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The Stages of Labor

What is real labor like? Ask 50 women and you'll get 50 different stories. It's a unique, wonderful, terrifying, thrilling, difficult, easy, fast, unforgettable experience that will bring your baby into the world one way or another. Although no one can predict the details of your labor and delivery, the stages of delivery are the same for most women. Knowing where you are in the labor process should help you feel more in control and therefore less anxious during the birthing process.

During the first stage of labor, the tough cervix begins to soften and stretch to prepare to let the baby's head pass through during delivery. This is called effacement. As the first stage of labor continues, the cervix begins to dilate (about 1 to 1½ centimeters per hour). When the cervix dilates to 10 centimeters, delivery of the baby begins.

Stage One Labor

Hey Mom!

When a woman tells you she was in labor for 40 hours, you can bet she's counting from the earliest stages of labor—not hard labor. Don't let tales like this one worry you.

Daddy Alert!

Your job in the first stage of labor is to keep your partner (and yourself) calm. Try relaxation exercises and a massage. Play board games or go for a short walk together. Do whatever you have to do to stay calm and distract your partner. Encourage her to rest and store up the energy she'll need for what's ahead. If you can't stick around for too long (after all, this stage of labor can last for days), keep in constant touch and always be available when your partner says, "It's time!"

The first stage of labor brings you from the first twinge of a contraction to the serious business of getting ready for birth. This first stage can be long—up to three days sometimes. That's why it's important to know what's going on so you don't rush to the hospital or birthing center only to sit around for hours or be sent home because it's still too early.

In the very early stage you might not even know you're in labor. You might feel some menstrual-like cramps, or a bloated, constipated feeling, or a pain that starts in the back and moves across to your abdomen. Gradually the discomfort will grow into sharp pains that become more regular and intense.

During this early stage you might (or might not) have two signs of progressing labor:

This early stage of labor can last hours (or even days), so don't get too excited and do things that will get you tired out. It's not necessary at this point to do any breathing exercises, for example, and forget about putting the last touches on the baby's bedroom. The best thing to do is get some rest. You have a physically challenging job ahead of you—rest up.

If your early labor drags on, you're bound to get hungry, but watch what you eat. During labor, your stomach and intestines slow down, so you don't want to burden your sluggish digestive tract. Eat light foods that will give you energy. Toast, crackers with jelly or honey, hot cereal, or soup are all good choices. Above all, drink lots of water and juice to keep yourself from dehydrating.

The early stage of labor ends when contractions are about five minutes apart for an hour. Your doctor will tell you to let her know when your contractions reach a certain frequency and intensity. She'll also tell you not to worry too much about accidentally delivering your baby on the living room floor. Despite all the anxiety, most new mothers manage to arrive at their birthing place when it's not too soon and not too late. If you pay attention to your body, you will hear the body signals that say, "It's time to go!"

Stage Two Labor

Pregnancy Facts

First babies usually take longer to deliver than second and third babies, because the unused birth passage is tense and unyielding.

Stage two labor is more intense than early labor. You might not be able to talk or walk through these contractions. In this stage, you should not eat anything (if an anesthetic is administered when the stomach is full, severe nausea might occur and complicate delivery). You may sip some fluids or eat hard candy or ice chips if you like.

Now is the time to use the breathing and relaxation exercises you were taught if you went to childbirth classes. These will help you relax and tolerate the pain. But don't expect them to make the pain go away completely—it is very unusual for this to happen. Expecting a pain-free labor will probably leave you very disappointed and surprised. Your cervix has to dilate to 10 centimeters, and the baby has to work her way down the birth canal—this just hurts.

Now is the time to get going. In the second stage of labor you should go to the hospital or birthing center to prepare for delivery. Ideally, you will have preregistered and won't have too many forms to fill out between contractions. When you're admitted, you will meet a nurse (or midwife, if you are delivering your baby in a birthing center) who will guide you through the rest of your labor and delivery. She will explain what's happening and will answer your questions. To prepare for the safe delivery of a baby in a hospital you can expect the following:

In days long passed, it was routine to give women in labor an enema (to empty the bowel, making more room for the birth canal to expand) and to shave their pubic hair (to keep bacteria out of the vaginal area). Today, many doctors and midwives have abandoned these practices, and recent studies show they are unnecessary. Still, some continue the habit. When you write your birth plan, talk to your doctor about having an enema and shaving. If you have the option, tell the primary nurse when you enter the hospital what you and your doctor have agreed upon.

You will have a bed to lie on during labor, but that doesn't mean that lying on your back is the best labor position for you. If you are not hooked up to fetal monitors or an IV pole, ask the nurses if you can get up and move around. Try different positions during your contractions until you find one that makes you feel most comfortable. Possible labor positions include the following:

Daddy Alert!

No matter how much you and your partner have practiced for active labor, you can't count on things going as expected. Your calm and collected spouse might get loud and obnoxious. She might tell you to get out. She might cry and forget everything she's practiced. Whatever happens, stay supportive. Follow her lead and give her whatever she needs. Don't be critical or demanding, just do your best to offer encouragement.

Hey Mom!

In the second stage of labor it's not uncommon to feel sick with nausea, chills, sweats, or shakes. Deep breathing and relaxation exercises can help you through this.

The best labor position is the one that makes you feel most comfortable. Try them all out, move back and forth from one to another. If you're able, moving around helps labor progress.

This stage of labor can last about 4 to 6 hours as your cervix continues to dilate (about 1 to 1½ cm per hour). Things move along a little faster if you've previously given birth.

