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| Home > Labour and Birth > Four Stages of Labor > The First Stage of Labor
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| | The First Stage of Labor
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The Dilating Stage
Generally, your labor will start within two weeks before or after your due date towards the end of your pregnancy. The exact moment of the beginning of labor may be missed by you; the process starts gradually and most of the early signs are subtle. Usually you may take some time, may be a few hours to a day to gauge the progression and recognize labor.
Signs of Labor
Familiarize yourself with the following signs so that you will prob-ably identify labor and not be taken unawares. There is no consis-tent pattern of occurrence. The signs are listed randomly because there is no fixed pattern of occurrence. All these signs of labor may or may not be experienced by you.
Backache that comes and goes, you feel uneasy or restless and do not find comfort in any position. This backache is not the same as the backache most women have in late pregnancy. This subtle symptom may occur for days before or along with other signs of labor.
Frequent soft bowel movements, often mistaken for an in-testinal upset. This is induced by hormonal change, the clearing of the lower digestive tract, makes more room for the baby to move down. Diarrhea-like symptoms on or near your due date may be a subtle sign of early labor.
Passage of a thickened mucus plug or "bloody show." a thick mucus plug (the operculum), which ensured the safety of the fetus through out pregnancy is loosened and released when the cervix begins thinning and opening. It may be tinged with blood from the ruptured blood vessels in the cervix. This bloody show can manifest itself days before any other signs of labor. Do not think that you are in labor by noticing this symptom. Keep an eye for other signs when you pass it.
Some women often pass brownish, bloody discharge about half - a - day after a vaginal exam during late pregnancy. Do not mistake this discharge for a show. Vaginal exam often causes some cervical bleeding. The appearance of the blood will confirm whether the discharge is show or post exam discharge, with the show the blood is bright red and mixed with mucus; after an exam, it is usually brownish.
Contractions of the uterus that progress and intensify over a period of time. With the passage of time the contractions become longer, stronger, and closer together. In early labor, contractions are usually felt as a tightening with some backache. Contractions usually become painful with the advancement of labor. The muscle fibers in the body of the uterus, are shortened by contractions pulling open the cervix, and push the fetus down and out of the uterus.
Non dilating contractions continuing for hours or days are felt by many women before the cervix actually begins to dilate. This is called "false labor:` this condition can be tiring and confusing. The following comparison chart will help you ascertain if you are in true labor. If you are still unsure, call for help from the nursing staff.
In order to assess your contractions, time them and keep a written record. A watch or clock with a second hand will suffice. Note the times when the contraction starts and ends. This is the duration of the contraction. Interval refers to the length of time between the beginning of one contraction and the begin-ning of the next. Fre-quency means repetition of contractions during a particular time for instance, every five minutes.
Rupture of the membranes (ROM) or breaking of the bag of waters begins labor about 10 to 15 percent of the time. Contractions usually begin immediately or within twenty-four hours with the rupture of the membranes. The membranes rup-ture late in labor, in most pregnancies. The amniotic fluid may gush out with a pop o r there may be an uncontrollable leak of fluid. ROM may feel like urina-tion; prompting women to believe that they have lost control of their bladders. The risk of infection increases with the passage of time when ROM occurs and labor fails to begin. The following suggestions are to be noted if your membranes rupture.
Note the time, color, odor, and amount of fluid. Notify your doctor. He may induce labor soon after ROM if it occurs at term. Labor may be prevented if it occurs before term. Some caregivers are comfortable waiting to see if you will go into labor spontaneously or if you can get labor started by yourself.
Do not insert anything into your vagina as that could increase the possibility of infection. Insertion of finger or tampons is a strict no. Vaginal examinations should also be minimized by your doctor to minimize the chance of infection.
Vaginal exami-nation confirms effacement and dilatation. Whether the cervix is opening or not is determined by your attendant by keeping the following records.
Record
In order to determine whether or not you are in true labor, keep track of what is happening by making an early labor record, where you note the timing of the contractions, the duration, interval or frequency of the contraction and your state in general. Also note the food eaten, whether or not show is present and also the status of the bag of water. These parameters will help you decide whether or not to go to the hospital. If you find that there is no progression of labor, that is to say they do not become longer, stronger and closer for an hour or more stop timing to resume after you notice a change.
When you decide to call on your doctor, be prepared to inform him about the duration, interval and frequency of labor. He may also enquire about your membranes, show or other details.
In Labor
You will be in the first stage of labor when your cervix is dilating, which normally lasts from two to twenty- four hours. The average length of the first stage for a primi-gravida is twelve and one-half hours; for a multigravida it is about seven and one-third hours. Prepare yourself for all the consequences as it is impossible to predict just how long it will take.
