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What Happens During Labor?
By Pam Cass, Certified Doula and Vice President of
ChildbirthSolutions.com
Every woman giving birth
is embarking on a wondrous journey. Fortunately, it's a journey that
countless women before them have taken so the territory is not
entirely uncharted. In preparation for labor, thousands of women
participate in childbirth education classes every year in the United
States. Many more pour over books and ask their care provider what
they can expect. Almost every woman at some point approaches another
woman who has completed the journey to get some insight. They are all
looking for the same information and asking the same questions: What
is labor like? How long will it last? What will it feel like? How can
I cope?
While it is true that every woman
experiences this journey in an individual way the basic sequence of
events is the same for all. This overview should give you an idea of
the physical steps all must go through in order to complete the
process of labor and birth. It will also show you what to expect
emotionally and give you tips on how to cope each step of the way.
This outline is designed to give you
an overview of a "normal" labor and birth. Therefore, it is
a completely intervention-free birth. All of the interventions and
possible medications used will be discussed on other pages of this
site.
Prodromal Labor
Often in the past prodromal labor has
been given the misnomer "false labor", yet every woman
experiencing it has said in frustration "There's nothing false
about what I'm feeling!" The misunderstanding has arisen because
prodromal labor can feel very much like active labor, yet is not
consistently progressive; it does not lead without a break to the
birth of the baby. It does, though, serve an important function in the
birth process. Prodromal labor does the preliminary work of preparing
the uterus, baby and cervix for birth. All of this work has to be done
before the baby can be born. Some women's bodies do it all without her
being aware of it. However, some women's bodies draw a great deal of
attention to the work being done. Too much sometimes.
"This is driving me crazy,"
one pregnant mother sighed. "I've been having contractions off
and on now for three days. Just when I think it's time to call
my midwife, they completely stop again!"
Length:
- Prodromal labor contractions may
begin hours or even days before active labor.
Contractions:
Physical Effects:
- The cervix is moving from a
posterior (back) position to an anterior (forward) position.
-
- The cervix is softening.
-
- The cervix is beginning its
effacement or thinning. It may thin anywhere from 0% to 50% during
this stage.
-
- You may lose your mucous plug from
the cervix.
-
- Your cervix may begin to dilate,
opening anywhere from 1 to 4 centimeters.
Emotional Effects:
- You may be quite excited when you
first feel these contractions, especially if they are stronger
than any you've had until now.
-
- As time goes on and the
contractions continue without any apparent progress you may feel
let down and eventually become quite tired and discouraged.
How To Cope:
- Resist the urge to call everyone
immediately and tell them you are in labor. That way you will feel
less like a watched pot waiting to boil. You should be able to
handle these contractions with some relaxation techniques and
concentration. If they are any stronger than that or you just
aren't sure, you might want to go ahead and call your doula, she
can help you to evaluate exactly what is going on.
- Use these contractions to get to
know how your body feels as it begins the hard work of labor.
Prepare mentally for the challenges you will shortly be facing.
- Now is not the time to hike ten
miles or tromp through the mall for hours in a vain attempt to get
labor going. You will just wear yourself out and have that much
less energy for active labor.
- Be sure to eat well. Complex
carbohydrates like whole grains are especially good now; they will
provide you with plenty of energy reserves. Try to stick with
foods that are easy on your digestion, you don't want to be
dealing with heartburn on top of labor.
- Get plenty of rest. Even if the
contractions are keeping you awake at night, nap as much as you
can. Again, you want to conserve your energy for the hard work
ahead.
- Resist as much as possible the
urge to focus too much attention on these contractions. The more
you watch, the more time will drag. Try to find some distracting
activities to participate in.
- Keep your spirits up; remember
that these contractions are doing important work!
Active
Labor--First Stage
Latent Phase
The latent phase is the beginning of
active labor and will carry you about half way through the birth of
your baby. This phase of the active stage of labor begins when your
contractions become progressively longer, stronger and closer together
and ends when your cervix is about 4 or 5 centimeters dilated.
Length:
- The latent phase of active labor
can last anywhere from a few hours to 10 hours or more.
Contractions:
- They will grow longer, stronger
and closer together.
- The timing of these contractions
can vary widely from woman to woman. Some start with contractions
30 minutes apart, others start right out at 7 or even as few as 5
minutes apart.
- They will vary in length from 15
to 30 seconds or so. A few women may find them lasting a bit
longer.
- These contractions will continue
no matter how you change your activity level.
