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Overview of Labor & Delivery

Signs & Stages of Labor

LABOR “PROGRESS” REQUIRES THAT:

1. the position of the cervix changes from posterior to anterior
2. the cervix softens (ripens)
3. the cervix effaces (thins)
4. the cervix dilates (opens)
5. the fetus descends
6. the fetal head rotates and molds

Usually the first four steps are well underway before a woman experiences the Positive signs of labor (see below). Occasionally, however, a woman begins having strong labor contractions before significant changes have taken place in the cervix. She will need help pacing herself and accepting the “slow progress” (in terms of measurable changes). There is no reason to believe that anything is wrong with such a labor. The woman simply needs more time and more contractions to bring about the early cervical changes. When her cervix is ready, the chances are that the labor will speed up and progress normally. The greatest challenge will be accepting the slow pace without becoming discouraged, Optimistic support people and caregivers can provide reassurance, along with distracting activities, nurturing, and rest.

These signs alone do not signify the onset of labor but they reassure that the mother is moving in the right direction (if the mother has had a previous rapid labor, she should be more alert to signs of another rapid labor):

* Vague nagging backache (different from common pregnancy backache), restlessness, need to change positions.
* Soft bowel movements, possible flu-like feelings (probably associated with increased prostaglandin which ripens and effaces the cervix), urination
* Intermittent or continuous menstrual-like cramps, may extend to thighs.
* Unusual burst of energy, increased or anxious activity, “nesting urge” to prepare, cleaning, talking

These signs and symptoms are more important than the above, but there still may be hours or even days before labor is really underway:

* Blood-tinged mucous discharge (“show” or mucous plug) from vagina, may continue on and off throughout labor (associated with thinning cervix)
* Bag of waters leaks, trickle of fluid but no contractions
* Non-progressive contractions (prelabor, “false” labor, Braxton-Hicks). Accomplishes softening and thinning of cervix; should not be perceived as unproductive!

These are the only certain signs that a mother is in “true” labor:

* Progressing contractions (become longer, stronger, and closer together). A clear sign that the cervix is opening is if the mother has had 10-12 contractions that a) average one minute in length, b) occur 5 or fewer minutes apart, and c) feel painful or very strong. It is an even clearer sign if these contractions are combined with blood-tinged discharge and if the mother can not be distracted from them. She may feel them in her abdomen or back, or both.
* Spontaneous rupture of membranes (bag of waters) with pop or gush of fluid, followed within hours be progressing contractions. (Usually happens in later labor, sometimes associated with rapid dilation).

EARLY FIRST STAGE LABOR:

   Acceptance. Calm. Confident. Excited. Ready for the challenge. May be hungry, may or may not be talking and/or moving through contractions. Feels many changes in her body. Settling into pattern. Contractions usually less than 10 minutes apart, 45-60 seconds, becoming progressively stronger and closer together and generally don’t space out from changing activity. Eventually 5 or less minutes apart, lasting around 60 seconds. Increasing pressure in pelvis, back ache, cramping in lower back or abdomen. May have sore or wobbly pubic bone.
   Trying various positions and techniques to see what works. Usually prefers to keep busy between contractions. Some feel restless and need to walk. Walking is important. Pelvic rocks may help. Support, reassurance, freedom of movement, plenty of space and air, share her excitement that she is in labor. No hovering or implying that this is intense labor.

ACTIVE FIRST STAGE LABOR:

   Seriousness. “Do-not-disturb” and “get-to-work” attitudes. No longer hungry. No longer talkative, even between contractions. Uncomfortable if disturbed. Contractions intense and close together, generally following a regular pattern and lasting 60 seconds or more. Pressure on bladder may cause need to urinate during contractions. Bag of waters may break. May be nauseous. Losing modesty. May still need to walk but uses slow, deliberate movements. May need to lie down. Deeply concentrating. Vocalizing, moaning. Hard work, intense, may feel overwhelming, lose track of time, must concentrate on relaxing. Pressure in pelvis.
   Good to relax completely and rest between contractions. Dim lights, comfortable temperature, quiet atmosphere, freedom of movement, drink and urinate often. Must “give in” and allow the labor to take over. Protection from being rushed, evaluated negatively, observed.

TRANSITION:

Self-Doubt. “This is too hard. I’m too tired. I can’t take any more; I can’t do it.”
May be sweaty, shaky, nauseous, hot & cold, may vomit, hiccup, burp, have cold feet. Contractions may come on top of one another, may double peak, may become irregular. May be angry and irritable. Confused, overwhelmed, nervous, may want to give up or go home, may yell at you, may be handling things fine. May be zoned out and trance-like. Moaning even more intense; sounds may frighten loved ones (reassure this is normal intensity). Changing sensations may cause fear or disbelief. May feel baby shifting, may feel increasingly intense rectal pressure.
Reassurance, praise, encouragement, coping techniques, calmness from caregivers. Do Not Disturb! One contraction at a time. Acknowledge that this is how the last part of labor really feels, and she is almost done.

SECOND STAGE:

Determination, calmness. Tiredness. Desire to complete the task and hold her baby. Can also have early, active, and final stages. Either gradually or suddenly gets urge to push (rectum feels full). More bloody discharge, water may break with a burst. Contractions usually space out; may ease into pushing urges at peaks or get expulsive type of contraction. No modesty. Usually more alert, may become more talkative, “second wind” or tired and resting between contractions.
Generally feels better to push, as if having a huge bowel movement. Some feel a stretching and burning sensation which builds to a tremendous release as baby is born.
Wait for overwhelming need to bear down. Encouragement and freedom to choose best position. May need a quick lesson in how to push. Everyone do as mother asks. Ice chips, water, fanning, and reminder to relax completely in between contractions. Quiet between contractions. Push and hold breath to point of comfort. Follow sensations, with added effort. This stage can last minutes or hours.

 

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