Contractions continue sporadically throughout labor, short-ening the muscle fibers in the body of the uterus and pulling the cervix open. Each contraction follows a wavelike pattern: At its peak it stays for fifteen to forty seconds, then gradually wanes. Giving rest to the uterus for sometime. The contractions feel like a dull, low backache or menstrual cramps early in labor. These are usually short and mild, lasting thirty to forty seconds. The interval be-tween two successive contractions may be as long as fifteen to twenty minutes. With the advancement of labor the contractions are felt more in your abdomen or in both your abdomen and low back. Sometimes the backache persists even between contractions. The first stage ends when the contractions last as long as 90 to 120 seconds and the interval shorten to two to three minutes. The uterus becomes the largest and strongest muscle in the body with the end of pregnancy. The uterus hardens and bulges like any other muscle when it contracts. The contractions become more powerful and strong with the progress of labor. The stronger contractions induce dilation of the cervix and the baby`s passage downward. Labor contractions, under the control of various hormonal and other physiological factors are involuntary. Once the process activates, it continues till the birth of the baby and placenta. Then you can rest and rejoice in your baby.
The first stage of labor is subdivided into three phases: latent, active and transition. The progress of labor shortens and intensifies the phases. If you and your partner understand each phase, you will be better prepared to recognize each phase and cope with your labor.
The Latent Phase
The latent phase is usually the longest phase of the first stage. The interval of the contractions is usually longer than in other stages. During this phase, your cervix will efface and dilate to three, four or possibly five centimeters. You will probably spend most of this phase at home, doing your normal housework, that is moderate activity. Whether you are in labor or not will not be clear to you and your partner. The Early Labor Record will help you decide on this count.
During this phase, do not become preoccupied with the labor. Instead, listen to some pleasant music, or engage in activities that refresh you. You will probably feel excited and a bit nervous. Focus on relaxing your muscles and your mind during your contractions. Have a massage. Take a bath or shower depending on the condition of your membrane. Eat easy-to-digest foods. Do whatever you feel like without straining yourself. You will reach a point when you cannot walk, talk during the peak of contraction without pausing, start patterned breathing of the first level.
When to Call Your Caregiver
A primigravida should call on the hospital when her membranes rupture or when the contractions are very strong, requiring total concentration and breathing. The interval of the contractions may be about five minutes apart. The multigravida should call when her mem-branes rupture or when she passes through several symptoms of labor. Furnish information on show mem-branes and contractions that you have recorded earlier. You may consult your doctor if you have any questions even without experiencing true labor.
The Active Phase
The labor pattern changes with the ending of the latent phase. Your contractions may be painful, though manageable. The duration of each lasting a minute or more and with an interval of three to five minutes This is the time you should go to the hospital or birth center, or when the midwife or doctor arrives for a home birth. You may feel that the process of labor is a never ending one. You may estimate the time taken to get to four or five centimeters of dilation and calculate to predict how much longer you will take to get to ten centimeters. You may feel hopeless and may wish get out of the situation. You may feel trapped in the labor, with no sight of hope but still have to go on and complete the process.
The active phase of labor is more demanding and more productive. In the latent phase, your spirits were high; in the active phase, you become serious and preoccupied with the contractions. Earlier you may have enjoyed your partner`s jokes and his conversation. Now you become in attentive. You may even feel resentful of the "small talk" around you. With you preoccupied with labor, your partner should come close to you, focus more on your labor and be concerned with your serious and sullen mood. He should assist you in relaxing in com-fortable positions, and maintain your focus and breathing. His significant contribution would be to identify the stage of labor you are in. You may feel let down because your progress may be slow, yet the contractions are demanding so much more of you. The truth is, the active phase, initiates the speeding up of labor which in turn facilitates the descent of the baby. Your partner should inculcate the sense of optimism that is, accomplishing something with each of these intense contractions. It is the knowledge that you are finally getting somewhere, renews your confidence and focus on the brighter side of things.
As the surroundings change in the hospital, getting settled there with your support people helps you shift your frame of mind to accepting these intense, productive contractions. At this time, your nurse or doctor will assess your labor with a vaginal exam and monitor the fetal heart rate. Your blood pressure, temperature, and pulse are also to be noted. They may also evaluate your urine and blood samples.
Retain your composure through these procedures. Try pres-sure and cold packs on your back, or hot compresses on your lower abdomen, groin and back. Pass urine at an hourly basis as a full bladder is uncomfortable and can slow labor. You need to change your position more often; try to walk and sit rather than lie in bed. Do not make the mistake of staying immobile in bed throughout labor. Lying down may increase the pain of contractions and slow the progress of labor. Try standing and walking for at least part of the time to let the pull of gravity assist you. Try to maintain your activity from the beginning unless you are very tired and real-ly need to lie down. Activity could be alternated with rest. Fluid supplementation is very important so drink something after each contraction or suck on ice chips. The effacement and dilatation as well as the station and position of the baby could be ascertained by vaginal exam which in turn will gauge your progress.
