Labor: Stage One

There are three stages to labor. 

In this post I will discuss Stage One and its three Phases. I would like to add that in the first stage of labor, not everything is by the book (I know mine certainly was not!), so use this as just a guide. If you wait to let every single symptom happen before you call your doctor you may end up waiting too long. Nothing can prepare you for labor, but educating yourself can at least give you a heads up.

Stage One: Labor

Phase One is called "Early labor" and usually takes the longest and is the least intense of all the stages. Early labor can last hours (approximately two to six hours with contractions that are unmistakable), days, or even weeks (yes, weeks - you'll notice contractions that are irritating). Your cervix will efface (thin) and dilate (open) to 3 cm. Contractions last around 30 - 45 seconds (may be shorter) and are mild to moderate in strength; they may be regular or irregular at this point (somewhere around 20 minutes apart), but will become closer together over time (but not necessarily in a set pattern yet). A note on contractions: yours will not feel like your mother's, your best friends, or the woman's in the next room. Some women have contractions that are clearly defined and in a totally set pattern, while others will have one that just blurs into the next one.

You may experience:

• A backache (either constantly or with each contraction). A note about lower back pain: back labor can be long, drawn out, and very discouraging. Counterpressure can be very helpful as well as a heating pad or hot water bottle and experimenting with different positions.
• Menstrual-like cramps
• Lower abdominal pressure
• Indigestion
• Diarrhea
• Bloody show
• Your water will break (though, its more likely that this will happen in Phase 2). A note about your water breaking: it does not all just gush out at once. It will dribble, and dribble, and dribble some more. And not just through Phase One, but through all the Phases.
• You may feel excited, relieved, uncertain, anticipation, anxiety, fear, relaxed, chatty, tense, or apprehensive.

What can you do?

• Well, you should relax. This part of labor, like I mentioned before, can take quite some time (eh, um...mine went on for 40 hours).
• Try to sleep (if its nighttime, or even if it isn't!). I was consistently woken up by my contractions and had to pee, pee, pee all night long (this is how I really knew something was up...not only was it not normal for me to wake up from my contractions, but I hadn't had to get up to go to the bathroom multiple times a night since the beginning of my pregnancy). If you absolutely can't sleep, you could try to do something you like to do. Some people may read, some people may cook, some may clean, some may walk. Whatever you feel like doing, go ahead and do it, but try not to wear yourself out.
• You should let your partner know what's going on, as well as work, or anyone else that may need to know. If you have a doula or if you plan on doing a home birth and have a midwife, you should let them know as well.
• Eat! You're going to need the energy. Keep it light. Things like broth, toast, plain noodles or rice, Jell-O, popsicle, pudding, bananas, etc. - i.e. energy foods. Stay away from greasy or acidic things.
• Stay hydrated!!
• Get comfortable. Try taking a nice warm shower (remember, no baths if your water broke). You can use a heating pad for your back as well.
• Get out your pen and paper - you need to start timing your contractions. To time a contraction, write down the time one starts and the time the next one starts. That will tell you how far apart they are. 
• Pee often. A full bladder can slow things down.

If your labor isn't progressing (your cervix isn't dilating or effacing), you may be encouraged to walk (or you might be encouraged to just rest). If those things do not help, you may be asked to try Pitocin, a prostaglandin E gel, or another labor stimulator.

Phase Two is called "Active labor." Your cervix will dilate to 7 cm and your contractions will be approximately 40 - 60 seconds (with a distinct peak midway through) and will be coming every 3 to 4 minutes. This phase of labor is usually shorter than Phase One; it usually lasts around 2 - 3 1/2 hours. As mentioned, your contractions are much closer together now, so they are accomplishing more in less time. They will also be more intense (painful) at this point. There wont be as much time for rest in this phase. You may choose to have an epidural, but if you don't, you may feel the following:

• Increasing pain an discomfort with contractions (you may not be able to talk during them)
• Increasing backache
• Leg discomfort
• Fatigue
• Increased bloody show
• Your water will break (if it doesn't, you may have them broken)
• You may feel restless and find it hard to relax, you might feel a more intense concentration, and you may become completely absorbed in your labor. Your confidence and patience may begin to decrease or, you may feel excited and very encouraged.

During Phase Two, you will probably be left alone (meaning the doctors and nurses will only come in for checks and monitoring, the rest of the time you'll be without them). If your labor isn't progressing (your cervix is dilating less than 1 or 1.2 cm/hour for women having their first baby, or less than a 1.5 cm/hour with a mother who has had previous children, or if your baby isn't moving down the birth canal at a rate of more than 1 cm/hour in women having their first baby or 2 cm or less/hour in women who have had previous children), your doctor may break your water (if he/she hasn't already) and/or continue giving pitocin.

What can you do?

• Ask for anything you may need to stay comfortable.
• Use your breathing techniques. If they aren't working for you, you don't have to stick to them. Don't hyperventilate; doing so could cause you to pass out. If you start to feel dizzy, have blurred vision, or numbness in your fingers and/or toes, let someone know.
• If you need pain relief, now is the time to ask.
• If you are laboring without pain meds, try to relax as much as you can between contractions.
• Stay hydrated.
• Keep moving (if you can) and change positions as needed.
• Pee periodically. Remember, a full bladder can slow things down.

Phase Three is called the "Transitional" stage of labor. You will be dilated to 10 cm now (fully dilated) and your contractions will be much longer (approximately 60 - 90 seconds long with very intense peaks that last most of the contraction) and about 2 - 3 minutes apart. You may feel that your contractions don't completely go away and you may find it very hard to relax at all between them. This will be the most demanding Phase of labor, but also the quickest. Unless you've had an epidural, you will feel:

• More intense pain with each contraction
• Strong pressure in the lower back and/or perineum
• Rectal pressure - with or without the urge to push
• An increase in bloody show
• Warm and sweaty or maybe chilled and shaky (or both)
• Crampy legs that tremble uncontrollable
• Nausea and/or vomiting
• Drowsy between contractions
• A tight feeling in your chest or throat
• Exhausted
• You may feel vulnerable and overwhelmed, frustrated, discouraged, irritable, disoriented, restless, feel that its difficult to concentrate or relax; you may feel excitement as well.

What can you do?

• Hang in there! Its almost time to push. Try to think of how far you've come. Once you hit that 10 cm it will be time to push!
• Continue to breathe. You may want to pant or blow.
• People touching you may now really irritate you; let your partner(s) know this.
• Try to relax as much as possible.