Labor is defined as the dilation (stretching and expanding) of your cervix. This occurs when your uterus, which is a muscle, tightens (contracts) to squeeze out its contents (your baby). Tightening of the uterus can cause pain.
Labor is different for every woman; that's the reason we can't predict what your labor will be like before it begins. You may also find your labor is different from one delivery to the next.
There are differences between true labor and false labor.
The Stages of Labor
Labor is divided into three stages-each stage is distinctly different and serves a specific purpose.
Stage 1.
Stage 1 of labor is the longest and consists of three phases-early, active and transition. This first stage of labor usually lasts 6 to 8 hours but can be longer for a first birth.
In the early phase, labor is just getting started and dilation of the cervix has just begun. In the active phase, the cervix dilates at a fairly constant rate. Transition includes complete dilation. Contractions help the cervix dilate and thin out. They also help move the baby down the birth canal for delivery.
At the transition phase, the pace and intensity of labor increases, signaling that labor is moving into the second stage.
True Labor or False Labor?
| Considerations | True Labor | False Labor |
|---|
| Contractions | Regular | Irregular |
| Time between contractions | Come closer together | Do not get closer together |
| Contraction intensity | Increases | Doesn't change |
| Location of contractions | Entire abdomen | Various locations |
| Effect of anesthetic or pain relievers | Will not stop labor | Sedation may alter or stop frequency |
| Cervical change | Progressive cervical change | None |
Stage 2.
In stage 2 of labor, you are fully dilated and begin to push. Contractions change and become much harder, longer and more frequent. Along with your pushing, these contractions help deliver the baby. This stage can take 2 hours or longer. Anesthesia at this point, especially an epidural block, may prolong this stage of labor because your urge to push is decreased. At the end of the second stage, your baby is born.
Stage 3.
Stage 3 of labor doesn't usually take too long. During stage 3, the uterus contracts and expels the placenta (afterbirth). You will be given oxytocin to help contract the uterus.
Some doctors describe a fourth stage of labor, referring to the time period after delivery of the placenta, while the uterus continues to contract. Uterine contractions are important in controlling bleeding after the birth of your baby.
It's a good idea to ask your doctor certain questions about preparing to go to the hospital. He or she may have specific instructions for you. You might want to ask the following questions:
 | When should I go to the hospital once I am in labor? |
| Should I call you before I leave for the hospital? |
| How can I reach you after regular office hours? |
| Are there any particular instructions to follow during early labor? |
The Three Stages of Labor |
Stage of Labor | Stage 1-Early Phase |
What's happening
| Cervix opens and thins out due to uterine |
| contractions |
| Cervix dilates to about 2cm |
| This phase can last 1 to 10 hours |
Mother is experiencing
| Membranes may rupture, accompanied by gush or |
| trickle of amniotic fluid from vagina |
| Pinkish discharge may appear (bloody show) |
| Mild contractions begin at 15- to 20-minute |
| intervals and last about 1 minute; contractions |
| become closer together and more regular |
Mother and/or partner
| Mother should not eat or drink once labor begins |
can do
| Mother may be able to stay at home, if she is at term |
| Begin using relaxation and breathing techniques |
| learned in childbirth class |
| If water has broken, if labor is preterm, if there is |
| intense pain, if pain is constant or there is bright red |
| blood, contact doctor immediately! |
Stage of Labor | Stage 1-Active Phase |
What's happening
| Cervix dilates from about 2cm to 10cm |
| Cervix continues to thin out |
| This phase can last 20 minutes to 2 hours |
Mother is experiencing
| Contractions become more intense |
| Contractions, come closer together |
| Contractions are about 3 minutes apart and last |
| about 45 seconds to 1 minute |
Mother and/or partner
| Keep practicing relaxation and breathing |
can do
| techniques |
| An epidural can be administered during this phase |
The Three Stages of Labor, continued |
Stage of Labor | Stage 1-Transition Phase |
What's happening
| Stage 1 begins to change to Stage 2 |
| Cervix is dilated to 10cm |
| Cervix continues to thin out |
| This phase can last a few minutes to 2 hours |
Mother is experiencing
| Contractions are 2 to 3 minutes apart and last about |
| 1 minute |
| Mother may feel strong urge to push; she shouldn't |
| push until cervix is completely dilated |
| Mother may be moved to delivery room, if she is not |
| in a birthing room |
Mother and/or partner
| Relaxation and breathing techniques help |
can do
| counteract mother's urge to push |
Stage of Labor | Stage 2 |
What's happening
| Cervix is completely dilated |
| Baby continues to descend into the birth canal |
| As mother pushes, baby is delivered |
| Doctor or nurse suctions baby's nose and mouth |
| and clamps umbilical cord |
| This stage can last a few minutes to a few hours |
| (pushing the baby can last a long time) |
Mother is experiencing
| Contractions occur at 2- to 5-minute intervals and |
| last from 60 to 90 seconds |
| With an epidural, the mother may find it hard |
| to push |
| An episiotomy may be done to prevent tearing |
| vaginal tissues as baby is born |