- You will find that you gradually
progress to needing to use all your concentration and are no
longer able to talk and laugh during a contraction.
Physical Effects:
- The cervix continues thinning out
(effacement).
- The cervix will dilate to 4 or 5
centimeters.
- You may have a couple of loose
bowel movements.
- You may lose your mucous plug.
- You may notice a bloody show.
Emotional Effects:
- Excitement and joy are often
primary emotions when you realize you are finally in labor.
- Don’t be concerned to find that
you are somewhat fearful, after all, this is going to be a big
day, full of hard work and intense sensations.
- You will still be interested in
conversation, though only between contractions.
How To Cope:
- Get in touch with your care
provider.
- Gather your support team around
you. Your doula, the baby's father, your mother or sister or best
friend…whomever you've chosen to share this life event with you.
- Whenever you begin thinking that
soon you won’t want to move very far, you should make your way
to your selected birthplace.
- Make your birthplace comfortable
to you as far as temperature, lighting, music, etc. are concerned.
- Use whatever physical comfort
measures appeal to you; relaxation, water, massage, birth ball,
effluerage, etc.
- If you've learned special
breathing techniques or visualization, feel free to use them.
- Keep moving, but don't overdo it.
Vary your periods of walking about with periods of rest.
- Make sure you drink plenty of
fluids, especially water, juices and sports drinks.
- Empty your bladder at least once
an hour.
- Eat whatever appeals to you to
keep your strength and energy levels high.
Active Phase
The active phase of labor will
continue with contractions that grow longer stronger and closer
together. This is the part of your experience that really warrants the
label ‘labor’. It begins about the time you are 4 to 5 centimeters
dilated and ends at about 9 centimeters. Keep in mind that these
beginning and ending measurements are ‘average’, they will vary
from woman to woman and from birth to birth.
Length:
- The active phase of active labor
can last anywhere from a couple of hours to 10 hours or more.
Contractions:
- Each of these contractions has a
definite beginning, peak and end. Some women describe them as
waves. The gripping sensation in your belly and back starts mild
and quickly grows stronger until it reaches a peak, then it grows
weaker until it goes completely away.
- They will grow longer, stronger
and closer together.
- The timing of these contractions
can vary widely from woman to woman. In general, contractions
through this stage start at about 5 minutes apart and grow closer
together until they are coming about every 2 minutes or so.
- They will vary in length from 30
to 60 seconds. A few women may find them lasting a bit longer.
- A few women will experience
"camel-back" contractions, a second contraction
beginning before the first entirely goes away. You don’t have
the usual 2 minutes of rest between contractions. You will
probably need your entire support team to help you to deal with
them.
- These contractions will continue
no matter how you change your activity level.
Physical Effects:
- The cervix continues thinning out
(effacement).
- The cervix will dilate to 9 or 9+
centimeters.
- Your body will be working very
hard during this stage. Some women sweat, some may have cold hands
or feet.
- Your water may break at any point.
If it does, you may find your contractions increasing in
intensity.
- You may notice a bit more bloody
show. Some blood is normal now as your cervix stretches open and
some of its tiny blood vessels break. If you are uncomfortable
with the amount of blood, bring it to the attention of your care
provider, nurse or doula.
- Most women are no longer
interested in eating anything.
- It is important to continue to get
enough to drink to avoid dehydration.
Emotional Effects:
- During this stage you will find
yourself working so hard that everything outside your body almost
ceases to exist.
- Some women want lots of support
people around them now, however many women find too many people
distracting and want only their doula and one primary support
person (husband, mother, sister, friend) with them.
- You will find that you need lots
of support from your team to help you deal with your labor.
- You will probably be concentrating
so hard on your labor that you find conversation annoying.
- You will want your support people
within reach at all times, and may feel abandoned if left alone
even to go to the bathroom.
How To Cope:
- Your doula and other support
people will be offering and providing many comfort measures now.
These will be whatever appeals to you and may include; warm
water—either in the tub or shower; using the birth ball,
position changes, massage, touch—stroking, counter pressure,
cold or warm compresses, etc.
- Many women find repeated rituals
comforting, things like stroking their hair or arm, hearing the
same phrases repeated throughout the contraction, singing, the
possibilities are as varied as women.
- Use any breathing techniques that
you find helpful. Some women use breathing patterns that they have
been taught in their childbirth education classes, others find
just the right pattern for them in their labor. The only concern
is to make sure that you do not hold your breath during a
contraction, keep breathing. Listen to your doula, she can help
guide you if you are holding your breath or find yourself
hyperventilating.