As your cervix becomes almost fully dilated, you'll have contractions that last for 60 to 90 seconds. You'll also have a strong urge to push out your baby. This "bearing down" is like pushing out a difficult bowel movement. You strain the vaginal muscles to push the baby down the birth canal. When you first feel this urge, the nurses might tell you not to push yet. This means you aren't dilated enough for the baby to be pushed out. (It can be hard to resist the urge but they know what they're doing!)

When you are fully dilated (at 10 cm) and feel the urge to push, it's time for delivery. If you are in a hospital, you might be wheeled into a delivery room where your doctor will join you, or you might deliver right in the labor room. After a quick examination and review of your labor, you'll be relieved to hear the doctor say, "Push!" with the next contraction. This pushing stage can last anywhere from a few minutes to a few hours. This is where you might find yourself getting very tired and impatient, but the end is near.

This is also when the doctor might perform an episiotomy. This is a surgical incision that is made from your vagina toward the rectum in order to make the opening wider. An episiotomy prevents tearing, which can damage the pelvic muscles. If there is enough time to give a local anesthetic into the area, the doctor will do that. But if you've had an epidural, you won't need further anesthesia.

There is some debate over the necessity of having an episiotomy. Certainly, it's not a necessity if the baby's head has enough room to pass through. But whether or not to perform an episiotomy is a judgment call made by the physician at the last moment. I would estimate that probably 90 percent-plus of first-time mothers get an episiotomy. On subsequent babies, there is more room, and the necessity for an episiotomy is less likely.

Instrument-Assisted Birth

If the baby is slow coming down the birth canal, he might need what's called an instrument-assisted birth. At this point, a woman under the care of a midwife at home or at a birthing center would be transferred to the care of a physician, who would take over the delivery process. She might also be moved to her backup hospital if the physician feels this would be best. A very long labor can endanger the life of the baby, so in some cases, forceps or vacuum extraction can be lifesavers. Forceps are large, spoon-like metal tongs, the smooth blades of which are inserted into the vagina and placed on either side of the baby's head. A vacuum extraction uses a caplike device that attaches to the baby's head and uses suction to extract the baby. These instruments are used in about 10 percent of all vaginal deliveries (especially medicated ones, in which the mother is unable to push hard enough).

Induced Labor

Although it's always best to let nature take its course, labor must be induced sometimes. This means that labor contractions are produced artificially with the use of the drug oxytocin (trade name, Pitocin). Oxytocin is a hormone that is produced naturally by the pituitary gland during pregnancy. As the cervix begins to efface and dilate, the uterus becomes sensitive to the oxytocin and reacts with contractions. Administering oxytocin as a medication can encourage the natural process of giving birth.

There are many reasons a doctor or midwife might decide to induce labor (which is always done in a hospital setting). A few common ones include the following:

Pregnancy Facts

The hormone oxytocin is released by a pregnant woman when her nipples are stimulated. To induce labor naturally, she might be asked to rub her nipples and stay alert for signs of uterine contractions.

There are two ways to induce labor. If the cervix is uneffaced and closed, you will be asked to go to the hospital the night before the induction to have a special medicated gel (a prostoglandin) placed on the cervix.

As soon as the cervix is soft and effaced, oxytocin will be administered through an intravenous (IV) drip. This will cause contractions to begin. Oxytocin is administered through a needle in the arm or the back of the hand. The needle is connected with a tube to a medication bag that hangs from an IV stand. This controls dosage.

Usually an induction begins slowly, with very little use of oxytocin. Then the rate of medication is increased gradually until strong contractions build in intensity and come closer together, mimicking normal labor. If labor hasn't begun after six to eight hours, the induction will be stopped, in all probability, and a second induction might be scheduled for a later time or a cesarean will be considered.

Whether the birth is natural, medicated, instrument-assisted, or induced, eventually your baby's head will "crown." This means the doctor (and you, with the help of a mirror) can see the baby's head pushing its way through the vaginal opening. After another strong contraction and a push the head might be delivered. At this point, the doctor might tell you to stop pushing. It can be very difficult to resist the urge to push, but some doctors and midwives like to suction the baby's nose and mouth immediately, in order to remove mucus and amniotic fluid. This takes only a minute and the next push is generally the one that delivers the baby's shoulders and body. Your baby is born! Shortly afterward, the umbilical cord will be clamped and cut.

Stage Three Labor

What? There's more? After the birth of your baby, contractions will continue, at intervals of about one minute, to help deliver the placenta. The contractions help separate the placenta from the uterine wall and move it down into the vagina so you can then push it out. Your doctor might help by pressing and kneading the uterus and gently pulling on the umbilical cord.

After the placenta is delivered, your doctor or midwife will stitch up your episiotomy (if you had one) and any tears (if necessary).

Now, you're finished. The labor and delivery that you looked forward to for so long is over and you are now officially a mother. At this time the nurses will sponge-bathe the lower part of your body, give you a clean gown, and help you put on a sanitary napkin to absorb the blood you will pass. You might also put an ice pack on the perineum (crotch area) to ease the discomfort of the stretched tissues.

During this third stage of labor, your newborn baby is probably lying on your stomach (or nursing, perhaps) while you and your partner admire, praise, and gush over this new miracle of life. If you are planning to breast-feed your baby, you might start nursing right away. (This early breast milk is not high in calories, but is high in antibodies that protect the baby from infection.) If you talk softly to your baby he might turn and look for the face that goes with the voice he has listened to for the last nine months.

Excerpted from The Complete Idiot's Guide to Pregnancy and Childbirth © 2004 by Michele Isaac Gliksman, M.D. and Theresa Foy DiGeronimo. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

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