Labor and delivery are often spoken of as a continuous process from the time the water breaks until the baby is born. There are however stages of childbirth that are separate and distinct. Each has it’s own characteristics during which the body goes through specific changes to prepare for the birth of the new child.
Research has shown that expectant mothers who learn about the stages, prepare for the expected pain management and have a supportive coach during the process have a more a positive experience during labor and delivery of their new child.
Compared with nine months of pregnancy and a lifetime of being a parent the hours spent delivering the baby is only a drop in the bucket. However, if those long and hard hours of labor and delivery are personal then the panting, pushing and recovery may not seem as minute.
These hours represent a time between life Before meeting this new person and the time After being introduced to this little child who will be the focus of attention, concern, worry and joy for years to come. This may be an experience anticipated with trepidation but it is one that is like no other – filled with joy and a mental, physical and emotional rush that is reserved only for women who have had the privilege of giving birth.
Labor for women can take between hours to a few days the normal active labor of a first time mom is 14 hours and then 8 hours for second time moms and beyond. The practitioner will not allow active labor to progress for several days in order to protect the health of the baby and mother – so there is no need to be concerned about laboring for days on end.
Two things help women to get through these hours – the first is keeping an eye on the prize at the end of the process. The new little baby resting in tired arms will be a reward that can’t even be described adequately. And secondly – being prepared with the process will help to decrease the amount of surprise and stress that may be anticipated.
The 3 Stages of Childbirth
Stages of childbirth happens in threes – three stages of birth are:
- delivery of the placenta
The three stages of labor are early, active and transitional. To get past the first stage of child birth from labor to delivery a women must first travel through the first three stages of labor. Let’s start with those first three stages.
Prior to the time when a woman may experience labor she should communicate with her practitioner to find when they would like her to go to the hospital. If it is a first time pregnancy the recommendations may be different than if it is a second pregnancy.
The 3 stages of Labor: Early Labor
In the first stage of labor – or the early stage – the uterus begins to contract about every 10 –15 minutes and are regular in nature. But, unless labor starts very suddenly (like in the television shows!) and you go from 0 contractions to one every 10 minutes, you may not be able to pinpoint when early labor really started. Early contractions are sometimes hard to distinguish from Braxton-Hicks contractions or so called false labor. These contractions aren’t efficient and don’t cause the cervix to dilate or efface – the first step in labor.
During the early stage the contractions of the uterus cause the cervix to efface or thin and then start to dilate. In some women the cervix is more ‘ripe’ or ready to move through the thinning process more quickly while others – usually first time moms – find that the early stage of labor can last about 8 hours.
The thinning or effacement of the cervix can be compared to the cervix going from a strong muscular closure to one that is soft and springy. Feel the tip of the nose and notice that it is hard without much give. Now compare that to the springiness and softness of the lips around the mouth. During the early stages of labor the cervix will go from a hard muscle to one that is soft and springy over a period of 8 hours to a week.
These early labor pains may not be noticed by the expectant mother until the last 2 to six hours of early labor. It isn’t uncommon for women to be seen in the doctors office 2 cm dilated and 50% effaced without having prior knowledge.
CAUTION: if the expectant mother is not yet 37 weeks and she notices signs of labor or contractions the caregiver should be called immediately to determine if this is pre-term labor and requires intervention. This is also a time when a woman may notice some blood tinged discharge from the vagina. This is called bloody show and should be very small amount of bloody discharge. If there is more than a slight amount the physician must be called because it can indicate a problem that must be addressed immediately.
As early labor continues to progress the contractions become longer, stronger and closer together. Every woman experiences labor differently, and it can be different from pregnancy to pregnancy. Even so most of the time the contractions, once noticed, in early labor last about 30 seconds and come every 10 minutes to 20 minutes. Most of the time the woman can continue to talk through them.
Women should conserve their energy in early labor for the later more active phases. If it’s nighttime try to sleep between contractions; if it is during the day rest, finalize the plans for the trip to the hospital, make sure the bag is completely packed or finish the laundry. Don’t get excited about timing these contractions because they may not even be regular. Time them every so often to be sure they aren’t coming closer together and be aware of whether they are getting stronger.
Early labor ends when the cervix is about 4 centimeters dilated and progress of labor begins to accelerate. This is when things really start to get rolling. Contractions become more frequent, stronger and most women notice a definite peak in the middle. The cervix begins to dilate faster through to 10 centimeters. Women can’t talk through these contractions.
At this point in the labor a woman should be at the hospital, birthing center or attended by a midwife. Contractions are lasting about 60 seconds and coming about every 2 to 3 minutes. This is a generalization because some women don’t have them closer than every 5 minutes through out all of labor.
Stages of Labor: Active Labor
The length of time a woman is in active labor can vary greatly. The average is about six hours from 4 centimeters to full dilation. Medical intervention can either speed that time (if she is getting pitocin) or delay it (if she uses an epidural). This is the time to use breathing techniques and relaxation methods to help pain management. It is also the time to use an epidural if it is chosen.
