dilation of the cervix up to 5cm. Contractions are 30 to 45 seconds long and 20 minutes apart.
Early Labor (Phase 1)
When Does Early Labor Happen?
Labor technically begins with effacement of the cervix and beginning of uterine contractions. When exactly this will happen is impossible to guess (unless of course your doctor decides on labor induction). On average, a pregnancy lasts 266 days (38 weeks) from conception. Babies are considered full-term after week 37 but are not overdue until after week 42. So you are likely to go into labor any time between weeks 37 and 42 of pregnancy.
How Long Does Early Labor Last?
This is usually the longest, but fortunately less painful phase of labor. Every woman is different. Typically this phase may last up to 8 hours, although some women experience early signs of labor for days. This phase is usually quicker for repeat mothers.
What Happens During Early Labor?
Contractions are mild to moderately strong, and gradually occur closer together, but not necessarily consistently. Many women are still able to do regular activities in this phase, like watching movies, cooking and household chores. In fact, it is good to do anything that will help you to relax. Start timing your contractions from the beginning of one to the beginning of the next. If they start to occur 10 minutes apart (even periodically), then you are moving closer to Active Labor.
What May Happen: You may experience lower backache, like a constant contraction. Also common symptoms are: pregnancy cramps (like a period), lower abdominal pain, indigestion and diarrhea. In a percentage of cases, some women's water will break, but this is more usual in phase 2, Active Labor.
When To Call The Midwife
Generally speaking, there is no need to call the midwife or head to hospital until you have reached Active Labor (phase 2). However, do call if your waters have broken and the amniotic fluid is greenish and murky, or if there is bright red vaginal bleeding indicating possible pregnancy complications. There are many causes for bleeding during pregnancy although it usually more of a concern in the third trimester. Also call if you feel no fetal activity. For a first pregnancy, women are generally advised to call their clinician when contractions have been 5 to 7 minutes apart and 30 seconds long for an hour. In subsequent pregnancies, the call should be made earlier, when the contractions are 7 to 10 minutes apart.
How Long Does Active Labor Last?
Usually much shorter than the Early Labor phase, Active Labor lasts on average 2 to 4 hours. You are likely to be in hospital or at your birthing center by now.
What Happens During This Phase?
This is where the real work begins and where all those birthing classes will finally pay off! Contractions come closer together and for longer. They also become more intense (read: painful!). The cervix dilates up to 8cm.
What May Happen: If you have not received an epidural for pain relief, you will feel increasing pain with the contractions. You may not be able to talk through them at this stage. Try to remember the relaxation techniques you learned in birthing class, or look to your labor coach for encouragement. Your back may ache considerably and your legs may feel heavy. You can also experience fatigue. If your waters have not already ruptured, they may have to be artificially ruptured now.
Midwife Role During Active Labor
Assuming the birth is progressing normally, your medical team will leave you alone for most of active labor. They will return regularly to take your blood pressure, monitor the baby with a Doppler or fetal monitor, and time your contractions. They will also check your cervix for dilation. If you are planning on an epidural, they will put an IV in place. Don't be afraid to ask for pain relief early. An epidural can be given as soon as you feel you need it.
What Should I Do During Active Labor?
Try to Relax: I know, easier said than done! This is particularly important if you are laboring without pain relief. As the contractions become stronger, your energy supplies will become increasingly depleted. Try to focus on the relaxation techniques you learned in birthing class. Practice your breathing exercises.
Rock on a birthing ball or take a warm shower or bath.
How Long Does Transitional Labor Last?
Fortunately because it is the most intense phase, Transitional Labor is the quickest part of labor. On average it can take 15 minutes to half an hour, although it can last as long as 4 hours.
What Happens During This Phase?
What May Happen: If you have not been numbed with an epidural, you will feel intense pain with the contractions. Also, increased lower back pain and rectal pressure/ perineum pain. You may alternate between feeling hot and cold and experience nausea or vomiting. Your legs may cramp and your chest constrict. And if that's not enough, you will probably be overcome with complete exhaustion. Try to stay focused though, you are almost there!
Midwife Role During Active Labor
When you are fully dilated, you will be moved to a delivery room if you are in a hospital. If you are in a birthing bed, the bottom of the bed will be removed in preparation for delivery.
Next see 2nd and 3rd Stages of Labor: Delivery and Childbirth
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