What to expect during the stages leading up to your baby’s arrival
Ask ten mothers to describe their labors, and you’ll hear ten different stories. Labor is unique, varying in length and intensity for each women and with each pregnancy. But all women in labor go through the same three stages.
Labor involves contractions, the progressive tightening and relaxing of the uterine muscle in a rhythmic pattern that opens the cervix and pushes the baby through the birth canal. The process can last about 15 to 20 hours with a first baby, and about 8 hours with a second. From early pregnancy, you might notice a tightening and relaxing of your uterus, followed by what is often described as pressure. These Braxton-Hicks contractions are normal and become more frequent as your pregnancy advances.
It’s not always easy to tell if labor pains are the “real thing.” True labor often resembles false labor, except that false labor does not result in progressive dilatation of the cervix and resolves with hydration, sedation and rest.
From a few hours up to a week or two before labor, lightening, which usually occurs with a first pregnancy, may happen as the fetal head engages in the pelvis. An expectant mom’s breathing is sometimes easier as a result. Since the fetus presses more on the bladder, you may feel an increased urge to urinate.
The loss of the mucous plug often signifies that the onset of labor is near. This may occur hours or up to two weeks before true labor begins. The mucous plug forms during pregnancy to seal the cervix, but as the cervix begins to open, mucous seeps into the vagina as a thick or blood-tinged discharge. A loss of clear liquid may mean a rupture of the membranes, and you should call your provider.
Stage 1: Early Labor, Active Labor and Transition
The first stage of labor — in which the cervix opens from zero to ten centimeters — lasts the longest, and has its own three stages. Early labor begins when the cervix thins (effaces) and opens (dilates) to three to four centimeters, preparing for the fetal journey from the uterus through the birth canal.
Contractions, which last from 30 to 60 seconds and occur every 5 to 20 minutes, may be mild, moderate or intense. This period may last only a few hours, or, for first-time moms, a day or more. A labor lasting over 24 hours is not normal. Some women are not aware that their cervix is opening. Their first sign of labor may be an upset stomach, diarrhea, a lower backache or a blood-tinged discharge from the vagina, known as a bloody show.
You can continue with daily activities — or relax, listen to music, watch TV, shower or practice slow breathing. Drink water and urinate often to avoid dehydration. Avoid eating a large meal in case anesthesia is required. Ask when you should call your provider and what to do if your membranes rupture.
You will be asked to come to the hospital or birthing center during the active phase of labor. Active labor brings stronger contractions every two to four minutes lasting from 45 to 60 seconds, or even longer. The cervix opens from seven to ten centimeters and is thus completely dilated. This phase averages from three to eight hours.
Don’t be afraid to ask for medication to stay in control or to assist in the delivery. Meanwhile, walking may help, stopping to take slow breaths during contractions. Your labor partner can apply ice or warm compresses to your lower back. For lower back pain, try rolling on a birthing ball or changing positions.
Transition is marked by strong, frequent contractions that reach peak intensity and last about 90 seconds each. By the time one contraction ends, it seems another begins. This phase may last from 15 minutes to 3 hours. The cervix stretches from seven to ten centimeters and is thus complete. There will be intense pressure on the lower back and rectum. Your delivery team will tell you not to push as extra pressure could cause the cervix to swell and tear. Focus on one contraction at a time — with each one, you are closer to holding your baby.
Stage 2: Birth
The delivery can take a few minutes or two hours. The second stage is the pushing phase. The cervix is fully dilated. Your provider will tell you when to push. Over two hours with no progress is called prolonged second stage and is not normal, though there is no time limit for delivery.
Most women opt to vary positions. Some prefer a birthing bed; others choose to squat or labor on all fours. The breathing techniques learned in childbirth education classes can keep you focused on pushing during — and relaxing between — contractions. A back massage can help you relax.
Well-named, labor is work, but the effort is well worth it, as you rejoice in seeing your baby. Right after birth, your baby will be placed on your abdomen. You are now a new parent!
Stage 3: The Placenta Is Delivered
When your provider sees signs of separation of the placenta (afterbirth) from the uterine wall about 5 to 30 minutes after delivery, your lower abdomen might be massaged to aid the uterus in expelling the placenta. Usually one or two pushes delivers it easily. Your provider will check that all portions of the placenta are expelled, which minimizes the chances of bleeding or infection. If you need suturing, you will be injected with a local anesthetic, if you are not already numb. You may receive medication to encourage uterine contractions to decrease bleeding.
Talk with your delivery team about the protocol for labor and delivery, and rely on them to guide you through the process. Do your research, and ask questions. The more informed you are, the smoother the progression of labor and delivery.
Adair R. Heyl, PhD, is Vice Chair of Education and Assistant Professor of Gynecology and Obstetrics at Emory University School of Medicine, Atlanta, GA.
Peter S. Heyl, MD, is Chief of Service of Gynecology and Obstetrics at Emory University Hospital Midtown, as well as associate professor in the Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Emory University School of Medicine, Atlanta, GA.