What Happens During Labor?

Every woman giving birth is embarking on a wondrous journey. Fortunately, it's a journey that countless women before them have taken so the territory is not entirely uncharted. In preparation for labor, thousands of women participate in childbirth education classes every year in the United States. Many more pour over books and ask their care provider what they can expect. Almost every woman at some point approaches another woman who has completed the journey to get some insight. They are all looking for the same information and asking the same questions: What is labor like? How long will it last? What will it feel like? How can I cope?

While it is true that every woman experiences this journey in an individual way the basic sequence of events is the same for all. This overview should give you an idea of the physical steps all must go through in order to complete the process of labor and birth. It will also show you what to expect emotionally and give you tips on how to cope each step of the way.

This outline is designed to give you an overview of a "normal" labor and birth. Therefore, it is a completely intervention-free birth. All of the interventions and possible medications used will be discussed on other pages of this site.

Prodromal Labor

Often in the past prodromal labor has been given the misnomer "false labor", yet every woman experiencing it has said in frustration "There's nothing false about what I'm feeling!" The misunderstanding has arisen because prodromal labor can feel very much like active labor, yet is not consistently progressive; it does not lead without a break to the birth of the baby. It does, though, serve an important function in the birth process. Prodromal labor does the preliminary work of preparing the uterus, baby and cervix for birth. All of this work has to be done before the baby can be born. Some women's bodies do it all without her being aware of it. However, some women's bodies draw a great deal of attention to the work being done. Too much sometimes.

"This is driving me crazy," one pregnant mother sighed. "I've been having contractions off and on now for three days. Just when I think it's time to call my midwife, they completely stop again!"

Length:

• Prodromal labor contractions may begin hours or even days before active labor.

Contractions:

• The contractions may feel like Braxton Hicks contractions or they may be quite a bit stronger.
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• They are irregular in length, frequency and intensity. The key word here is irregular. In general though, they are not longer than a minute and not more frequent than 7 to 10 minutes apart. They shouldn't be so intense that they take your breath away.
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They may or may not be affected by your activity. The wisest course is to vary your activity level, alternating periods of mild activity with rest.

Physical Effects:

• The cervix is moving from a posterior (back) position to an anterior (forward) position.
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• The cervix is softening.
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• The cervix is beginning its effacement or thinning. It may thin anywhere from 0% to 50% during this stage.
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• You may lose your mucous plug from the cervix.
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• Your cervix may begin to dilate, opening anywhere from 1 to 4 centimeters.

Emotional Effects:

• You may be quite excited when you first feel these contractions, especially if they are stronger than any you've had until now.
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• As time goes on and the contractions continue without any apparent progress you may feel let down and eventually become quite tired and discouraged.

How To Cope:

• Resist the urge to call everyone immediately and tell them you are in labor. That way you will feel less like a watched pot waiting to boil. You should be able to handle these contractions with some relaxation techniques and concentration. If they are any stronger than that or you just aren't sure, you might want to go ahead and call your doula, she can help you to evaluate exactly what is going on.

• Use these contractions to get to know how your body feels as it begins the hard work of labor. Prepare mentally for the challenges you will shortly be facing.

• Now is not the time to hike ten miles or tromp through the mall for hours in a vain attempt to get labor going. You will just wear yourself out and have that much less energy for active labor.

• Be sure to eat well. Complex carbohydrates like whole grains are especially good now; they will provide you with plenty of energy reserves. Try to stick with foods that are easy on your digestion, you don't want to be dealing with heartburn on top of labor.

• Get plenty of rest. Even if the contractions are keeping you awake at night, nap as much as you can. Again, you want to conserve your energy for the hard work ahead.

• Resist as much as possible the urge to focus too much attention on these contractions. The more you watch, the more time will drag. Try to find some distracting activities to participate in.

• Keep your spirits up; remember that these contractions are doing important work!

Active Labor--First Stage
Latent Phase

The latent phase is the beginning of active labor and will carry you about half way through the birth of your baby. This phase of the active stage of labor begins when your contractions become progressively longer, stronger and closer together and ends when your cervix is about 4 or 5 centimeters dilated.

Length:

• The latent phase of active labor can last anywhere from a few hours to 10 hours or more.

Contractions:

• They will grow longer, stronger and closer together.

• The timing of these contractions can vary widely from woman to woman. Some start with contractions 30 minutes apart, others start right out at 7 or even as few as 5 minutes apart.

