Labor: What To Expect

There's no way to truly understand labor until you've been through it. No matter how much you've read or how many people you've talked to, you'll be shocked by the intensity of your feelings, both physical and emotional. But that doesn't mean you want to go blindly into the birthing room. You can take some of the shock and uncertainty out of childbirth by learning about the basic process of labor.

Every birth is different. Some women have to labor for many hours while others finish before they even have a chance to get to the hospital. Still, most births can be broken down into three distinct stages.

First stage: Active labor

In the simplest terms, the first stage lasts from your first labor contraction until your cervix is fully dilated to 10 centimeters. There's an unforgettable experience hiding within this bland definition. This is the longest stage of the entire birth process. It often starts at home, and by the time it's over, you'll be on the brink of motherhood.

When labor starts, you can expect regular contractions that last for about 30 to 45 seconds. Your contractions might feel like a backache or a strong menstrual cramp. At first, the contractions may be mild and as much as 30 minutes apart. But as the labor progresses, the contractions will grow stronger and closer together. Your water can break at any time during this stage. Take note of the time when it breaks, but don't panic. Delivery may still be a long way off.

Assuming you already have your bags packed for the hospital, there's only one thing to do now -- try to relax. Distract yourself by listening to music, taking a bath, or indulging in a top-quality back rub. Your cervix is opening very slowly, and you might have as much as 12 hours of contractions ahead of you before you have to leave home or call your midwife.

Time those contractions carefully. When they last for 40 to 60 seconds and are only three to four minutes apart -- from the start of the first contraction to the start of the next one -- it's time to get to the hospital or be sure the midwife is on hand. By now, your cervix will be dilated to about 4 to 7 cm and your contractions will be gaining strength. In a hospital you'll be admitted to a birthing room and hooked up to monitors that measure your contractions and your baby's heartbeat. If you opt for pain medications, you'll probably start receiving them now.

At this point you can expect to stay in a holding pattern for a few more hours: About one minute of strong contractions, two to three minutes of rest. Repeat. This is still a good time for distractions. Instead of dreading each contraction, try talking to your partner, listening to music, breathing deeply, or thinking of calming things you enjoy. It's likely to start getting difficult soon, which is why you'll need everyone in the room to help you stay focused. Drugs for pain management -- from narcotics to epidurals -- are available to you in the hospital.

As your cervix starts opening all the way to 10 cm, you won't be in any shape for thinking calming thoughts and idle chitchat. Your contractions will be extremely painful and close together -- so close that one might start before the previous one finishes. You might also start vomiting or feeling hot flashes or chills. Just remember: It will all be over soon. The most intense stage of labor rarely lasts longer than two hours.

Stage 2: The big push

When you're finally completely dilated, it's time to start pushing. You'll still have some contractions, but squeezing that baby through your birth canal will add a new brand of pain. Naturally, the pain will move from your abdomen or back to your pelvic area. It's a searing, burning kind of pain, but it's all for a good cause.

At this stage, pushing comes naturally. Your body knows that it's time for your baby to come out. Your health care provider may tell you when to push, or you may be told to push whenever you feel the urge. You can expect to push off and on from about 20 minutes to about two hours, especially if it's your first baby or you've had an epidural.

Delivering a baby is hard work, so you'll have to rest in between pushes. Don't be surprised or embarrassed if you have a bowel or bladder leak while you're pushing. Your body is under tremendous pressure, and that sort of thing is entirely normal -- it may even make room for the baby to come out.

You'll know the end is really near when your baby "crowns." The sight of his head will send a buzz through the room. His head might disappear again for a few moments, but don't get discouraged. You're minutes away from the finish line. With just a few more pushes, your baby will come out into the world. The head tends to rock up and back as it is pushed beneath the pelvic bone. With each push, there will be a little bit of forward progress that may at first be imperceptible but becomes obvious as the baby's head begins to pop out in the last several minutes.

After your baby is out, your health care provider will cut the cord and evaluate his health. If the baby is healthy, hospital staff will wipe him off, wrap him in a warm blanket, and place him directly on your chest. He may even nurse within minutes of being born. Assuming all went well, he'll be in your arms before you really have a chance to catch your breath.

In fact, you may hold your baby even before the umbilical cord is clamped and cut. Doctors' and midwives' associations recommend waiting from 30 seconds to 60 seconds to 5 minutes to cut the cord to allow the transfer of oxygen-rich blood to the baby. This is especially important in premature babies, who enjoy better heart circulation and red blood cell volume with delayed clamping. Talk to your doctor in advance to see if you're a good candidate.

Stage three:winding down

You have your baby, but your job isn't completely done. You still have to deliver the placenta, which can take anywhere from three to 30 minutes, although it's frequently less than 10 minutes. You'll feel some small contractions as the placenta separates from your uterine wall, but they won't be anything like what you've already endured. Your health care provider may help things along by gently massaging your abdomen. When the placenta comes out, you may start shivering or shaking. It's a natural response and nothing to worry about.

When the placenta is out, there's nothing left to do but rest, recover, and enjoy your new baby. It's a big reward. And you earned it.

References

American Pregnancy Association. First stage of labor. http://www.americanpregnancy.org/labornbirth/firststage.html

Lucile Packard Children's Hospital. Labor. http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/pregnant/labor.html

Wait to cut the cord, experts say, CNN, March 3, 2017.

American Academy of Family Physicians. Labor pain: what to expect and ways to relieve pain. http://www.aafp.org/afp/20030915/1121ph.html

Murkoff, Heidi, Arlene Eisenberg, Sandee Hathaway. What To Expect When You're Expecting. 4th ed. Workman Publishing.

American Pregnancy Association. Second stage of labor. http://www.americanpregnancy.org/labornbirth/secondstage.html

AskDrSears.com. The Ninth Month. www.askdrsears.com/html/1/T010900.asp#T010911

Palo Alto Medical Foundation. Stages of Labor. http:www.pamf.org/pregnancy/labor/stages.html

Lucile Packard Children's Hospital. Care of the Baby in the Delivery Room. http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/pregnant/care.html

American Pregnancy Association. Third stage of labor. http://www.americanpregnancy.org/labornbirth/thirdstage.html

Magann, E. et al. The Length of the Third Stage of Labor and the Risk of Postpartum Hemorrhage. Obstetrics and Gynecology. 105:290-293.

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