14. Stages of Labor

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15. Unexpected Birth Experiences

Labor is defined by actual cervical change – cervical “ripening”, “softening”, “effacement”, and “dilation” of the cervix – see Labor Detailed.  You may hear other terms such as “fully” or “complete” which refer to the cervix being completely dilated and when you can begin to “push”.  Physical signs of being in labor are contractions and the rupture of amniotic fluid.

For every woman in labor, these changes will happen very differently and in their own, unique time frame. Patience is needed here as you can’t force Mother Nature to get things going. She moves in her own time and when your body and baby are ready to say hello to the world together.

The progression of labor is broken down into segments, or stages.  These stages state what “should” be happening in labor within a particular time stage, what the cervical changes are as well as the emotional and physical challenges.

The problem with this is when you learn about the stages, you begin to expect that the very same changes will happen to you as described and in the suggested time frame!  Not so.

What you learn about the stages of labor here and in everything else you read,  are guidelines to give you a general idea of, or a “text book” example of the progression of labor.  Remember, reality is always different from what you read about or even imagine in your mind, and your labor will not follow the exact course that has been written about.

So, what do you do with this information? Well, it helps to prepare you by giving an overall picture of what happens physically and emotionally during labor.  The actual birthing process is the same and has been for thousands of years globally.

What is different is how YOU labor and what your circumstances surrounding the birth of your child.  The information is a guide to help you in your own personal and special experience.

Now, let’s look at the progression of labor in a different way. Imagine you want to climb a mountain. It’s overwhelming, but it is something you want to do.  You also know that once you start you can’t go back!  You pack your gear, and you begin your journey knowing that you WILL be challenged PHYSICALLY and EMOTIONALLY.

There will be times as you climb when you feel like giving up because you are tired and your muscles are sore.  You continue though because your dream of reaching the top is keeping you steady and FOCUSED on your goal.

You also know, that once you reach the peak of the mountain the way down will be much easier and less physically exerting.  In fact, you won’t even remember how exerting it was because you will be basking in the joy that you did it!

Yes, you will break out in a sweat as you reach the peak, but it will subside as you begin to climb down the mountain.  Your friends may have taken longer to climb the same mountain, and some may have finished sooner.  Some even took a different path, but the end result was the same. So what.

You did it too!  What you accomplished, gained personally, and the breathtaking views, will have been worth all the aches. It is an experience you will remember forever.

As the drawing shows, the progression of labor is the mountain you are going to climb which will eventually peak (with the delivery of your baby), and then subside shifting instantly into postpartum and parenthood. Here are some things to keep in mind:

  • Your experience is unique only to you.
  • Labor progress can be slow, at an even rate, or fast.
  • Labor progress can slow down naturally and have “lulls”.
  • The phases of the first stage of labor blend from one into another.The hallmarks of each phase are determined by cervical dilation, effacement, and emotional changes.
  • As labor progresses, contractions will get stronger, longer, and closer together.
  • As labor progresses, the phases in the first stage get shorter in duration.
  • As labor progresses your contractions, emotional state, and discomfort intensify.
  • The amniotic fluid or “bag of waters” can break at any time, during any phase
  • You may experience a “bloody show” most likely from small blood vessels breaking in response to pressure of the baby moving down into position for birth.
  • Relaxation and the use of breathing techniques work to keep you focused and in control.

 

The  Phases and Stages of Labor

Timing Contractions

Timing a contraction from when it starts (X) to finish just tells you how many seconds it lasts = duration.

To know how often they are coming, time from the beginning of one to the beginning of the next one (note the X’s in the image) X to X  = frequency.

The pattern of contractions is they get longer, stronger, and closer together.

GUIDELINE: call you doctor or midwife when contractions are coming 5 minutes apart, lasting 60 seconds, for one hour (that’s about 12 contractions in an hour).

Make sure you check these guidelines with you care provider.

Contractions are:

  • temporary
  • come in waves
  • there’s ALWAYS a rest in between
  • may or may not be painful
  • diminish greatly when baby is born
  • you know there’s an end
  • manageable
  • unique to you only
  • the more you focus on discomfort the more pain you will experience
  • Relaxing into discomfort decreases intensity of pain

 

The First Stage has three phases

1. Early labor phase = cervical dilation 0 – 3centimeters, mild contractions maybe 20 minutes apart, lasting possibly 30 – 45 seconds.

