Thứ Ba, 18 tháng 12, 2012

Pregnancy, Babies, and Birth: The Stages of Labor

There is a common misconception that being in labor=having contractions.  True labor, however, is when you are progressing towards giving birth; meaning that your cervix is changing (either effacing or dilating progressively).  Pregnant women can start having "practice" contractions, also known as Braxton Hicks contractions, as early as the second trimester, but this doesn't necessarily mean they are in labor.  Labor itself is divided into three separate stages:

  • First Stage: This is the stage of labor that we most commonly associate with "being in labor."  This stage starts when contractions cause progressive changes to the cervix and ends when you are completely dilated and effaced.  The first stage is often divided into 3 phases: early labor, active labor, and transition.  Early labor is when your cervix gradually begins to dilate (widen) and efface (thin out); usually between 0-4 centimeters (cm) dilated.  Active labor is when contractions come on stronger and closer together; usually between 4-7 cm dilated.  Transition, which is the most difficult and painful part of labor, is when you have the most intense contractions and your body moves from 7-10 cm dilated (10 cm is fully dilated).  You may notice an increase in mucusy discharge from your vagina that may be tinged with a small amount of blood.  This is completely normal and is known as "bloody show."  This is your body shedding your mucus plug, the literal plug of your cervix that developed to help keep foreign particles out of your uterus while your baby grew.  Additionally, your water may break at this point, either in a gush or a slow trickle.  If your water breaks, call your care provider immediately and ask when he/she wants you to go to the hospital.  Most providers will want to have you come in right away after your water breaks.
    • Early labor can sometimes be difficult to distinguish from the Braxton Hicks contractions that you may have been having for several weeks now.  You will be able to tell the difference between false labor and true labor by monitoring your contractions.  True labor contractions will become longer, stronger, and closer together and they will not go away with a change in position or change in activity.  False labor contractions are irregular and sporadic and will oftentimes diminish or go away completely if you change your activity (If you are laying down, get up and walk around.  If you are walking around, lay down on your side).  As you approach the end of your pregnancy, talk to your doctor about recognizing signs of true labor and when he/she wants you to head to the hospital.  If you've had a healthy pregnancy, expect to go through early labor at home.  Most providers will have you rest comfortably at home until your contractions get to a specific frequency and duration (usually between 3-5 minutes from the start of one contraction to the start of another and usually lasting about 30-60 seconds for each contraction).  It's important not to wear yourself out during early labor because you'll need all the strength and endurance you can get for the later stages of labor.  Avoid strenuous activity and even try to sleep in between contractions if you can.  Also, stay hydrated and empty your bladder often because a full bladder may impair the ability of your uterus to contract as much as it needs to.
    • Active labor is when things really get rolling!  If you haven't already gotten to the hospital, get there as soon as you can.  At this point, most women who are going to have a medicated birth will be in enough pain that they will ask for an epidural or other medications.  Baby may start descending into the birth canal now, but may not get all the way down into the position he/she needs to be in for the pushing stage until after transition.
    • Transition is the most intense part of labor for most women, but also the shortest phase of the first stage.  At this point, your contractions may be occurring very frequently and lasting a long time (sometimes only 30 seconds apart and contractions lasting up to 90 seconds).  You may begin to shake, shiver, or feel nauseated and vomit at this point as well.  If you are trying for an all natural birth, you may begin to lose faith in your ability to manage the pain.  Reach out to your support person for extra coaching and support and focus on getting through one contraction at a time.  If you change your mind or find that the pain is too intense, consider your backup plan (medications that you may be comfortable with).  Having a medicated birth does not make you any less of a woman or your birth experience any less important!  Do what is right for you, whether that be pushing through transition med-free or choosing pain relief through medication.  Additionally, you may begin to feel some rectal pressure as your baby gets lower in the birth canal.  Some moms report the beginnings of the urge to push, but it is important to avoid pushing until your nurses/doctor gives you the okay.  The cervix needs to be completely dilated and effaced and baby needs to be in the right position in the birth canal before any pushing is beneficial.  Pushing before your body is ready will only wear you out and sap you of whatever energy you have left.

  • Second Stage: From the point that your cervix is completely dilated and effaced to the point where you actually give birth to your baby is the second stage of labor.  This is often referred to as "the pushing stage" because this is when women get to become a more active participant in the labor process as they push their baby through the birth canal.  Your contractions may slow down at this point, offering you a chance to get some much needed rest.  If your baby has not descended all the way into position yet, you may have a while before you are ready to push.  If baby has descended, you may feel pressure in you bottom and an urge to push.  Make sure to communicate this to your nurses.  You can choose to have your nurse coach you on when to push or wait until you feel the spontaneous urge to push.  With the combined effort of your contracting uterus and your abdominal muscles, your baby will slowly make his/her way down the birth canal.  For first time mothers, baby's descent through the birth canal is usual gradual, lasting about 1 hour.  It can feel like a slow, "two-steps forward and one step back" process.  But, eventually, your sweet little boy or girl will enter the world!

  • Third Stage:  The third stage of labor typically occurs about 5-15 minutes after the birth of your baby when the doctor delivers the placenta.  After the baby is delivered, the body receives a signal to detach the placenta from the uterine wall and through a series of contractions, the placenta is delivered in much the same manner as the baby.  Don't worry, this isn't like giving birth to another child!  Most of the time, mom is so elated and wrapped up in her new little miracle that she barely notices this part of labor.  The doctor may ask her to give one or two pushes to help deliver the placenta, but it is nowhere near as painful as the rest of labor.  After the placenta is delivered, your uterus will clamp down to stop up the blood vessels where the placenta was previously attached in order to prevent you from bleeding too much.  Your doctor or nurses will make sure your uterus continues to do this by checking and even massaging your uterus (by pressing down on your belly).  If you tore your perineum or had an episiotomy, your doctor will deliver a local anesthetic to the area and then stitch up the tear or cut. 

Every birth and every woman are different, so it's difficult to say exactly how long each stage of labor will last.  For most first time moms, it typically takes between 10-20 hours to go through all 3 stages of labor (some moms go quicker and others are in labor for much longer).  Similarly, each mom will spend different amounts of time in each stage of labor, but each stage should be progressively shorter than the last (first being the longest and third being the shortest).  Remember that birth can be a very unpredictable process, so be flexible in your expectations and be open to suggestions from your care team.  The most important result, regardless of the methods, is a healthy mom and healthy baby.


Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only.  It's intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves, with their partners, and with their medical care providers.  Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner.  Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist.  Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions.  We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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