- Relaxation is especially important
now, particularly between contractions. You may find it impossible
to relax during contractions because your body is working so hard
that you need to work with it, just beware of fighting against
your body. Your doula can help guide you to find a balance between
working in concert with your body and relaxing when you can.
- Make sure you empty your bladder
at least every hour. A full bladder will not only increase the
intensity of your contractions; it can interfere with your
cervix’s progress.
- You will appreciate lots of verbal
encouragement from your support team and care providers throughout
this phase, don’t be shy about asking for it.
Transition
As its name suggests, transition
marks the period when your body completes its labor and prepares to
move into birthing your baby. Transition is perhaps the most intense
part of the labor process, both physically and emotionally. While it
is a very trying time, you can take comfort in the knowledge that it
is also the shortest phase of labor and that soon your dilation will
be complete and you can begin pushing.
Length:
- Transition will last from ten
minutes to an hour and encompass as few as three to as many as 25
contractions.
Contractions:
- The contractions come closer
together, perhaps one to two minutes apart.
- They will last from one minute to
ninety seconds.
- Some may come in pairs with no
rest period between them. These are called camelback contractions.
- These contractions will be the
most intense in strength. They reach their peak quickly and
maintain it for most of the contraction.
Physical Effects:
- The cervix will dilate to 9 or 9+
centimeters.
- Your body will be working very
hard during this stage. Some women will tremble or shake.
- Some women may be nauseous and/or
vomit.
- If your water hasn’t broken yet,
it may do so at any time.
Emotional Effects:
- Transition is a difficult time
emotionally. Many women during transition say, "I just
can’t do this anymore."
- Some women find themselves more
drawn to the women in their support team at this point.
- You will find that you need lots
of support from your team to help you deal with your labor.
- It is not unusual for your sense
of time to slow down.
How To Cope:
- Your doula and other support
people should be giving you lots of encouragement and verbal
validation.
- Many women find that as the
contractions grow more intense so does their need for touch. At
this point many women appreciate close physical comfort, needing
to be held or embraced through the contractions.
- Water can be an invaluable comfort
measure through this phase of labor, either using the shower or
the tub.
- Use any breathing techniques that
you find helpful. Some women use breathing patterns that they have
been taught in their childbirth education classes, others find
just the right pattern for them in their labor. The only concern
is to make sure that you do not hold your breath during a
contraction, keep breathing. Listen to your doula, she can help
guide you if you are holding your breath or find yourself
hyperventilating.
- Relaxation is especially important
now, particularly between contractions. You may find it impossible
to relax during contractions because your body is working so hard
that you need to work with it, just beware of fighting against
your body. Your doula can help guide you to find a balance between
working in concert with your body and relaxing when you can.
Second
Stage-Birth
Latent Phase
The latent phase of second stage is
the period that it takes your body to "switch gears" so to
speak, moving from the dilating of your cervix to pushing your baby
down the birth canal. It begins when your cervix is completely dilated
and ends with the urge to push along with your contractions. It is a
kind of rest period for you. After the intense sensations of the end
of labor, you may find the lack of contraction activity disturbing.
Don’t worry though, you will have more contractions and they will
end in the birth of your baby.
Length:
Contractions:
- The contractions become further
apart since the work of dilating the cervix is completed. It is
not unusual for there to be five or more minutes between
contractions.
- For some women contractions may
all but cease.
Physical Effects:
- The cervix is completely dilated.
- The uterus is shifting gears from
dilating contractions, to pushing contractions.
Emotional Effects:
- Most women feel a good deal of
relief at hearing the cervix is completely dilated and find
themselves able to smile and converse for the first time in hours.
- Some women find themselves
disoriented by the relative lack of activity.
How To Cope:
- Take advantage of this time to
rest and gather your strength for the work of pushing still ahead.
Active Phase
The active phase of second stage is
the long awaited pushing. Although completely different in sensation
from your labor so far, it is every bit as intense and just as much
hard work.
Length:
- Pushing the baby out can take as
little as five minutes or as long as three hours.
Contractions:
- Pushing contractions are usually
five to ten minutes apart.
- They are accompanied for most
women by an intense urge to push.
- Some women may feel little or no
urge to push.
- You may be able to feel the
baby’s head moving down the vagina.
Physical Effects:
- The baby’s head is molding to
fit through the pubic outlet, stretching the birth canal as it
goes.
- You may expel some feces, urine or
gas.
