The First Stage

The months of preparing for your baby’s birth have now reached their climax as labor begins. In medical terms, the first stage starts when your contractions bring about the opening (dilation) and thinning (effacement) of the cervix and ends when these are complete. At this point your midwife will confirm that you are fully dilated.

WHAT HAPPENS IN LABOR

It’s difficult to be sure about the onset of labor because it differs from woman to woman. Certain classic signs-intense contractions, dilation and thinning of the cervix, and rupturing of the membranes-are taken to mean that labor is underway.

Contractions When true labor starts, the nature of your contractions changes. They become more rhythmic and more painful, and they come at regular intervals. These contractions are not within your control and, once they have begun, won’t stop until your baby is born.

You can time your contractions from the start of one contraction to the start of the next. In early labor, contractions are usually about 30-60 seconds long and come at intervals of about five to 20 minutes. This can vary; some women may not notice their first contractions until they are closer together-say, every five minutes. During the active phase, contractions usually last 60-90 seconds, at intervals of two to four minutes.

As your uterine muscles tighten, you may feel something like menstrual cramps, spreading around your lower abdomen like a tight band. This is because the uterine muscle runs short of oxygen as its blood vessels are compressed. The uterus is a huge muscle and needs a lot of energy during contractions.

Every woman feels contraction pains differently, but in early labor they may be similar to menstrual cramps or a mild backache. Some women experience a persistent and severe backache. Very often a contraction feels like a wave of discomfort all the way across your abdomen that reaches a peak for a few seconds and then diminishes. At the same time, you can feel a hardening and tightening of the uterine muscle, which is held at the peak of its intensity for a few seconds before the muscle begins to relax.

Women assume that contractions will get steadily longer, more frequent, and stronger. This is not so; don’t be disturbed if your contractions seem to vary. It’s as normal for a strong contraction to be followed by a weaker one that doesn’t last quite as long, as it is for contractions to follow one another relentlessly.

Your cervix dilates and thins The cervix is usually a thick-walled canal about three-fourths of an inch (two entimeters) long, and firmly closed. In the last few weeks, pregnancy hormones may soften your cervix, but the intense contractions of first-stage labor are needed to dilate and thin it. Dilation is measured in centimeters from 0-10 (up to four inches). Your cervix will only dilate about four centimeters (or one-and-a-half inches) during the latent phase, then progress to 10 centimeters (four inches) in the active phase. The pain increases as it becomes fully dilated during transition. Eventually, the whole cervix opens up and is made one with the body of the uterus, creating a continuous channel that your baby can pass through.

Your water breaks The membranes of the amniotic sac may rupture painlessly at any time during labor, although this usually happens toward the end of the first stage. Fluid may leak or gush out; the flow depends on the size and site of the break and whether or not the baby’s head is plugging the hole.

Usually, if the membranes rupture spontaneously near term, labor follows within a short time, although occasionally it’s delayed-if your baby’s presenting part is not engaged, or if your baby is presenting abnormally. Delay also occurs in normal cases. When this happens, you’ll be advised to have labor induced.

HOW LONG DOES LABOR LAST?

Labor times vary greatly, but an average labor lasts about 12-14 hours for first-time mothers, and about seven hours for subsequent labors. If your labor lasts longer than 12 hours the first time, or nine hours in subsequent labors, your doctor
will want to find out why progress is slow, and may intervene.

The first stage of labor can be further divided into three separate phases. The latent phase is the longest, lasting about eight hours for first babies, and you’ll feel contractions coming with increasing frequency and length, but they won’t be too distressing. Try to conserve your energy during this time as your body will be warming up for the more demanding phases to follow. The next, active phase, will be shorter, lasting about three to five hours, but this is when your contractions become more painful, and you may want some pain relief. The final, transitional phase, is the shortest and most intense of all, usually lasting just under an hour, and comes right before the delivery.

Transition

This is the most intense phase of the first stage. Your Contractions will now last about 60-90 seconds, with intervals of only 30-90 seconds. As the contractions become more forceful, you may find it hard to relax and this is the time you may feel the most discomfort. You may also feel a very strong urge to push, but should not do so unless you’re fully dilated. The intense pain may make you feel extremely irritable, even bad-tempered with your birth partner. This is natural. Don’t think you’re failing if you fear you lack the energy to go on any more; you’ll find hidden resources of energy to help you cope. Remind yourself that this phase means your baby’s birth is now just minutes away.