Breathing method:

  • Slow breathing technique. Use this one as long as you like.
  • Best Breathing – slow and deep, your own way

Comfort Measures:

  • RELAXATION, change positions, walking, music, shower, a massage during  contractions.  Your partner can rub your back while you focus on your slow breathing technique.  Soft stroking on the belly (effluerage).You can also add visualization to this!

2. Active labor phase = cervical dilation 4 – 7 centimeters, moderate contractions maybe 3 – 5 minutes apart, lasting possibly 45 – 60 seconds.

  • Breathing Method: Slow breathing technique if that is still comfortable for you, or shift to the “blowing out the candle” method in a nice even, relaxed, rhythmic manner.
  • Best Breathing – slow and deep, your own way
  • Comfort Measures: Back massage using the tennis balls in the sock rolled up and down the back during a contraction, shower, birthing ball, changing positions, rocking, walking, sit on the birth ball, sway, squat, slow dance, make noise (moan and grown in a rthymic manner) breathing techniques used with visualization, music, touch massage, hand massage, loving – comforting words from your partner.

3. Transition phase = cervical dilation 8 – 10 centimeters (10 cm = 4 inches in diameter), strong contractions maybe 2 – 3 minutes apart, lasting possibly 60 – 90 seconds long. It is called transition because you are just about to start “pushing”  to deliver the baby.

  • Breathing Methods: Hee, hee, hoos, slow and focused.
  • Best Breathing – slow and deep, your own way
  • Comfort Measures: Partner support by counting and helping you to stay focused on your breathing, loving words of encouragement, counter pressure, relaxing in between contractions with visualization, or massage, music, change positions and stay upright using gravity, avoid laying down in bed on your back (if you haven’t been medicated) if possible, depending on the situation (if you had an epidural, for example, your movement may be restricted, check with your care providers). Make noise, moan and groan in a rhythmic manner and in sync with your contractions.

 

Amniotic Fluid or breaking of the “bag of waters”
The amniotic sac, which contains the fluid that cushions the baby in the uterus, can break at any time during labor, thus releasing the fluid as a “gush” of “water”, or a slow continuous trickle. This is a sign of labor, however, it is not always the first sign. Usually the contractions come first. Often the amniotic sac is ruptured by your Doctor or Midwife in the hospital.  Whether it breaks spontaneously or “artificially” by the Doctor, you can expect labor to intensify.  If it breaks outside the hospital, take note of the following, and always call your healthcare provider with this information when it happens.

1.The time your “water broke”.
2.The color of the fluid (It should be clear. If it is tinted a pea green/yellowish color, what has happened is baby has taken its first bowel movement called meconium, in utero).

Second Stage of Labor

Pushing and the delivery of your baby.
Pushing is VERY  p -h -y -s -i -c -a -l!  It can last 15 minutes to 2+1/2 hours. There are two styles of pushing.

  • One is spontaneous pushing –  that is, you just do what comes naturally, from positioning yourself to birth your baby, to making the noises necessary to push your baby out!  Here, you listen to your body and your instincts.
  • The other one is directed pushing.  This one involves assistance from others to guide you in pushing. This one is used more often if you have been medicated. When you push, you hold your breath and bear down on your bottom, quickly count to ten, stop, take a quick breath and repeat. You do this throughout the contraction! Your partner or other support person will assist you by counting for you as you are holding your breath and bearing down.
  • You are using the same muscles in pushing as when constipated.
  • The “urge to push” comes from the baby coming down the vaginal canal and putting pressure on the rectum.  Feeling this sensation often signals to your healthcare provider that your cervix is completely dilated and pushing can begin.
  • Avoid pushing BEFORE you are fully dilated (10 centimeters) this can cause swelling of the cervix.  If you feel the need to push before being 10 centimeters dilated, do quick blows.  Why? Because you can’t push and blow at the same time.

Also, it is at this time you may have an Episiotomy, or forceps, and vacuum instruments used.

  • Breathing Methods: None here, you will be to busy pushing. However, if you rest from pushing, you will still have contractions and you can resume your breathing methods, most likely the hee, hee, hoos.
  • Comfort Measures: Cool wash cloth on the forehead, warm compresses on the perineum, SQUATTING position if possible for birth of baby, position changes, loving words of encouragement, visualize the birth of your baby, relax the perineum.

Many women express relief when pushing, and before you know it, your baby is in your arms!