• They will vary in length from 15 to 30 seconds or so. A few women may find them lasting a bit longer.

• These contractions will continue no matter how you change your activity level.

• You will find that you gradually progress to needing to use all your concentration and are no longer able to talk and laugh during a contraction.

Physical Effects:

• The cervix continues thinning out (effacement).
• The cervix will dilate to 4 or 5 centimeters.
• You may have a couple of loose bowel movements.
• You may lose your mucous plug.
• You may notice a bloody show.

Emotional Effects:

• Excitement and joy are often primary emotions when you realize you are finally in labor.

• Don’t be concerned to find that you are somewhat fearful, after all, this is going to be a big day, full of hard work and intense sensations.

• You will still be interested in conversation, though only between contractions.

How To Cope:

• Get in touch with your care provider.

• Gather your support team around you. Your doula, the baby's father, your mother or sister or best friend…whomever you've chosen to share this life event with you.

• Whenever you begin thinking that soon you won’t want to move very far, you should make your way to your selected birthplace.

• Make your birthplace comfortable to you as far as temperature, lighting, music, etc. are concerned.

• Use whatever physical comfort measures appeal to you; relaxation, water, massage, birth ball, effluerage, etc.

• If you've learned special breathing techniques or visualization, feel free to use them.

• Keep moving, but don't overdo it. Vary your periods of walking about with periods of rest.

• Make sure you drink plenty of fluids, especially water, juices and sports drinks.

• Empty your bladder at least once an hour.

• Eat whatever appeals to you to keep your strength and energy levels high.

Active Phase

The active phase of labor will continue with contractions that grow longer stronger and closer together. This is the part of your experience that really warrants the label ‘labor’. It begins about the time you are 4 to 5 centimeters dilated and ends at about 9 centimeters. Keep in mind that these beginning and ending measurements are ‘average’, they will vary from woman to woman and from birth to birth.

Length:

• The active phase of active labor can last anywhere from a couple of hours to 10 hours or more.

Contractions:

• Each of these contractions has a definite beginning, peak and end. Some women describe them as waves. The gripping sensation in your belly and back starts mild and quickly grows stronger until it reaches a peak, then it grows weaker until it goes completely away.

• They will grow longer, stronger and closer together.

• The timing of these contractions can vary widely from woman to woman. In general, contractions through this stage start at about 5 minutes apart and grow closer together until they are coming about every 2 minutes or so.

• They will vary in length from 30 to 60 seconds. A few women may find them lasting a bit longer.

• A few women will experience "camel-back" contractions, a second contraction beginning before the first entirely goes away. You don’t have the usual 2 minutes of rest between contractions. You will probably need your entire support team to help you to deal with them.

• These contractions will continue no matter how you change your activity level.

Physical Effects:

• The cervix continues thinning out (effacement).
• The cervix will dilate to 9 or 9+ centimeters.
• Your body will be working very hard during this stage. Some women sweat, some may have cold hands or feet.
• Your water may break at any point. If it does, you may find your contractions increasing in intensity.
• You may notice a bit more bloody show. Some blood is normal now as your cervix stretches open and some of its tiny blood vessels break. If you are uncomfortable with the amount of blood, bring it to the attention of your care provider, nurse or doula.
• Most women are no longer interested in eating anything.
• It is important to continue to get enough to drink to avoid dehydration.

Emotional Effects:

• During this stage you will find yourself working so hard that everything outside your body almost ceases to exist.

• Some women want lots of support people around them now, however many women find too many people distracting and want only their doula and one primary support person (husband, mother, sister, friend) with them.

• You will find that you need lots of support from your team to help you deal with your labor.

• You will probably be concentrating so hard on your labor that you find conversation annoying.

• You will want your support people within reach at all times, and may feel abandoned if left alone even to go to the bathroom.

How To Cope:

• Your doula and other support people will be offering and providing many comfort measures now. These will be whatever appeals to you and may include; warm water-either in the tub or shower; using the birth ball, position changes, massage, touch-stroking, counter pressure, cold or warm compresses, etc.

• Many women find repeated rituals comforting, things like stroking their hair or arm, hearing the same phrases repeated throughout the contraction, singing, the possibilities are as varied as women.

• Use any breathing techniques that you find helpful. Some women use breathing patterns that they have been taught in their childbirth education classes, others find just the right pattern for them in their labor. The only concern is to make sure that you do not hold your breath during a contraction, keep breathing. Listen to your doula, she can help guide you if you are holding your breath or find yourself hyperventilating.

