By Judith Lothian, RN, PhD, LCCE, FACCE

Think of this as your childbirth manual, a step-by-step guide to prepare you for what lies ahead. We've divided the process into stages to describe the typical changes that occur as labor progresses. The first stage encompasses the very beginning of labor, when contractions begin, all the way through active labor, when your cervix is almost fully dilated. The second stage covers transition, when your body shifts from dilating to pushing, and the movement of your baby through the birth canal and into the world. Finally, there's the third stage, when all of your hard work is done and your body begins to recover. Although every labor and childbirth is unique yours will unfold in its own way the process is remarkably constant.

STAGE ONE

Prodomal Labor

What's Happening

• The cervix begins to soften, thin and move forward, and it may begin to open. The baby settles into the pelvis.
• At this point of childbirth, contractions may be noticeable as an achy sensation or as pressure in the lower abdomen or back. Contractions in this phase are usually irregular starting and stopping; sometimes strong, sometimes mild. This is your body's natural way of gearing up.
• This phase can last from a few hours to a few days.

What Helps

• Don't worry whether or not this is really labor. For the vast majority, labor eventually makes itself very clear.
• Try to be patient and feel confident that your body knows what it's doing.
• Take good care of yourself. Eat, drink plenty of fluids, and rest or take a walk.
• Surround yourself with people that help you feel comfortable and safe. Your support team can keep you company and provide reassurance.

Early Labor (Latent Phase)

What's Happening

• The cervix continues to thin out and open, dilating to 3 or 4 centimeters.
• Labor is meant to be gradual, so this phase may take quite a while usually about two-thirds of the total labor time. Over a period of several hours, contractions will become longer, stronger and more regular (about 5 minutes apart, each one lasting 25 to 45 seconds -- but these times can vary).
• A pinkish vaginal discharge (called show) usually increases as labor progresses.

What Helps

• It can be hard to believe that this is it. Take time to settle down and work with the labor -- change positions and go with what feels best.
• Once again, the best thing to do is to take care of yourself. Alternate rest and activity (for instance, take a nice walk followed by a relaxing shower), eat easily digested foods and drink plenty of fluids.
• Many women find that the best place to be during this phase of childbirth is at home, where you can move about and do things for yourself.
• When contractions become so strong that you can no longer talk yourself through them, try using relaxation and breathing strategies. Your support people should be nearby, helping you to stay calm and confident.
• Keep the environment pleasant perhaps listen to music, ask your partner for a shoulder massage or prepare the baby's room.

Active Labor

What's Happening

• Contractions continue to become longer and stronger, until they're eventually about 3 minutes apart and last for about a minute or more (again, times may vary).
• During this phase, which on average takes from 2 to 6 hours, the cervix effaces and dilates to about 8 centimeters.
• Women in active labor usually get very focused as the hard work begins.

What Helps

• Now labor has real momentum. Listen to your body and develop a rhythm to work with it instead of fighting against or tensing up with contractions.
• Do something active during the contractions, such as breathing in a pattern or moving around, and rest between contractions.
• As the strength of the contractions increases, so does your need for support. All present should focus their attention on you.
• Changing positions frequently not only helps you stay more comfortable, but also enhances progress.
• The environment can influence your labor. Make it peaceful and personalize itwith music and dim lights.

Transition

What's Happening

• The cervix finishes dilating and effacing.
• Contractions are now powerful and efficient, so this phase is usually quite short (less than an hour).
• Some women feel nauseous, shaky, restless or irritable during this phase of childbirth.

What Helps

• To keep from feeling overwhelmed, focus on one contraction at a time.
• Continue with breathing, vocalization (if it helps) and rhythmic movement.
• Even though rest periods are short, they allow you to relax deeply and restore yourself.
• Those providing labor support should offer close undivided attention, unwavering encouragement and praise. If you're using a breathing pattern, your team should try conducting to help you focus or moving with you in rhythm to your breathing.

Birth

What's Happening

• Your body shifts from dilating to pushing.
• The baby makes his way down through the pelvis and birth canal.
• This phase can last from 15 minutes to several hours.
• Although it may take several contractions after full dilation to be noticeable, most women get an urge to bear down. Your body is giving you clear instructions on what to do. The urge to push usually gets stronger as the baby descends.
• Many women feel more clearheaded and have a renewed sense of optimism when pushing begins.
• Just before the baby is born, you may feel a burning, stinging, stretching sensation at the vaginal opening: A sure sign that you're almost there!
• As the baby's head emerges, it turns to one side to allow the shoulders to align and then the rest of his body slips outs.

What Helps

• The urge to push usually feels strongest at the peak of the contractions and then fades toward the end. Just follow along and do what feels right. For most women, this means taking normal breaths as the contractions build and then pushing when it becomes irresistible.
• It may help to make sounds (much like athletes do) in response to what you're feeling.
• Labor supporters should provide quiet, reassuring encouragement. There's no need for yelling.
• If progress is slow, change positions. Squatting, all-fours and side-lying are all good options.
• Let go of any tension in your perineum. Asking your care provider to apply warm compresses there may help you push.
• Rest deeply between contractions.

Recovery

What's Happening

• What a mix of feelings excitement, joy, awe, and relief!
• Your baby is placed on your abdomen and you can both take in each other as you begin skin-to-skin care.
• The baby's cord is cut, optimally when it is done pulsing with rich blood from your placenta.
• The placenta is delivered, usually within the first 10 minutes.
• Your health-care provider will make sure you are comfortable. Cold compresses are often applied to the perineum to ease discomfort and reduce swelling.
• Many women get after-pains (uterine cramps) and the shakes after childbirth.

What Helps

• Touch, caress and cuddle your baby without time constraints. Keep him skin-to-skin with you from the moment of birth.
• This is a good time for your first breastfeeding, which tightens the uterus and decreases bleeding.
• All routine infant procedures can be done without removing the baby from your side. Request that measuring, weighing and applying eye medication be delayed for a few hours.

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