Continue your relaxation and breathing techniques. Your partner`s encouragement is essential at this stage. Lauding your efforts, rubbing your back and legs, and counting off every fifteen seconds in the contraction, and reminding you to move around, drinking fluids, and going to the bathroom will be very heartening to you.. Relaxation is the key at this time. Make a special effort to keep from tensing during contractions.
Slow breathing may be continued for as long as it helps you relax. When your breathing begins to sound tense or labored, and the rate of breathing increases, or if you find you lose your focus and become tensed in spite of renewed efforts and more active encouragement from your partner, switch to accelerated or light breathing. This will boost you immensely. Accelerated breathing matches the pattern of your contractions. It lightens and quick-ens as the contraction intensifies. It slows and deepens as the contraction wanes. The accelerated breathing pattern synchronizes with your labor con-tractions and calms you with its rhythm.
The Transition Phase
Intensity, pain and difficulty reach its climax during the transition phase in most labors. The cervix dilates the remaining one or two centimeters, the baby presses down lower in the pelvis, and your body prepares for the expulsion stage. This phase is comparatively short, lasting from five to twenty contrac-tions. These contractions, the longest of your labor, come with a high frequency therefore you will get the shortest rest in between. You will probably be tired, rest-less, and irritable, totally consumed by your efforts to cope. The strength of this phase is almost crushing, so you will need greater support and help to tide over.
During this phase you are truly in a transition-from first to second stage. Your body demonstrates the symptoms of the second stage, although it is still in the first stage. For example, your dia-phragm may be stimulated, initiating involuntary spasms that are the precursors of descent. This may result in hiccups, grunting or belching. Nausea and vomiting may also be noticed. The pressure of the baby`s head on your rectum feels like a bowel movement and may cause a backache or aching thighs. Trembling legs may spread throughout the body and a heavy discharge of bloody mucus from the vagina point to the increased downward pressure. Contractions may be irregular, with double peaks, with duration of 90 to 120 seconds with only thirty-second interval. You may doze off during the interval between contractions, allowing your body to conserve every bit of energy for the contractions.
During transition, your labor is the center of your focus, every thing else becomes a non entity. You may be worrisome of your labor; the intensity of labor may scare you and make you more depen-dent on those around you. The transition may seem like eternal that you cannot take any more. One woman rightly pointed out "When you can`t take any more, there`s no more to take." You are pushed to your limits. With backing from your partner, and being knowledgeable, you will wea-ther the storm because transition is short.
Getting through Transition
Recognition is one of the keys to coping with transition. If you are going through the extreme feelings of transition and think that you are only five or six centimeters dilated, you will probably be dejected thinking the effort still needed to extract the baby. Remember that labor is a pro-gressive process. You progress every minute. You should bear this in your mind especially if you become more sensitive to your contractions. Familiarize yourself with the signs of transition described above and be ready for them any time after you enter the active phase of labor. When women or couples know where they stand they are delighted by their progress and see the pain and difficulties of transition a mere passing phase to get to their baby.
The normal feelings, reactions, and events of transition range from, Pain, nausea, trembling, despair, dependence, crying, inability to relax and breathe "perfectly". These symptoms do not signify that something is wrong. You may think that pain medications or anesthesia may be a way out of the intense feeling associated with this stage. You may also assume that your labor is worse than it is supposed to be. Do not take pain medication because you fear your transition is abnormal. The medication will relieve pain but will not improve you or your baby`s health (except in very rare instances where labor stops because the pain and stress are so great that a woman cannot respond to emotional support).
Encouragement from your partner and caregiver is essential. You should be reassured that you and your baby are well, that your sensations are normal, that you are faring well, and that this difficult time will be short.
Finally, Positive support and coaching from your partner will help you through transition. Your partner might "conduct" your breathing by pacing you with his hand or breath-ing with you. If accelerated or slow breathing does not help you now, you have to switch to transition or "scramble" breathing. Many women like being held close at this time; others do not want to be touched, at the same time enjoy visual or verbal contact. Hot, moist towels on the low back, lower abdomen, and perineum can alleviate your pain. Changing positions between con-tractions sometimes brings relief.
Women often unnecessarily worry that transition will be too much for them, that they will lose control, they panic, and behave in a way they will want to forget looking back.. They are frightened by stories` of women who struggled, screamed, or begged to be put to sleep. Drugs such as scopolamine took away their control, not their labor. These drugs altered human behavior are not in use today. These impressions of childbirth are carryovers from the past.
Mental and physical preparation will help you get through transition without drugs, especially if you prepare in advance, have good support, are knowledgeable and use relaxation breathing, and comfort techniques. You should be able to respond to clear, simple directions. Your partner should not mistake your cries, or other sounds during transition with cries of agony. Making noise during contractions eases transition. One nurse remarked that she is able to identify the stage of labor by the sounds of the women.
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