Delivery stages

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Delivery Stages

The process of labor and birth is divided into three stages:

The first stage begins with the onset of contractions that cause progressive changes in your cervix and ends when your cervix is fully dilated. This stage is divided into two phases: early (or latent) and active labor. During early labor, your cervix gradually effaces and dilates (opens).
During active labor, your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as "transition."

The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is sometimes referred to as the "pushing" stage.

The third and final stage begins right after the birth of your baby and ends with the separation and subsequent delivery of the placenta.

Every pregnancy is different, and there is wide variation in the length of labor. For first-time moms who are at least 37 weeks along, labor often takes between 10 and 20 hours. For some women, though, it lasts much longer, while for others it's over much sooner. Labor generally progresses more quickly for women who've already given birth vaginally.

1st stage:

During early labor:

  • Your cervix will begin to dilate.
  • You'll feel mild to moderately strong contractions during early labor.
  • They may last 30 to 90 seconds and come at regular intervals.
  • As your cervix begins to open, you might notice a thick, stringy, blood-tinged discharge from your vagina. This is known as bloody show.

How long it lasts: Early labor is unpredictable. It can last for hours or even days, especially for first-time moms. It's often much shorter for subsequent deliveries.

What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. You might feel like doing household chores, taking a walk or watching a movie, or you might simply continue your daily activities.
To promote comfort during early labor:

  • Don't become a slave to your stopwatch just yet; it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead, you may want to time them periodically to get a sense of what's going on.
  • It’s important to do your best to stay rested, since you may have a long day (or night) ahead of you. If you're tired, try to nap between contractions.
  • Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to urinate often, even if you don't feel the urge.
  • Try slow, deep breathing.
  • Eat light, healthy snacks.
  • If you're feeling anxious, you may want to try some relaxation exercises or do something to distract yourself a bit, like watching a movie or reading a book.

Active labor:

  • Now it's time for the real work to begin.
  • During active labor, your cervix will dilate to 10 centimeters.
  • Your contractions will get stronger, last longer and come closer together.
  • Near the end of active labor, it might feel as though the contractions never completely disappear.
  • You might feel increasing pressure in your back as well. If you haven't headed to your labor and delivery facility yet, now's the time.

Don't be surprised if your initial excitement wanes as your labor progresses and the pain intensifies. Don't feel that you're giving up if you ask for pain medication or anesthesia. Your health care team will help you make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief.

How long it lasts: Active labor often lasts up to eight hours. For some women, active labor lasts hours longer. For others, especially those who've had a previous vaginal delivery, active labor is much shorter.
What you can do: Look to your labor coach and health care team for encouragement and support. Try breathing and relaxation techniques to combat your growing discomfort.
To promote comfort during active labor:

  • Breathing exercises may help you during labor.
  • Change positions.
  • It may feel good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction.
  • If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to ask your partner for a massage.

Transition

  • The last part of active labor — often referred to as transition — can be particularly intense.
  •  If you feel the urge to push but you're not fully dilated, your gynecologist might ask you to hold back.
  • Pushing too soon could cause your cervix to tear or swell which might delay delivery or cause troublesome bleeding. Pant or blow your way through the contractions.

Tips:

  • If you're laboring without an epidural, this is when you may begin to lose faith in your ability to handle the pain, so you'll need lots of extra encouragement and support from those around you.
  • Because transition can take all of your concentration, you may want all distractions -- music or conversation or even that cool cloth or your partner's loving touch -- eliminated.
  • It may be useful to focus on the fact that those hard contractions are helping your baby make the journey out into the world. Try visualizing his or her movement down with each contraction.

Second stage: The birth of your baby

It's time! You'll deliver your baby during the second stage of labor.
How long it lasts: It can take from a few minutes up to several hours or more to push your baby into the world. It often takes longer for first-time moms and women who've had an epidural.
What you can do: Push! You might be encouraged to push with each contraction to speed the process. Or you might take it more slowly, letting nature do the work until you feel the urge to push.
When you push, don't hold tension in your face. Bear down and concentrate on pushing where it counts. Experiment with different positions until you find one that feels best. You can push while squatting, sitting, kneeling, and even on your hands and knees.
At some point, you might be asked to push more gently or not at all. Slowing down gives your vaginal tissues time to stretch rather than tear. To stay motivated, you might ask to feel the baby's head between your legs or see it in a mirror.
After your baby's head is delivered, his or her airway will be cleared and your gynecologist will make sure the umbilical cord is free. The rest of your baby's body will follow shortly.

Out at last!

Once your baby hits the atmosphere, your little needs to be kept warm and will be dried off with a towel.
Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps, or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over.
Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and about 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.

Third stage: Delivering the placenta
After your baby is born, you'll likely feel a great sense of relief. You might hold the baby in your arms or on your abdomen. Cherish the moment. But a lot is still happening. During the third stage of labor, your gynecologist will deliver the placenta and make sure your bleeding is under control.
How long it lasts: The placenta is typically delivered in about five to 10 minutes. In some cases, it may take up to 30 minutes.
What you can do: Relax! By now your focus has likely shifted to your baby. You might be oblivious to what's going on around you. If you'd like, try breast-feeding your baby.
You'll continue to have mild contractions. Your healthcare provider might massage your lower abdomen to encourage your uterus to contract and expel the placenta. You might be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood.
Your health care provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see the placenta.

If you're planning to breastfeed (click here to learn more about breastfeeding techniques), you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but try holding your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse in the first hour or so after birth if given the chance.
Early nursing is good for your baby and can be deeply satisfying for you.

Unless your baby needs special care, be sure to insist on some quiet time together: You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his or her birth.
Savor this special time with your baby. Your preparation, pain and effort have paid off. Revel in the miracle of birth!