• Relaxation is especially important now, particularly between contractions. You may find it impossible to relax during contractions because your body is working so hard that you need to work with it, just beware of fighting against your body. Your doula can help guide you to find a balance between working in concert with your body and relaxing when you can.

• Make sure you empty your bladder at least every hour. A full bladder will not only increase the intensity of your contractions; it can interfere with your cervix’s progress.

• You will appreciate lots of verbal encouragement from your support team and care providers throughout this phase, don’t be shy about asking for it.

Transition

As its name suggests, transition marks the period when your body completes its labor and prepares to move into birthing your baby. Transition is perhaps the most intense part of the labor process, both physically and emotionally. While it is a very trying time, you can take comfort in the knowledge that it is also the shortest phase of labor and that soon your dilation will be complete and you can begin pushing.

Length:

• Transition will last from ten minutes to an hour and encompass as few as three to as many as 25 contractions.

Contractions:

• The contractions come closer together, perhaps one to two minutes apart.

• They will last from one minute to ninety seconds.

• Some may come in pairs with no rest period between them. These are called camelback contractions.

• These contractions will be the most intense in strength. They reach their peak quickly and maintain it for most of the contraction.

Physical Effects:

• The cervix will dilate to 9 or 9+ centimeters.
• Your body will be working very hard during this stage. Some women will tremble or shake.
• Some women may be nauseous and/or vomit.
• If your water hasn’t broken yet, it may do so at any time.

Emotional Effects:

• Transition is a difficult time emotionally. Many women during transition say, "I just can’t do this anymore."

• Some women find themselves more drawn to the women in their support team at this point.

• You will find that you need lots of support from your team to help you deal with your labor.

• It is not unusual for your sense of time to slow down.

How To Cope:

• Your doula and other support people should be giving you lots of encouragement and verbal validation.

• Many women find that as the contractions grow more intense so does their need for touch. At this point many women appreciate close physical comfort, needing to be held or embraced through the contractions.

• Water can be an invaluable comfort measure through this phase of labor, either using the shower or the tub.

• Use any breathing techniques that you find helpful. Some women use breathing patterns that they have been taught in their childbirth education classes, others find just the right pattern for them in their labor. The only concern is to make sure that you do not hold your breath during a contraction, keep breathing. Listen to your doula, she can help guide you if you are holding your breath or find yourself hyperventilating.

• Relaxation is especially important now, particularly between contractions. You may find it impossible to relax during contractions because your body is working so hard that you need to work with it, just beware of fighting against your body. Your doula can help guide you to find a balance between working in concert with your body and relaxing when you can.

Second Stage-Birth
Latent Phase

The latent phase of second stage is the period that it takes your body to "switch gears" so to speak, moving from the dilating of your cervix to pushing your baby down the birth canal. It begins when your cervix is completely dilated and ends with the urge to push along with your contractions. It is a kind of rest period for you. After the intense sensations of the end of labor, you may find the lack of contraction activity disturbing. Don’t worry though, you will have more contractions and they will end in the birth of your baby.

Length:

Some women skip this little rest period altogether and have the urge to push immediately. Some women have up to 30 minutes before they feel the urge to push.

Contractions:

• The contractions become further apart since the work of dilating the cervix is completed. It is not unusual for there to be five or more minutes between contractions.

• For some women contractions may all but cease.

Physical Effects:

• The cervix is completely dilated.
• The uterus is shifting gears from dilating contractions, to pushing contractions.

Emotional Effects:

• Most women feel a good deal of relief at hearing the cervix is completely dilated and find themselves able to smile and converse for the first time in hours.

• Some women find themselves disoriented by the relative lack of activity.

How To Cope:

• Take advantage of this time to rest and gather your strength for the work of pushing still ahead.

Active Phase

The active phase of second stage is the long awaited pushing. Although completely different in sensation from your labor so far, it is every bit as intense and just as much hard work.

Length:

• Pushing the baby out can take as little as five minutes or as long as three hours.

Contractions:

• Pushing contractions are usually five to ten minutes apart.

• They are accompanied for most women by an intense urge to push.

• Some women may feel little or no urge to push.

• You may be able to feel the baby’s head moving down the vagina.

