Stages of Labor

Prelabor and Dilation

During this first stage, women are often going about their day and begin to feel some cramping or pressure. They might lose their mucus plug and their contractions begin to get closer together. There are 3 phases to Prelabor. The first stage is the latent phase when the cervix is dilated zero to three or four centimeters (Fraser, D. M. & Cooper, M. A., 2009). When the cervix is dilated three to four centimeters, active first stage of labor has begun and is completed once the woman’s cervix is fully dilated. The onset of the transitional phase of labor occurs at approximately 8 cm when there is a brief interval in the contractions. The duration of Prelabor depends on the mother and if she has had previous pregnancies. Dilation is caused by uterine action and the counter-pressure applied to the intact bag of membranes or the presenting part of the fetus’s head (Fraser, D. M. & Cooper, M. A., 2009). The fetus’s head is flexed and closely applied to the cervix to help with efficient dilation. The membranes or “water” breaks days before or sometime during this first stage. At the end of the first stage of labor and when the cervix is completely dilated, the forewaters break because it can no long support the bag.

In the Prelabor stage, the mother generally diagnoses herself that she is in labor. When her labor begins, she will experience a wide array of emotions that are influenced by her previous life experiences and by her culture (Fraser, D. M. & Cooper, M. A., 2009). Research has shown that mothers who use labor support during their birth help them to feel more secure and satisfied which, has positive effects on the outcomes of her delivery. The mother can feel excited, restless, in control, and fearful during the first stage of labor. She is able to talk through her contractions in the early first stage and during the active first stage of labor her contractions require her full attention. In addition to this active stage, she might feel irritable, retreat inward or get quieter, and is less aware of her surroundings (eHow, 2010). Depending of the length of her first stage, this might be a time where the mother is feeling discouraged and losing confidence in herself and her ability to birth naturally. She might request pain medications during this time. Some women begin to feel the pain of labor and experience this as a positive and motivating experience whereas other women feel pain and become fearful and resistant. She needs much encouragement and support during this time of dilation and the first stage of labor.

Birthing

Once the woman’s cervix has dilated to 10 centimeters, the woman begins to push her baby out. Her contractions become stronger and last longer but are less frequent allowing the baby to rest in between each contraction. According to Fraser, D. M. & Cooper, M. A., 2009., contractions become expulsive as the fetus descends further into the vagina creating the Ferguson reflex, which is when the woman experiences the urge to push. The fetal head advances and begins to crown with each contraction until the head is delivered. The baby’s shoulders and body are delivered with the next contraction (Fraser, D. M. & Cooper, M. A., 2009). Blood and the remaining amniotic fluid are expelled followed by the delivery.

There is no time limited on the duration of the second stage. The mother’s ability to move and change positions helps to ease the baby further into the right position for delivery. The mother will generally adopt a position that is her instinctive preference. She can use birthing balls, chairs, other support persons, and any music or lighting that makes her feel safe and secure during her birth. The mother’s ability to cope emotionally and physically is assessed by her midwifes or doctor. She might feel hot and have a dry mouth and lips. Her bladder is at risk for damage during this second stage of labor due to compression during the birth. Mothers with previous pregnancies will generally progress more rapidly during this stage. If the mother has had analgesia, she is continuously monitored and has less flexibility with her choices.

Placental

The third stage of labor is the delivery of the placenta and membranes and the control of bleeding from the placenta site (Miles, 2009). The placenta is detached centrally from the uterine wall and a retroplacental clot is formed to strip away the membranes and reduces blood loss. There is a risk of hemorrhage, infection, retained placenta and shock, which can sometimes result in maternal death. With the use of a controlled cord traction or (CCT) this helps to reduce blood loss by shortening the third stage of labor by manually assisting the delivery of placenta and membranes. After placental delivery, the doctor or midwife examines the placenta for any missing pieces.

The mother should remain in the care of the doctor or midwife for at least one hour after delivery (Miles, 2009). The mother will undergo physical examinations to ensure that she is not hemorrhaging and that her uterus is contracting well. If she chooses to breastfeed, placing the baby immediately to the breast helps to stimulate the uterus to contract and the uterus will empty. Oxytocin is released during breastfeeding which also produces these light contractions. Once the baby is on her chest, the mother might feel a warm, loving, and instinctive response towards her newborn. If no complications arise from the delivery of the placenta, the mother might feel exhausted from her delivery and elated by being able to finally meet the baby that she carried inside of her for so long.

References

Fraser, D. M. & Cooper, M. A. (2009). Myles textbook for midwives. (15th Edition). Elsevier Health Sciences. (First Stage Labor, 457-491; Second Stage of Labor, 509-530; Third Stage of Labor, 531-554)

eHow, (2010) Early 1st stage of labor. [Video]. Retrieved on July 14, 2010 from http://www.ehow.com/video_4939974_early-1st-stage-labor-physical.html

© Drew Starr, 2011

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