Stage 1 Early labor active labor and transition Early labor

During labor, the cervix opens (dilates) so that your baby can move downward into the vagina in preparation for pushing and delivery. Over time, the cervix will go from being completely closed to being completely open (complete) at 10 centimeters (cm), which is 4 inches in width. This opening is large enough for the baby's head to pass through.

The uterus, which houses the baby, is a muscular, hollow organ. Think of it as a large, upside-down elastic bottle. The opening of the uterus (cervix) is the neck of the bottle. When labor begins, the cervix is closed. But contractions cause the cervix to open by creating pressure downward through the uterus. This force is directed through the uterus in two ways. During a contraction, your baby is subjected to pressure that forces him or her against the cervix. The contractions also cause the cervix to thin and pull up around the baby's head. Repeated contractions eventually stretch the cervix to a full 10 cm.

What's happening

Early labor is the phase when your cervix dilates from 0 cm to a little over 3 cm. This period is usually the longest and, fortunately, the least intense phase of labor. Early labor begins with the start of contractions, which vary tremendously from woman to woman. Some women may not even recognize that they're in labor if their contractions are mild and irregular. Other women dilate the full 10 cm in just a few hours with clear contractions.

In general, contractions during early labor last 30 to 60 seconds. They may be irregular or regular, ranging between five and 20 minutes apart. They're usually mild to moderately strong.

Along with contractions, you may experience backache, upset stomach and, possibly, diarrhea. Some women report a sensation of warmth in the abdomen

Factors that affect labor

Many factors can affect how your labor will progress. They include: Size of your baby's head

Because the bones of the skull aren't yet fused together, your baby's head molds itself to the shape and size of your pelvis as it moves through the vagina (birth canal). If the head moves through at an awkward angle, it can affect the location and intensity of your discomfort and the length of your labor.

Position of your baby

Birth is easiest if your baby comes headfirst through the birth canal, with its chin tucked down on the chest so that the smallest diameter leads the way. But babies aren't always so accommodating — sometimes their heads aren't in the best position, and sometimes they're breech, with their buttocks or feet coming first. They may even be sideways in the uterus or come shoulder-first.

Shape and roominess of your pelvis

Your pelvis, which consists of three bones forming a hollow cavity, must be roomy enough for your baby's head to pass through. Fortunately, babies are generally well-matched to the size of their mothers. Women who have smaller frames, for example, tend to have smaller babies. Nature helps in another way, too. Near term, the placenta releases a hormone called relaxin. This hormone relaxes the ligaments of the pelvis, widening it and contributing to that feeling that you're waddling in your later months of pregnancy. This widening, along with the molding of the baby's head, usually allows the head enough room to move through the pelvis.

Ability of your cervix to thin and open

Rarely, the cervix may be unable to thin (efface) and open (dilate). In most labors, the cervix opens as expected, but the speed of that dilation may vary considerably.

Your ability to push

Because you use your abdominal muscles to help push the baby out, the better shape you're in physically, the more you can assist. If you've had a long labor and you're tired, your pushing may be less effective.

as labor begins. You may also experience bloody show at this time — a blood-tinged, mucous discharge from your vagina — as the cervix begins to open.

Early labor (latent labor) can last for hours to days, so you may need to be patient. Your cervix needs to soften before it can dilate. Labor doesn't always begin when your contractions start. You may have irregular, painful contractions for hours or even several days before your cervix dilates, especially if this is your first baby.

Your physical state

If you go into labor healthy and well-rested, you'll have more strength to work through your contractions. But if you're ill or tired or the early phase of your labor is particularly long, you may already be exhausted when it comes time to push. Your energy level can affect your ability both to cope with pain and to concentrate during labor.

Your outlook on labor

If you have a positive outlook, know generally what to expect, trust your health care team and have thought through your choices, you're ready to take an active part in your labor and delivery. Women who are frightened or anxious about labor and birth tend to have a harder time. That's because stress can lead to a range of physiologic reactions in the body that can ultimately interfere with labor.

Support from staff and your labor coach

Your health care provider, the nurses, your labor coach or other loved ones in the labor room with you — they all work together to support you and help you stay relaxed during labor. Through their presence and coaching, they can enhance the coping skills necessary for labor and delivery. Especially important is your relationship with the health care team caring for you. Medical professionals who explain why things are done and what your options are, in an atmosphere of caring support, give you peace of mind and promote a more positive birth experience.

Medication

Certain medications for pain relief can both help and hinder labor. Some health care providers believe that if medications relieve pain early on, they can leave you rested and better equipped for the work ahead, and if they help you relax, you can concentrate on getting the baby out. But if the medications slow down labor or interfere with your ability to push, they can undo some of their usefulness. Remember, only you can decide when you need help for labor discomfort.

