Understanding the Stages of Labor

The stages of labor are commonly broken down into three main phases.  This is misleading, however, in that the first stage is comprised of three sub-phases and is what most people identify as labor.  Stage I consists of early labor, active labor and transition.  Stage II is the pushing stage and Stage III is the birth of the placenta.

It is common practice to define the phases of Stage I by the degree of cervical dilation and length of each contraction.  However, these are truly poor indicators of how a labor will progress.  This is because dilation doesn't usually occur in a completely linear fashion.  In other words, your cervix may go from 1 to 4 centimeters dilated, skipping all the degrees in between. Your contractions may resemble those seen in transition while you are only 3 centimeters dilated and you could be holding that baby only minutes later.

I can personally attest to the fact that women can go from 4 centimeters to full dilation in mere minutes (been there, done that - twice).  Always remember that the focus should be on you as a person, the mother as a whole, and not just your cervix.  It's the same principle that applies when a nurse or doctor relies too heavily on machines when one glance at a mother's ashy skin and ragged breathing should tell them that something is seriously wrong.  Only after she or the baby goes into distress do they realize that the machines were mal-functioning. 

In the case of a homebirth, most mothers do not submit to cervical checks since they provide little useful information and are poor predictors of labor progression.  In these cases, the care provider more accurately relies on their powers of observation to judge your progress through the stages of labor.  Some mothers will even push their babies out never having known how many centimeters they are dilated.  Instead, they wait for an uncontrollable urge to push to tell them its time rather than an arbitrary cervical check.

But because most medical personnel are fixated on using dilation to judge progress through the initial stages of labor, I will present the common terminology for the stages of labor so that you will be able to speak a common language with them in regards to the progression of your birthing:

Stage I

EARLY

Early labour takes up the majority of your birthing experience.  It is characterized by contractions that are regular but may not be very close together or last very long. The contractions maybe 10 minutes apart and last only 30-45 seconds. This is the most comfortable of the stages of labor and gives you a chance to ease into the process.  In this phase, you are usually dilated up to a maximum of 4 centimeters.

ACTIVE

Active labor is more intense with longer, stronger, more intense contractions that may be 3-5 minutes apart and last up to 60 seconds. This is the beginning of the serious phase, where relaxation comes into play and the birth companion’s role becomes greater. Dilation is usually from 5-7 centimeters.

TRANSITION

Transition is by far the most challenging, although the shortest, phase of birthing.  This is when you might begin to feel overwhelmed and your focus might falter.  This is the phase usually depicted in the media.  These contractions are stronger and longer and finish dilating the cervix. They usually last 90-120 seconds with breaks of about a minute or two in between. Generally this phase only last for 30 minutes to 2 hours.  You may also experience a time distortion in this phase that makes it seem to go more quickly.  You may not remember much of this period after the birth.  You may feel out of focus and a bit foggy here.  Nausea can also set in as well as involuntary painless shaking from the intensity.  You are especially vulnerable to suggestion here, which can be used for good or evil.     

Stage II- Pushing

The pushing stage the second phase of labor, begins once you've dilated to 10 centimeters.  This will end with the much-anticipated birth of the baby. This stage can last a few minutes or several hours.  In a natural birth, the pushing phase is typically much shorter than in a medicated one.  Contrary to any rumors you may have heard, such as the "ring of fire", this is probably the most empowering part of the experience and can be the most motivating and comfortable.  You know you will be holding that baby in just a short time and that thought is all the motivation you need.

Pushing is usually much more manageable than transition.  The pushing contractions are of a different variety than those you have previously experienced.  You will feel your body pushing independent of any extra effort on your part.  Remember, this is exactly what is supposed to happen.  Your body will birth your baby best when you let it.  True “pushing” is rarely required.  The best course of action is to let your body be your guide.  Don’t push until you feel the urge to do so.  Just because you’re 10 cm dilated doesn't mean you have to push.  It will be a waste of time and effort.  That is also how complications start, including fetal distress, malpositioning, pulled ligaments and shoulder dystocia.  If you find that you have a lull in contractions, feel free to let the baby drift down on its own.  This saves energy for you and the baby.  It also makes for a slow, controlled delivery with less chance of tearing and can eliminate the "ring of fire" that means your body is stretching very quickly. 

Stage III - The Placenta Delivery

When you've got your babe in your arms, the last of the stages of labor, the placenta delivery, often gets neglected, but it begins with the birth of the baby and ends with the arrival of the placenta.  On average it takes about 20 minutes for the placenta to detach from the uterine wall, although it can be longer without complications.  

The placenta will detach from the uterine wall and be expelled through the birth canal. Your care provider will be able to tell that your placenta is ready to detach by a small gush of blood or a lengthening of the cord.

The most important thing to realize is that it is not enough to just recognize the stages of labor: you must know exactly how to handle each stage as it comes.  By becoming familiar with the unique qualities of each stage, you can eliminate your anxiety about giving birth.  When your labour starts, you will be fully prepared to face each step along the way to holding your newborn baby.

References

Lauzon L, Hodnett E. Antenatal education for self-diagnosis of the onset of active labour at term. Cochrane Database of Systematic Reviews 1998, Issue 4. Art. No.: CD000935. DOI: 10.1002/14651858.CD000935.

Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD000936. DOI: 10.1002/14651858.CD000936.


Giving Birth Naturally: Stages of Labor