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Stages of Labor

For forty weeks, you wait for a single day: the day you have your baby. You may well look back at it as one of the greatest days of your life, but you are probably not looking forward to it with such enthusiasm. You may be scared. You may be impatient. You may be nervous. You are guaranteed to be in some pain and discomfort on the day in question. But it won't last nearly as long as your memories or your love for your baby. And it's easier to get through when you know what to expect.

There are four stages of labor, and though their character varies just as much as individual women do, there are some things you can anticipate.

You could know you are in labor when:

• your baby drops
• your water breaks;
• a small, clot like plug (bloody show) dislodges itself;
• steady contractions begin and take on a pattern;
• you suffer from cramps or diarrhea; and/or,
• you are flooded with energy, relief, nerves, excitement, or all four at once.

Bloody show can occur as early as a couple of weeks before labor, or once you're already in it. Your water may break now, but it may break much later. You know that you are officially in early labor because your contractions will become steady and persistent and your cervix will dilate from zero to four centimeters. Like the Braxton Hicks contractions you have probably been experiencing for some time, early labor contractions are mild and begin in the back, moving forward in a wave like motion. You can differentiate them from the Braxton Hicks contractions by moving. Changing your position or getting up and walking strengthens a labor contraction, while it has no effect on a Braxton Hicks contraction. These contractions will be thirty to sixty seconds long and between five and twenty minutes apart.

You may be in early labor anywhere between two and 20 hours so sit back and stay as comfortable as possible at home with a stop watch in hand. Time your contractions from the beginning of one contraction to the beginning of the next. Once your contractions have been five minutes apart for about an hour if you are a first time mom, or ten minutes apart for about an hour if you have had a baby before, call your doctor or caregiver. They will probably tell you that unless your water has broken, it is too early to go to the hospital or birthing center, and they will let you know when you should plan to leave for the hospital. When making that decision, don't forget about traffic. Sleep if you can. Eat a small, light snack. Call your coach and add any last minute items to your hospital bag. If you find yourself getting worked up and stressed out, practice your relaxation techniques.

Active labor begins when your cervix is dilated to between four to seven centimeters. You should be at your delivery destination already and if your water did not break earlier, it will be broken now. Your contractions are getting longer, stronger, and closer together. They will be between one and three minutes apart and may last 60 to 75 seconds. You will be very seriously and intensely focused on them. Seek reassurance, good music, a massage, and anything that will keep you comfortable. Concentrate on relaxing. The more relaxed you are, the easier it will be to dilate and thin out your cervix. Standing up and walking around will help, too. Walk to the bathroom every hour to empty your bladder. You'll be in this stage of delivery for 12 to 16 hours if you are a first-time mom, and maybe six to eight hours if you've already been through this once before.

Transition is the most difficult part of labor, but it is also the shortest. Your uterus is no longer opening the cervix; it's pushing the baby out. This could last as few as 10 minutes, and it probably won't last longer than an hour. Your contractions will be hard and strong, about one minute apart and somewhere between 90 and 120 seconds long. There may be multiple peaks to them rather than a wave-like action, and you may not have a break between contractions. You will be dilated between seven and 10 centimeters, and you will probably be irritable and teary. Panic, disorientation or nausea may set in. You may get hot or cold flashes, and your legs might tremble. You will be feeling rectal pressure, and may have a premature urge to push. Your coach will be there to offer support and to remind you that it is not long now. The moment in which you think you cannot wait or survive another second, you don't have to.

Upon arrival at the final stage of labor, birth and afterbirth, you will be fully dilated and ready to push. Your contractions will be wavelike again, giving you three to seven minutes of resting time in between them. They will be about a minute or so long, and your doctor, midwife, or nurse will tell you when and when not to push.

Whether upright, squatting, or lying on your side, you will push evenly and intensely from the diaphragm downward, and keep the vaginal canal as relaxed as you can. Depending on what kind of medication you have or have not taken, you may feel your baby in your birth canal during contractions, and you may experience a stretching almost burning sensation as your perineum is widened, allowing your baby to pass through into the world.

Once your baby is born, your uterus will continue to contract gently for another half hour to push out your placenta. You may not even notice these last minutes of labor. You are a mom now and the most beautiful baby in the world may be all you have the time or energy to think about.