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Since every woman's experience of labor is different, it's hard to say exactly what your experience will be like. However, the stages of labor are common for all women. The first stage, when labor becomes established, starts when contractions start to open, or dilate, the cervix (see Dilation). For some women, especially those who don't want strong pain relief, this is the hardest part of labor. Waiting for the cervix to dilate can be a long process with your first baby, and there isn't much you can do to hurry the process. The first stage of labor can be broken down into different phases, referred to as the early, or latent, phase, and the active phase. After these phases comes transition, when your cervix becomes fully dilated and before you start to push your baby out.
During the early phase, which can last for over a day or so in a first labor, your contractions gradually become more uncomfortable, but still relatively mild, and occur more frequently, although they may be irregular. During this phase, your cervix gradually shortens, a process known as effacement (see Effacement) and begins to dilate. When the cervix is approximately 3-4 cm dilated and you're having regular, strong contractions, the active phase has begun. The changes to your cervix during the early phase can be slow or fast and are hard to predict.
The active phase of the first stage is the individual point for each woman where cervical change happens more quickly and predictably. However, exactly when you enter active labor can be hard to establish, even for a doctor. For most women, active labor occurs at around 4 cm dilation. Your contractions are regular and may be every 5 minutes or so and getting closer together until they're 2 to 4 minutes apart and lasting from 45 seconds to one minute or more. From the start of active labor to the birth can last for around 10 to 12 hours, although this may be considerably shorter in a second labor.
In active labor, the nature of your contractions change, with pain becoming less concentrated in the lower abdomen, instead starting higher in the abdomen and moving down toward the pelvis and lower back as your baby is pushed down. Contractions are caused by a painful tightening of the muscles that may start off feeling like a severe period pain and increase in intensity as they reach their peak. Your doctor will assess if you're in active labor by observing your pain levels, the frequency and strength of contractions, and by using a tool called a labor curve, which plots cervical change and the position of your baby's head in relation to your pelvis over time (see Labor Graphs).
It's important for your doctor to determine when you enter active labor so she can assess how labor is progressing. For first labors, 90 percent of women have a cervical dilation of about 1 cm per hour, whereas labor moves faster in subsequent births. If you've had an epidural, labor may be slower. Once it's established that you're in active labor, the doctor can predict when you may deliver. However, since women vary widely in how long it takes them to have a baby, bear in mind that this is only an estimate.
During active labor, you may want to have medical pain relief if you haven't so far, such as analgesics or an epidural.
During the first stage, your partner has a varied and important role. In addition to helping you feel comfortable and assisting you with positions, your partner can also support you mentally. This is especially important at the end of the first stage, when you reach transition), a point when women often feel panicky and out of control. Your partner can offer reassurance that you're doing well and that the delivery of your baby is not far off. He can also improve your comfort, for example by applying a damp, cool washcloth to your face and neck, and he can help you focus on your breathing, reminding you to pant or blow to help you resist the urge to push before the cervix is fully dilated.
Excerpted from Pregnancy Day by Day.
Copyright ©2009 Dorling Kindersley Limited.
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