Skin to Skin with baby immediately after birth

Some hospitals are now encouraging moms to place their newborn on their chest between the breasts right after birth to initiate breastfeeding. This action helps baby with:

  • successful breastfeeding
  • sleeping
  • self-regulated temperature development
  • neurological development

Skin to Skin with Dad

  • promotes bonding
  • increases participation in care of baby

Third Stage of Labor

Delivery of the Placenta.

It takes from 5 – 20 minutes for the placenta to be delivered.  Once delivered, the Doctor will check to make sure it is “intact”.  This is because if any pieces of it are still attached to the uterine wall, bleeding will occur!  You may have mild contractions afterwards. You will receive Pitocin after delivery to help contract the uterus.

Labor Induction

The following is from www.childbirthconnection.org

  •  Rates of labor induction are on the rise in the United States. This trend is fueled by increases in the number of women having high-risk pregnancies and more frequent use of labor induction for non-medical or social reasons (sometimes referred to as elective induction). There is confusion and disagreement about the safety and appropriate use of labor induction. As a result, use of induction varies widely from one caregiver or hospital to the next. Even the results of research studies on labor induction provide conflicting answers. It can be difficult to make informed choices about induction of labor in the midst of these uncertainties.

This section of the website contains research, information, and conclusions about labor induction:

  • Options: includes a look at the most common reasons caregivers recommend induction of labor and the alternatives to labor induction
  • Best Evidence: tells you which reasons your caregiver may recommend induction are supported by research evidence and which are not.
  • Tips and Tools: includes tips for avoiding an unnecessary induction of labor and for keeping you and your baby as safe as possible if induction is necessary.
  • Resources: provides resources for learning more about induction of labor.

What normally causes labor to begin?

Although the complex process that causes labor to begin is not fully understood, researchers believe that the most important trigger is a surge of hormones released by the fetus. This hormone surge, which prepares the lungs and digestive system for life outside the womb, signals the fetus’s readiness for birth. In response to these signals, hormone receptors in the woman’s uterus turn on and the muscles in her uterus change to allow her cervix, at the lower end of her uterus, to open. In short, when a woman goes into labor on her own, this is a powerful signal that her baby is ready to be born and that her body is ready for labor.

What is the safest point in pregnancy for the

baby to be born?

Just as infants reach developmental milestones, like rolling over or crawling, at different times, every baby reaches the “developmental milestone” of readiness for birth at a slightly different time. The most reliable sign that the baby is ready to be born safely is labor beginning on its own at full-term.

Full-term has traditionally been defined as any time between 37 and 42 weeks of pregnancy, with your estimated due date at 40 weeks near the middle of this window. (You can find an estimated due date calculator on the. However, more and more research shows that babies born between 37 weeks and 38 weeks and 6 days, whether labor started on its own or was induced, face a higher risk of several health problems than babies born from 39 weeks on. For this reason, labor induction or planned cesarean surgery should never be used before 39 weeks unless there is a clear medical reason. (The Best Evidence: Induction of Labor page describes the medical reasons for induction of labor.) Although the risk of stillbirth or newborn death is very low, this risk begins to rise around 41 weeks and rises significantly after 42 weeks. To prevent these rare deaths, most caregivers will offer induction of labor between 41 and 42 weeks.

 

Why are so many women experiencing induced

labor? Many medical, legal, social and financial factors influence the use of labor induction. These include: Women’s lack of knowledge about the risks, benefits, and appropriate use of labor induction.

  • A surprising number of women don’t have accurate information about how long a normal pregnancy should last. A study of new mothers found that nearly one in four believed that a baby was full-term when it reached 34-36 weeks, and more than half believed it was safe to deliver the baby at that point. In fact, it is unsafe to deliver a baby before 39 weeks unless there is a clear medical need.
  • Childbirth education classes that teach specific information about the risks, benefits, and appropriate uses of labor induction reduce the number of women having induced labor. However, attendance at childbirth education classes appears to be decreasing in the United States, and childbirth education classes are getting shorter, leaving less time to address this important topic.

 

Birth bold,

Lesly 🙂

Test your knowledge! Take the QUIZ below! I f you have questions, write them in the comment box below 

How do you "time" contractions?



If you are contracting, when should you call your doctor or midwife (remember to check this guideline with them)?



What is the 2nd Stage of labor?





 

 

 

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