Labor - Stage 1

Prelabor

As the mother's body prepares for birth in the last few weeks before the baby is due, a number of signs arise indicating that the mother's labor is about to happen. Along with the Braxton Hicks contractions mentioned before, the baby also enters engagement. Engagement refers to the descent of the baby's head (or rump, if in the breech position) into the mother's pelvis in preparation for delivery. This positioning may relieve some of the pressure on the mother's diaphragm, giving the mother the sensation that she can breathe again.

Many women describe a newfound spurt of energy known as 'nesting behavior' in which they feel a surge of energy to make final arrangements for the baby's arrival. Often, prospective mothers feel like cooking large meals and cleaning and decorating the house. If this urge is felt, follow these desires in moderation, but try to save energy for the big day ahead.

The mother's cervix undergoes many changes in preparation for delivery. The process of effacement, or ripening of the cervix, occurs when the mother's cervix thins itself as the baby's due date approaches. While the cervix thins out, it also dilates and opens from zero to about 10 cm. There is another event known as 'the show' or 'the bloody show' in which a mucus plug that once sealed the cervix against infection has become dislodged and released. While the show usually doesn't appear until labor has begun, it can also be released up to 12 days before birth. The substance released is a sticky, brownish-pink discharge that may have capillaries within.

The breaking of waters is one of the most well known signs of entering labor. The processes occurs when the amniotic sac breaks and the fluid that once cushioned the baby gushes or trickles out. If the mother's water has broken and labor has not begun within 24 hours, consult the mother's doctor. Do not take baths, use tampons, have intercourse or engage in any other activity that may introduce bacteria into the now exposed fetal area.

The first stage of labor is the longest because the cervix must dilate from closed to open (4 inches). For first time deliveries the average time is about 12 hours and successive pregnancies are about half that time.

During this time the mother may wish to take a shower, have a quick nap or talk to some friends. Many women like to stay at home at this time to save their energy for the task ahead. Ensure the mother's fluid intake is maintained but limit the foods eaten to those that are easy to digest, such as toast, fruit and other carbohydrates.

Active Labor

In active labor, the contractions grow stronger and longer, lasting from 45-60 seconds and occur every two to three minutes. Painful sensations may include tightening in the pubic area and pressure in the back region. As well, the mother may feel nauseous and pass loose stools. Between contractions, the mother will still be able to walk around and emptying the mother's bladder every hour is also a good idea. Once in the hospital, the mother may have to stop eating altogether and only consume clear liquids if general anesthesia is being used. During this stage the mother will become focused on the labor and perhaps not be as sunny and cheerful, maybe even irritable. This phase lasts about an average of 4 hours.

The Transition Phase

This phase is the most difficult one of labor but fortunately also the shortest. The transition phase can last on average about 30 minutes and involves the last dilation of the cervix from 7 to 10 cm. Contractions will be stronger here, and while the mother may feel the urge to push, she should hold off until her cervix is fully dilated. Puff-breath breathing techniques may help the mother deal with this urge to push.

The birth canal will be hurting now and pain may be severe. Without any medication, this will be the most painful stage of labor. The mother should allow her uterus to do its work through contractions. The mother should use breathing, relaxation and focusing techniques to get through each contraction.

Emotionally, the time of transition can be short-lived or horrendously long. The mother may be filled with intense pain and the fear that either the baby will never be born or she may die in the course of giving birth. These fears are normal but remember the mother's body is built to survive such a difficult process.

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