At this time the woman should do her best to stay relaxed. Stress and anxiety will actually release hormones that will delay the labor and progress of the labor. Ask the coach for what is needed to help – washcloths, massages, change of position, or back rub. The partner will have a difficult time anticipating the needs of a woman in pain, so ask!
During the active phase the hospital will encourage ice chips to keep the woman hydrated and may insert an IV for just that reason. Remember to urinate often because a full bladder will get in the way of the labor process. Changing position may become more difficult if an epidural is used but positions should be changed to help move labor along.
Stages of Labor: Transition
The very end of active labor is called transition. This is when the cervix dilates from 8 centimeters to 10 centimeters. Contractions are stronger and may seem like they come one right after another. Fortunately this phase lasts only 15 minutes to 1 hour and is followed quickly by delivery.
Women have various reactions during this phase of labor including shaking, shivering, nausea, fatigue, tightness in the chest and throat, or chills. Women can have a combination of these symptoms throughout transition. This is also a time where it isn’t uncommon for women to vomit.
By the end of transition the baby is usually in the pelvis and the woman will feel rectal pressure and the urge to push. Some babies descend earlier and others later – it is different for each labor, each woman and each pregnancy. If a woman has had an epidural they may feel pressure. If she wants to be a more active participant during the pushing stage the amount of medication used in the epidural can be decreased after transition.
Although the woman may feel the urge to push she should rely on the guidance of the practitioner who is attending the birth. Pushing before the cervix is fully dilated can make the cervix swell and complicate the labor. Panting and breathing through the urge to push with a coach is usually effective.
2nd Stage of Childbirth: Delivery!
The birth is about to happen! After hours of labor the next stage is delivery and pushing. This is often referred to as the second stage of child birth. The cervix is fully dilated and the baby begins final descent. Contractions may begin to be a bit further apart and the pain is often easier to handle because bearing down offers relief.
At the stage of the game contractions slow and may even stop for a short time. This is a great time to rest and decrease the exhaustion at the end of the delivery. However, in some hospitals it is a routine practice to coach the woman to push with each contraction to speed the delivery and speed up the baby’s descent. If the woman prefers to wait until there is a spontaneous urge to bear down let the caregiver know.
Using an epidural will also blunt the urge to push so feeling the sensation of pushing may not be as apparent. Patience is a virtue best practiced during the delivery of the new baby. The descent may be rapid or slow and gradual. Pushing during this stage may require that the woman find different positions that are most effective for her individual situation.
Toward the end of this stage the perineum – or the tissue between the vagina and rectum – will start to bulge with the pushes and the scalp will come into sight. The urge to push will be even more compelling but at this point the doctor may ask to slow the pushing or even pant through them as the baby’s head will gradually stretch the tissue and decrease the potential that the perineum will tear during the delivery.
As this tissue stretches the woman may experience a strong burning or stinging sensation. As the head becomes more visible it is called ‘crowning’ – when the widest part of the head is visible and birth of the head is imminent. As the head comes the practitioner will suction the mouth and nose to help clear the airway as well as feel around the neck for the cord that may have slipped down. At this point the cord can be slipped over the head or clamped and cut.
The baby’s head will turn to the side and the shoulders will be born followed quickly by the rest of the body. He’s born!
Once he hits the air the baby must be kept warm and dried to prevent heat loss. After an initial quick towel dry and suction the baby can be placed on the mother’s bare belly and held. The skin-to-skin contact and a warm blanket over the top will keep the baby’s body temperature stable. This is an excellent time to offer a breast if breast feeding is the planned method of feeding.
3rd Stage of Childbirth: Delivery Of The Placenta
This may feel like the end of the journey but there is one more stage. The placenta – or the organ that fed and oxygenated the baby during the last nine months – needs to be delivered. Within minutes after the delivery the uterus will begin to contract and separate the placenta from the uterine wall. Once that is complete the practitioner will ask the mother to push one more time to expel the placenta.
This last push isn’t difficult or painful. This stage takes about 5-10 minutes but it has been known to take up to 30 minutes.
After delivery of the placenta the uterus will continue to contract slightly. It will begin to feel firm. The nurses will periodically check this to confirm that it continues to remain firm and will massage it if it isn’t contracting and closing down well enough. This process helps the mother to decrease the blood loss from the vessels in the uterus.
If this loss appears to be too large the practitioner may prescribe medication to increase the contractions of the uterus. Breastfeeding also releases a hormone that helps the uterus to contract and decrease the possibility of blood loss. These contractions are relatively weak comparatively and feel like menstrual cramps. If they are bothersome the practitioner can prescribe some mild pain relief medication. The mother may also experience shakiness or chills directly afterwards – this is normal.
In the delivery room the practitioner will lay out the placenta and be sure that it’s all there and none is left in the uterus. At this time any perineal tears are repaired, the epidural may be removed and eye drops and vitamin K are administered to the baby.