Go! Labor in Three Acts
Labor is a series of three distinct stages, aptly called first, second, and third stages. For most women, the longest span is the first stage, which lasts from the earliest signs of labor right through baby's descent into the birth canal in preparation for stage two—pushing. Stage three consists of delivering the placenta, which mothers usually feel is a cakewalk after all the hard work involved in baby's arrival.
First Stage
The first stage of labor begins with early labor and ends with active labor. Your provider probably uses the term transition (or descent) to refer to the end of the first stage of labor.
If your birthing center or hospital has whirlpool tubs or showers available for laboring moms, you might find the pulsating water welcome relief for getting through contractions. This pain-relief method (called hydrotherapy) is not the same as a water birth, in which a baby is actually born submerged in a pool of water.
During the early phase the cervix effaces (thins) and dilates (opens). This process may have started several weeks ago. Now your cervix will dilate to 4–5 centimeters. Contractions will arrive every 15–20 minutes and last 60–90 seconds. Try to stay up and moving through contractions as much as you can to let gravity help your baby descend. Use the breathing and relaxation techniques you picked up in childbirth class to get you through these first few hours. Then leave for the hospital and the next phase—active labor.
In active labor, your contractions are coming closer together regularly, perhaps 3–5 minutes apart, and they can be intense, lasting 45–60 seconds. These strong contractions are dilating your cervix from about 4–5 centimeters to around 8.
Don't feel inadequate or guilty about asking for pain medication at any point if you want it. Pain medication is a tool, just like your breathing exercises. Wisely used, it can result in a better birth experience for both you and your child.
Once your cervix reaches 8 centimeters and contractions start coming one on top of the other to get you to full dilation, the end of the first stage has arrived. Because of the frequency of contractions and the overwhelming urge to push, this is the most difficult part of labor. Fortunately, it culminates in your child's delivery, once you bridge those final 2 centimeters to become fully dilated.
As you begin to transition from first-to second-stage labor:
You could be nauseous and may even vomit.
You have chills or sweats, and your muscles twitch.
Your back really, really hurts.
Contractions are just minutes apart, if even that.
There is pressure in your rectum from the baby.
You are absolutely exhausted.
You may feel like pushing even though your cervix is not yet fully dilated.
Although every fiber of your body is probably screaming, “PUSH!” you need to hold back just a few moments more. Your cervix is almost but not quite open far enough for baby's safe passage. Take quick, shallow breaths and resist the urge to push until your doctor or midwife gives the go ahead.
Second Stage or PUSH!
Your cervix has made it to 10 centimeters, and you are finally allowed to push. This second stage can last anywhere from a few minutes (with second or subsequent babies) to several hours. Your contractions will still arrive regularly, but they aren't quite as close together—a welcome relief. Pushing is very hard work, but the sensations may change from the intense gripping you've experienced to more of a stinging or burning sensation.
If possible, try to find a pushing position that makes you feel comfortable and in control. Use gravity to your advantage by kneeling, squatting, or sitting up with your legs and knees spread far apart. Stirrups are likely available, but don't feel forced into using them if they don't work for you.
Your birth attendant and/or coach will let you know when the peak of the contraction occurs, the optimum time for pushing effectively. Use whatever it takes to push effectively. If that means moaning, grunting, and emitting other primal sounds that make your prenatal snoring sound like a lullaby by comparison, go for it. The people attending your birth have probably heard just about everything. Don't be embarrassed, because the noise won't even faze them.
You may be asked to stop pushing momentarily as the baby's head is ready to emerge, in order to prevent perineal tearing. Panting can help you suppress the urge. The obstetrician or midwife may decide on an episiotomy if your skin doesn't appear willing to stretch another millimeter or she may attempt perineal massage.
Finally, the head slides face down past the perineum and is eased out carefully to prevent injury to the baby. The attendant may wipe the eyes, nose, and mouth and suction any mucus or fluid from her upper respiratory tract. It's all downhill, from here as the rest of the body slides out.
As your baby leaves the quiet, dim warmth of the womb, his respiratory reflexes kick in and the newborn lungs fill with air for the first time. He'll probably test out those lungs with a full-fledged wail. Your doctor will place the baby on your stomach for introductions, usually with the umbilical cord still attached.
Third Stage or You Aren't Done Yet!
The third stage of labor is the delivery of the placenta. The entire placenta must be expelled to prevent bleeding and infection complications later on. Contractions will continue, and your doctor may press down on your abdomen and massage your uterus or tug gently on the end of the umbilical cord hanging from your vagina. You might also be injected with the hormone Pitocin (oxytocin) to step up your contractions and expel the placenta. Once the placenta is out, any stitches you require to repair tearing or episiotomy incisions will be put in. A local anesthetic will be injected to deaden the area if you aren't still anesthetized from an epidural.