- You may feel nauseous and/or
vomit.
Emotional Effects:
- Pushing the baby out will take a
great deal of concentration and possibly some direction from your
care provider, nurse or doula.
- While most women start out pushing
with a burst of enthusiasm and energy, some women find themselves
becoming exhausted and discouraged if it drags on with little
apparent progress.
How To Cope:
- Tune in to what your body is
doing. Cooperate with the signals your body is sending you. Push
hard along with the urge; rest when it is absent.
- If you can’t feel your baby
moving down through enough to use as a reference for how
effectively you are pushing, your care provider, doula or nurse
can help you by giving direction and feedback.
- If there is a stall in the
progress of the baby, changing positions may help. Your doula,
nurse or care provider will be able to suggest some.
- Warm compresses to your perineum
can help you to focus on where you are pushing the baby.
- Gentle perineal
massage by your care provider can help the tissues to stretch,
especially if warm oil is used to help lubricate the area.
- Get lots of feed back on how much
you are accomplishing each time you push.
- Concentrate your energy down low
by tucking your chin down and pushing down and out.
- Avoid wasting energy and strength
by throwing your head up or arching your back as you push.
- Your doula or another support
person should be giving you sips of water between contractions and
wiping your face and neck with a damp cloth.
Crowning and Birth
As your baby’s head becomes visible
it is called crowning. This is an extremely intense phase emotionally
and physically. After all, we’re talking about the actual birth of
the baby!
Length:
- From the first sight of the baby
at the vaginal outlet to the birth of the baby, this stage can
last from two to twenty minutes or so.
Contractions:
- These pushing contractions may be
a bit farther apart if you are especially tired. Otherwise they
remain unchanged from pushing.
Physical Effects:
- First the baby’s head will
emerge.
- Following a short pause to make
sure the umbilical cord is not wrapped around the baby’s neck;
your care provider will gently ease the top shoulder out first,
then the bottom shoulder. The rest of the baby’s body should
slip right out.
- You may feel an intense burning at
the vaginal outlet, although many women do not.
- You may expel some feces, urine or
gas, though you will probably be unaware of it.
Emotional Effects:
- You will be intensely focused on
what you are doing. This is the time that many women find that
they are conscious only of what is within a few inches of their
bodies.
- You may need to be reminded that
you are birthing your baby. Many women become so focused on the
work that they forget what they are working so hard to accomplish.
- Many women, if they reach down and
feel their baby’s head emerging, experience a burst of energy
and enthusiasm, finishing the birth immediately.
- If everyone attending you is
focused on the emergence of the baby, you may feel a bit ignored.
- As your baby is born it you will
be euphoric, proud and amazed that you accomplished such an
incredible feat!
How To Cope:
- Tune in to what your doula is
saying. She should be up by your ear relaying instructions from
your care provider. Your universe will have shrunk down so much
that direction from just down at the end of the bed may feel as
though it is coming from clear across the room.
- Focus on the fact that your baby
is here.
- Reach out and touch your baby as
soon as you can, if you are inclined, by touching the baby’s
head as it crowns.
- Hug your baby to your breast and
rejoice!
Third
Stage—Delivery of the Placenta
Although the baby has been born, you
have a little more work to do. The placenta or afterbirth needs to be
expelled.
Length:
- The delivery of the placenta after
the birth of the baby may take from five to thirty minutes.
Contractions:
- Other than a cramping sensation,
there will be no more contractions.
Physical Effects:
- The placenta separates from the
uterine wall and is expelled through the vagina.
- You may feel the uterus cramp,
especially if the baby begins suckling immediately.
- You may feel an uncomfortable
"full" sensation even though the baby is out, until the
placenta is delivered.
- Many women notice no sensation at
all until they are asked to bear down "one more time."
Emotional Effects:
- The delivery of the afterbirth is
truly an afterthought. Most women are so involved with their new
baby that the delivery of the placenta is hardly noticed.
- You may feel a real sense of
relief when the placenta is out. Now the birth is truly over.
- You may be annoyed at the
interruption in your bonding.
- If the placenta is delayed, your
caregiver may encourage its expulsion by having an assistant
‘knead’ your belly to get the uterus to contract more
effectively. This is called fundal massage and can be quite
painful.
How To Cope:
- Remember, this stage will truly
only take a couple of moments and a couple of mild pushes. Then
you will be entirely free to enjoy the baby.
- If you need fundal massage, have
your support people help you to use the same relaxation techniques
that worked for you during labor.
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