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Stages of Labour

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THE FIRST STAGE OF LABOR

- Early phase. For most women the latent phase is the easiest part of labor; it's also the longest. In this early phase, contractions can range from 5 to 30 minutes apart and last from 30-45 seconds. The early phase of labor lasts an average of eight hours for first-timers, but it can vary from a few hours to a few days. During early labor your cervix thins out, becoming from 50-90 percent effaced. It also dilates, reaching 3-4 centimetres by the end of early labor.

- Active phase. Contractions in the active phase usually occur every 3- 5 minutes and last 45-60 seconds. Women often describe active labor contractions as waves starting at the top of the uterus and going to the bottom, or from the back radiating around to the front. This is also the phase of labor when your membranes are most likely to rupture and produce a gush of fluid as your water breaks. This phase of the first stage of labor lasts on average of 3-4 hours. Your cervix completely effaces and you dilate from 4 to 8 centimetres. Baby's head descends lower into your pelvis, which often breaks the membranes and releases the amniotic fluid with a gush. Your brain responds to your increased discomfort by releasing endorphins, your body's natural pain-relievers.

- Transition phase. Transition means you are moving from the first stage of labor - stretching the pelvic passages open -- into the second stage, pushing baby out. Transition is the most intense phase of your entire labor, but the good news is it's the shortest, usually lasting only 15 minutes to an hour and a half. Many women do not experience more than 10 or 20 contractions during transition. Transition contractions are more frequent than those of active labor -- 1-3 minutes apart - and will last at least a minute or a minute and a half. Your cervix dilates the final few centimetres during transition

SECOND STAGE OF LABOR

Helping to push the baby out. Your contractions may now be less painful and are further apart, around 3-5 minutes from the beginning of one to the beginning of the next. Once transition ends, your cervix is fully dilated, and baby's head begins to descend into the birth canal. You may feel an uncontrollable urge to bear down. As you push your baby through the birth canal you may feel an alarming sensation of tearing momentarily as your vaginal tissues stretch to accommodate baby's head. The average length of the pushing stage is from one to one and a half hours in first-time moms. Your cervix, fully dilated after transition, allows baby's head to enter the birth canal. As baby's head stretches the vaginal and pelvic floor muscles, microscopic receptors in these tissues trigger the urge to bear down. They also signal your system to release more oxytocin, the hormone that stimulates uterine contractions. These two natural stimulants work together to push baby out.

Crowning - baby's head appears. After you push for a while your labia will begin to bulge - visible results of your work. Soon your birth attendant can see a puckered little scalp appearing as you bear down, then retreating when the contraction stops, to reappear with the next one. When your birth attendant announces, "Baby's starting to crown" your perineum gradually begins stretching until eventually your vaginal opening fits like a crown around baby's head. Once baby's head rounds the corner and ducks under your pelvic bone, it won't be able to slip back anymore. As your labia and perineum become more stretched, you will feel a stinging, burning sensation like a "ring of fire." This stinging feeling is your body's signal to stop pushing for a moment. In a matter of minutes the pressure of baby's head naturally numbs the nerves in the skin and the burning sensation will stop.

Once baby crowns, your birth attendant may advise you not to push, but rather to ease baby's head out slowly to avoid tearing your internal tissues or your perineum. As baby's head begins to stretch the skin of your perineum, some practitioners will decide to do an episiotomy. Be sure you have made your episiotomy wishes known ahead of time. A few more contractions and the baby slithers out into the hands of your birth attendant or onto the bed.

Your healthcare provider will suction mucous out of baby's nose and mouth if necessary, rub baby's back to stimulate a breath (you'll then hear baby's first cry!), and then drape baby over your belly tummy-to-tummy where a quick check-up for Apgar score is done. The cord will be cut (some dads want to do the honors) and your baby is ready to meet you. Sometimes baby may need some special care such as suctioning meconium, stimulating respirations, or administering oxygen, in order to make a healthy transition into life outside the womb.

THE THIRD STAGE OF LABOR

Delivery of the placenta. You will feel some cramping and even a weak pushing sensation as somewhat milder contractions help deliver the placenta. If you had an episiotomy or tore, your birth attendant may have a bit of stitching to do. Your uterus continues contracting, both to expel the placenta and to clamp down on the blood vessels to stop the bleeding. If there's a problem, you may receive an injection of pitocin and ergot to help contract the uterus and stop the bleeding more quickly. A birth attendant may massage your uterus to help it contract and make sure it stays firm. Delivery of the placenta may take from five to thirty minutes.