How you may be feeling

During those early hours to days of labor, you'll likely labor at home. Many women do. They use that time to rest or nap, while they still can, to conserve energy for the work ahead. Some women continue a normal schedule, barely aware that the process has begun.

With the onset of your first real contractions, you may be giddy with excitement and full of relief that after all the long months of waiting, your baby is soon to be born. At the same time, though, you may be scared about the unknown. Try to remain relaxed. Remember: You've done a lot to prepare yourself for this moment. You're ready!

What you can do

Until your contractions pick up in frequency and intensity, you may feel like doing household chores, watching television or a movie, playing games or making phone calls. Choose activities that you find most comfortable and that help distract you from your contractions. You may want to relax in a chair or get up and move around. Walking is a great activity because it may help your labor along.

During early labor, you may also find it helpful to:

• Listen to relaxing music.

• Ask your partner for a massage.

Tips on dealing with back labor

Some women experience back labor — intense and relentless back pain, especially during active labor and transition. Often, back labor occurs when the baby is in an awkward position as it enters the birth canal. The baby's head is pressing against the mother's tailbone (sacrum). But that doesn't have to be the case. During labor and delivery, some women simply feel more tension in their backs than others do. To relieve back labor:

• Have your labor coach apply counterpressure to your lower back. Have him or her massage the area or use hands or knuckles to apply direct pressure.

• Apply counterpressure by placing a tennis ball or rolling pin — if you brought either with you — under your tailbone.

• Have your labor coach apply heat or cold, whichever feels better to you, to your lower back.

• Change to a more comfortable position.

• If possible, take a shower and direct the warm water spray on your lower back.

• Ask for an epidural or spinal anesthetic, if desired, to try to help relieve the pain.

• Change positions often.

• Drink water, juice or other clear liquids.

• Cool yourself with a wet washcloth.

• Use the bathroom often.

For lower backache, try ice packs or heat, or switch between hot and cold. Use a tennis ball, rolling pin or doorknob to apply pressure to the lower back. But don't take aspirin or any other pain reliever except acetaminophen (Tylenol, others) for your discomfort.

Without an examination, there's no way to know when you've moved into the more active phase of labor, but many signs suggest that you're ready to go to the hospital or birthing center. The timing and intensity of your contractions can help you and your health care provider pinpoint which phase of labor you're in. Follow your health care provider's instructions about when to leave for the hospital or birthing center.

At the hospital or birthing center

Once you check into the hospital or birthing center, you're typically taken to your room, often a labor room, where admission procedures are completed. After you've changed into a hospital gown or your own nightgown, you'll probably be examined to see how dilated your cervix is. You'll likely be connected to a fetal monitor to time your contractions and check your baby's heart rate. Your vital signs — your pulse, blood pressure and temperature — are taken on admission and at intervals throughout your labor and delivery.

You may have an intravenous (IV) needle placed into a vein, usually on the back of your hand or arm. This needle is attached to a plastic tube leading to a bag of fluid that drips into your body. The bag hangs on a movable stand, which you can wheel with you when you take a walk or go into the bathroom.

The fluid you receive through the IV helps to keep you hydrated during labor. Medications such as oxytocin also can be administered through your IV, if they're needed. Many health care providers routinely request an IV early on in labor. Some wait until there's a clear need for one before requesting it for you. In some situations, no IV is required. In normal labor, without anesthesia, it's more of an insurance policy against trouble than a necessity.

If your contractions aren't forceful enough to open the cervix, you may be offered a medication to make your uterus contract. Contractions can sometimes start regularly, but then stop halfway through your labor. If this happens and the progress of your labor halts for a few hours, your health care provider may suggest breaking your water (rupturing your membranes) — if it hasn't already broken — or artificially stimulating your labor with oxytocin.

Active labor

Active labor is the second phase of the first stage of labor. It's the period of time when your cervix dilates from a little more than 3 or 4 cm to nearly 7 cm.

What's happening

Active labor is when the real work begins for the mother-to-be. Your contractions will become stronger and progressively longer. They may last 45 seconds to a minute or longer. They may be three to four minutes apart, or perhaps even two to three minutes apart. There's definitely less rest for you between contractions.

The good news is that your contractions are accomplishing more in less time. Your baby is on the move down through the stations of your pelvis as your cervix continues to open. During active labor, the average woman in

Baby's head ■ Amniotic fluid ■ Cervix before effacement and dilation

Cervix

60% effaced 1-2 cm dilated Cervix Vagina

Cervix

90% effaced 5-6 cm dilated

Cervix

60% effaced 1-2 cm dilated Cervix Vagina

Cervix

90% effaced 5-6 cm dilated

If you think of the cervix as the neck of a turtleneck sweater, you can visualize it stretching and pulling over the baby's head. The three insets show that during labor the cervix thins out (effaces) and opens (dilates) to allow the baby to pass through.

Baby's head ■ Amniotic fluid ■ Cervix before effacement and dilation

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