What to Expect in a Normal Delivery

Dilation and effacement of cervix

Stages of Labor
You'll find that the medical community uses a lot of jargon while you're in labor. We'll try to clear up some of what you're likely to hear and what it means throughout this chapter. There are three stages of labor, and you have to go through all three stages to get to the final outcome, aka the baby. The length and duration of these three stages may vary slightly for each woman.

The first stage of labor is when you are actively having contractions and officially diagnosed as being in labor. This can last a few hours or from to 8-14 hours. The first stage of labor is divided into two phases. The latent phase is the first portion of the first stage. This is the slow, drawn out portion that everybody hates (and they're told, "no, you're not in labor, go home.") Active phase is the second portion of the first stage of labor, and this is when the delivery process occurs at a faster rate. Because labor is more predictable at this point and the progress is steady, patients are typically admitted to the hospital once they reach this point.

The second stage of labor occurs when the cervix is maximally dilated (10 centimeters). This is usually when the mother is told she can push. For a first-time mother if she doesn't have an epidural, this second stage of labor can last one to two hours; with an epidural two to three hours (an epidural can slow labor down).

The third stage of labor begins after the baby is delivered until the placenta comes out. This stage can last up to 30 minutes. We'll break down these stages more completely in the sections that follow.

When You're First Admitted to the Hospital: The Preliminary Exam
After you are evaluated in the labor and delivery area and a determination is made that you are indeed in labor, you will be admitted to the hospital. Forms will need to be signed and papers filled out, but the hospital staff is conscious of the fact that you may be otherwise preoccupied (insert primal scream: I'M IN LABOR – LEAVE ME ALONE!). Your partner can help with this part of the administrative process. In fact, he or she is expected to do so, except for any signatures that you may need to provide.

From the time that you are admitted, doctors and nurses will be discussing your examination findings, based on the fetal heart rate tracings and contraction patterns. But first things first – you'll be given a preliminary exam, either by a doctor or a nurse.

Your first exam at the hospital will include a cervical exam, where three areas are measured: your dilation, effacement, and the station.

Dilation of the Cervix
The dilation of the cervix is measured in centimeters. During the exam, the doctor basically is trying to decide how dilated (or open) the cervix is. The doctor will place his hand gently (we hope) inside your vagina all the way up to the cervix to feel the presentation of the baby's body part. He should feel the head if all is well. Occasionally, the baby will be breech – that is, the doctor will feel the baby's butt or feet. If this condition is diagnosed, the patient will probably be advised to have a c-section, or the doctor may try to turn the baby to the head-down position.

Dilation can be measured anywhere from 1-10 centimeters, one being the beginning of the dilation process and 10 being fully dilated (i.e., the baby is almost out). If the cervical dilation is approximately 3-4 centimeters or greater and the mother is contracting regularly, then she will usually be diagnosed as being in active labor and will be admitted to labor and delivery (in first stage labor).

Effacement of the Cervix
In most cases, the baby's head is down, so the doctor continues with his exam and measures the effacement of the cervix (or the thinness of the cervix). Effacement is measured in percentages. In a normal, nonlaboring woman the cervix is 3-4 centimeters long, which is 0% effacement. If a woman is in labor, then the cervix thins. As it thins, it starts to stretch and becomes incorporated into the lower part of the uterus. For example, if the doctor determines the cervix is about 2 cm. thick, then the effacement is approximately 50%.