The First Stage of Labor

Labor is described as having three stages: the first stage, from the onset of progressing labor contractions until the cervix is completely dilated; the second stage, from complete dilation of the cervix until the baby is born; and the third stage, from the birth of the baby until the placenta is expelled.
A fourth stage, from the delivery of the placenta until the mother's medical condition is stable and safe, is also frequently mentioned.

The first stage is almost always the longest (2 to 24 or more hours), usually starting slowly and then speeding up when the dilation of the cervix reaches about four or five centimeters. Your contractions may not be clear and strong at first, but they will become longer, stronger, and closer together with time.

You may spend much of your time in the first stage trying to figure out if you are in labor or not. If you can be distracted from your contractions, it is unlikely you are in very advanced labor. On rare occasions, women have been unaware of labor until the baby was about to be born! In these cases, there really is no way to prevent a hectic scene unless a woman has had such a birth previously. Then she should watch carefully for any sign of labor -- subtle, preliminary, or absolutely clear.

As labor progresses, you will no longer have any question whether you are in labor. Its pace quickens, and the contractions usually become painful. Once you are certain you are in labor, go to the hospital or birthing center, or if the birth is to be at home, await your caregiver's arrival. Of course, if you have any concerns, feel free to go to the hospital. Be sure to take your bag and have needed items on hand.

You may become serious and quiet, focused on only one thing -- your labor. Jokes are not funny; world events lose their importance. You need support, encouragement, help, and comforting gestures from your partner, caregiver, and nurse. You are likely to have emotional ups and downs throughout labor. You may feel discouraged and may weep from time to time, but if you accept and understand what is happening and what to expect, you can recover from these down periods and go on.

Arrival at the Hospital


On arrival, your first stop is usually the admitting office, where you are asked to read and sign forms and indicate how you will pay for your hospital stay. However, hospital procedures vary considerably, so prior to going into labor, check with your hospital regarding their admitting policies -- especially their procedures for late-night and weekend admissions.


From there you go to the maternity ward, where a nurse greets you, does a quick health check on you, assesses your contractions and the baby's condition, and does a vaginal examination to establish how far along you are in labor.

From then on, hospitals vary widely in their routine care for labor. You may undergo various routines depending on what your doctor feels is best for you. In addition, your nurse periodically takes your temperature and blood pressure, monitors your baby's heartbeat, and feels your abdomen during contractions to determine how labor is progressing. Discuss the procedures in advance with your doctor and express your preferences.

Factors Influencing Labor


Factors you cannot control:

Size and shape of your pelvis


Size and shape of baby's head and shoulders


Baby's station, presentation, and position


The condition of your cervix when contractions begin


The power of your contractions


The amount of rest you have between contractions


Some aspects of your general health and your baby's well-being
Factors you can control, to some extent:

Your emotional state and attitude toward birth (optimism, confidence, and relaxation versus anxiety, fear, and tension)


Presence of helpful, caring partner(s)


Knowledge of what to expect


An environment and a professional staff that help you feel secure and well cared for


Good care of yourself (including good nourishment and good health habits)

Station refers to how low the baby is in the pelvis.

Presentation refers to which part of the baby's body emerges first (usually it is the head, but on occasion it maybe the buttocks, the feet, or even a shoulder).

Position refers to the location -- on the left or the right side of the mother -- and the orientation -- anterior (toward the mother's front), posterior (toward the mother's back), or transverse (lying crosswise) -- of a given part of the baby, specifically, the occiput (back of the head), brow, chin, shoulder, or sacrum (the bone at the lower end of the spinal column). For example, if a baby's position is left occipitoanterior, the back of the head is on the left, pointing toward the mother's front.

Mother's Activities During Labor


Once settled in at the hospital, you will find a routine for handling contractions, perhaps based on what you learned in childbirth classes. Many women learn and use the following routine:

Greet the contraction with a long sigh. As you breathe out, release all bodily tension.


At the same time, focus your attention in some way (for example, focus on your partner's face or on a picture or object of your choice; close your eyes and picture your cervix opening as your uterus contracts; picture a peaceful, relaxing place and picture yourself there; focus on music of your choice or the soothing voice of your partner; or focus on the feel of your partner holding or stroking you).


Breathe slowly and easily.


Maintain relaxation throughout the contraction. Stay limp. It may help if you focus on one part of your body with each breath out. Try to release tension in that part as you breathe out. Then focus on another part with the next breath.
You can follow this routine with every contraction and in any position -- lying down, sitting, standing, on your hands and knees. You can do it in the tub or shower, in bed, in the car, in a chair, in the hospital corridor, or in your room. You can lean on your partner, the wall, or your bed.

These techniques often keep pain within manageable limits for part or all of your labor. Women who use them generally need less pain medication than others. Indeed, some women do not need to use any pain medication when using these techniques.

Some women learn several types, or levels, of breathing to use progressively during labor. Besides the slow pattern just described, they may learn a lighter, faster, but still relaxing pattern and other variations.

Besides using a routine for each contraction, you should try to change position every 20 or 30 minutes, go to the bathroom every hour or so, and sip liquids or suck on ice after every contraction. These measures may be comforting.

You may find hot packs on the lower portion of your abdomen, your groin, and your perineum (external genital-rectal area); cold packs on the lower part of your back; and a cool, moist washcloth rubbed over your face and neck ease some discomfort. Being touched and rubbed, especially in tense, sore areas, such as the shoulders and the lower part of the back, helps a lot. If you feel a bit out of control, it helps when your partner holds you tightly or gently but firmly holds your head in his hands.

During intense periods, such as the transition phase (from about seven to ten centimeters of cervical dilation), you may feel almost out of control. You may feel your body is running away with you, and you are being swept along in a tide of intense sensations. Fighting these sensations is pointless.

You may feel an urge to push but be told that you are not yet fully dilated. It is important that -- for the time being -- you resist the urge to push. Pushing too soon could injure the cervix and perineal tissues and may lead to heavy bleeding. What helps the most is knowing nothing is wrong. Just accept that your body is in charge, and don't try to stay in control. Let your loved ones help you, moan and complain if you want to, and know it will not last too long.