Mother and/or partner
| Mother will begin to push with each contraction |
can do
| after cervix dilates completely |
| Mother may be given analgesic or local anesthetic |
| Mother listens to doctor or nurse when baby is |
| being delivered; doctor or nurse will tell mother |
| when to push |
| As mother pushes, she may be able to watch baby |
| being born, if mirror is available |
The Three Stages of Labor, continued |
Stage of Labor | Stage 3 |
What's happening
| Placenta is delivered |
| Doctor examines placenta to make sure all of it has |
| been delivered |
| This stage can last a few minutes to an hour |
Mother is experiencing
| Contractions may occur closer together but be less |
| painful |
| Doctor repairs episiotomy |
Mother and/or partner
| You'll meet and hold your baby |
can do
| You may need to push to expel the placenta |
| You may be able to hold your baby while the doctor |
| repairs your episiotomy |
| Nurse will rub or massage the uterus through the |
| abdomen to help it contract to control bleeding |
Stage of Labor | Stage 4 |
What's happening
| Placenta has been delivered |
| Uterus continues to contract, which is important to |
| control bleeding |
| This stage usually lasts a couple of days |
The Bloody Show
You may bleed a small amount following a vaginal exam or at the beginning of labor. This "bloody show" occurs as the cervix stretches and dilates. If it causes you concern or appears to be a large amount of blood, contact your healthcare provider immediately.
Along with a bloody show, you may pass some mucus, sometimes called a mucus plug. Passing this mucus doesn't always mean you'll have your baby soon or that you are beginning labor.
Timing Contractions
It helps to time contractions correctly once they begin. There are two goals in timing contractions:
| to find out how long a contraction lasts |
| to find out how often contractions occur |
It helps for your doctor or the nurses to have this information so they can decide if it's time for you to go to the hospital.
Be sure to ask your doctor which method he or she prefers, because there are two ways to time contractions.
| Start timing when the contraction starts and time it until the next contraction starts. This is the most common method. |
| Start timing when the contraction ends and note how long it is until the next contraction starts. |
Labor and Your Partner
Well before your delivery date, sit down and talk with your partner about how you will stay in touch as your due date approaches. Some of my patients'partners rent personal pagers for the last month or so. (Some hospitals or HMOs supply pagers for expectant couples the last few weeks.) Line up a backup support person, in case your partner cannot be with you or if you need someone to take you to the hospital.
Your partner may be your labor coach, or you may have chosen another person for this important job. A labor coach can do a lot to help you through labor. He or she can:
| time your contractions so you are aware of the progress of your labor |
| encourage and reassure you during labor |
| help you deal with your physical discomfort |
| help create a mood in the labor room |
| report symptoms or pain to the nurse and/or doctor |
| keep a watch on the door and protect your privacy |
| control traffic into your room |
Eating and Drinking during Labor
Women often get nauseated as they labor, which may cause vomiting. For that reason your stomach should be empty during labor. You are not allowed to eat or drink anything during labor for your own safety.
You will not be allowed to drink anything, even if your labor is long. You may be allowed sips of water or ice chips to suck on. If labor is long, you may be given fluids through an I. V.
Enemas
You may not be required to have an enema-it is usually a choice. Discuss this with your healthcare provider at one of your prenatal appointments. There are benefits to having an enema early in labor. It decreases the amount of contamination by bowel movement or feces during labor and at the time of delivery. It may also help you after delivery if you have an episiotomy because having a bowel movement very soon after delivery can be painful.
Bowel Movement
Your first bowel movement usually occurs a day or two after delivery. If you had an enema, it could take a few days longer. It could be painful, especially if you have an episiotomy.
Most doctors prescribe stool softeners after delivery to help with your bowel movements. They are safe to take, even if you are nursing.
Back Labor
Back labor occurs when the baby comes out through the birth canal looking straight up. This type of presentation often causes lower-back pain.
Back labor may make delivery last longer. It may require rotation of the baby's head so it comes out looking down at the ground rather than looking up at the sky.
Who Will Be Present at the Birth?
You may want lots of family or no one except your partner present when you have your baby. Whomever you want present at the birth should be OK with your partner. As long as it's acceptable to your
doctor, you may make some of the decisions like this about the birth. My advice is to keep it small; don't let friends or family make you feel they have a "right" to be there.
Too many people in the delivery room can be a problem. Delivery is a very personal experience for you and your partner; it is not a spectator sport. Don't feel pressured to invite others to be with you at this time if you'd rather have privacy. For every additional person in the room, there is an increased risk of infection for you and the baby.