Physical Effects:

• The baby’s head is molding to fit through the pubic outlet, stretching the birth canal as it goes.
• You may expel some feces, urine or gas.
• You may feel nauseous and/or vomit.

Emotional Effects:

• Pushing the baby out will take a great deal of concentration and possibly some direction from your care provider, nurse or doula.

• While most women start out pushing with a burst of enthusiasm and energy, some women find themselves becoming exhausted and discouraged if it drags on with little apparent progress.

How To Cope:

• Tune in to what your body is doing. Cooperate with the signals your body is sending you. Push hard along with the urge; rest when it is absent.

• If you can’t feel your baby moving down through enough to use as a reference for how effectively you are pushing, your care provider, doula or nurse can help you by giving direction and feedback.

• If there is a stall in the progress of the baby, changing positions may help. Your doula, nurse or care provider will be able to suggest some.

• Warm compresses to your perineum can help you to focus on where you are pushing the baby.

• Gentle perineal massage by your care provider can help the tissues to stretch, especially if warm oil is used to help lubricate the area.

• Get lots of feed back on how much you are accomplishing each time you push.

• Concentrate your energy down low by tucking your chin down and pushing down and out.

• Avoid wasting energy and strength by throwing your head up or arching your back as you push.

• Your doula or another support person should be giving you sips of water between contractions and wiping your face and neck with a damp cloth.

Crowning and Birth

As your baby’s head becomes visible it is called crowning. This is an extremely intense phase emotionally and physically. After all, we’re talking about the actual birth of the baby!

Length:

• From the first sight of the baby at the vaginal outlet to the birth of the baby, this stage can last from two to twenty minutes or so.

Contractions:

• These pushing contractions may be a bit farther apart if you are especially tired. Otherwise they remain unchanged from pushing.

Physical Effects:

• First the baby’s head will emerge.
• Following a short pause to make sure the umbilical cord is not wrapped around the baby’s neck; your care provider will gently ease the top shoulder out first, then the bottom shoulder. The rest of the baby’s body should slip right out.
• You may feel an intense burning at the vaginal outlet, although many women do not.
• You may expel some feces, urine or gas, though you will probably be unaware of it.

Emotional Effects:

• You will be intensely focused on what you are doing. This is the time that many women find that they are conscious only of what is within a few inches of their bodies.

• You may need to be reminded that you are birthing your baby. Many women become so focused on the work that they forget what they are working so hard to accomplish.

• Many women, if they reach down and feel their baby’s head emerging, experience a burst of energy and enthusiasm, finishing the birth immediately.

• If everyone attending you is focused on the emergence of the baby, you may feel a bit ignored.

• As your baby is born it you will be euphoric, proud and amazed that you accomplished such an incredible feat!

How To Cope:

• Tune in to what your doula is saying. She should be up by your ear relaying instructions from your care provider. Your universe will have shrunk down so much that direction from just down at the end of the bed may feel as though it is coming from clear across the room.

• Focus on the fact that your baby is here.

• Reach out and touch your baby as soon as you can, if you are inclined, by touching the baby’s head as it crowns.

• Hug your baby to your breast and rejoice!

Third Stage-Delivery of the Placenta

Although the baby has been born, you have a little more work to do. The placenta or afterbirth needs to be expelled.

Length:

• The delivery of the placenta after the birth of the baby may take from five to thirty minutes.

Contractions:

• Other than a cramping sensation, there will be no more contractions.

Physical Effects:

• The placenta separates from the uterine wall and is expelled through the vagina.
• You may feel the uterus cramp, especially if the baby begins suckling immediately.
• You may feel an uncomfortable "full" sensation even though the baby is out, until the placenta is delivered.
• Many women notice no sensation at all until they are asked to bear down "one more time."

Emotional Effects:

• The delivery of the afterbirth is truly an afterthought. Most women are so involved with their new baby that the delivery of the placenta is hardly noticed.

• You may feel a real sense of relief when the placenta is out. Now the birth is truly over.

• You may be annoyed at the interruption in your bonding.

• If the placenta is delayed, your caregiver may encourage its expulsion by having an assistant ‘knead’ your belly to get the uterus to contract more effectively. This is called fundal massage and can be quite painful.

How To Cope:

• Remember, this stage will truly only take a couple of moments and a couple of mild pushes. Then you will be entirely free to enjoy the baby.

• If you need fundal massage, have your support people help you to use the same relaxation techniques that worked for you during labor.