1. Birth & Newborn Care Signs & Stages of Labor
Most of our weekly meeting time will be spent on discussions and hands-on activities, and most of the concepts and information will be introduced through our online classroom. But, since we’re just getting started, I want to begin with an overview of the signs and stages of labor.
First, stop and think of what you know about labor and delivery. What are some the first images that come to mind?
Why do these images come to mind? Where have you seen them?
Hollywood and the media would have you believe that a woman’s water breaks with a giant gush, which cues her rush to the hospital. There, we typically see her yelling and screaming at her partner and giving a few good pushes before the baby is born. While there are aspects of this sort of stereotypical birth scene that are based in truth, labor is typically a much longer, calmer process than what we see on TV. So let’s take a look at what labor really looks like.

2. Signs of Labor Dropping or lightening Nesting A sudden burst of energy
Changes to cervix
Loss of mucous plug (bloody show)
Regular contractions
Persistent lower back pain
Membrane rupture (water breaks)
Let’s begin with the signs that labor has started or is approaching. How do you know that you’re in labor or that you’re getting close?
You may hear some people talk about the baby “dropping.” This is also sometimes referred to as “lightening,” and it’s when the baby moves down in your abdomen. For first-time moms, this can happen a couple of weeks before labor actually begins. For second-time moms, the baby may not drop until labor has actually begun. When the baby does drop, moms, you might notice that your lung capacity improves. You might also feel more pressure on your bladder, leading to the need to urinate more frequently.
Another common sign of labor is called “nesting.” This might be described as an overwhelming desire to cook or clean. While for much of your third trimester, you may feel very fatigued, when you’re nesting, you might experience almost a sudden burst of energy and drive to get things done.
Also, leading up to labor, your cervix may begin to thin and dilate. You won’t be able to feel these changes, but your healthcare provider can check for these changes as you near your due date. One indication that your cervix is thinning and dilating is the loss of your mucous plug, which is sometimes called the “bloody show.” That sounds a lot scarier than it is. When you lose your mucous plug, it might appear as an obvious plug or just as a sudden increase in vaginal discharge with a tinge of brown or red—just a little bit of blood. Most women lose their mucous plug within a few days of the start of labor; though, you could lose your mucous plug up to a couple of weeks before. Also, it’s important to note here that if you do experience more significant bleeding, you should absolutely contact your healthcare provider.
Regular, consistent contractions are a pretty good indicator that labor has begun. One thing that surprises some laboring moms is that they might experience labor pains through their back as well as through their abdomen.
And then, of course, if your water breaks, your labor has begun. This could happen as one big gush or as a slow, consistent trickle. Or, you may be well into active labor without your water breaking at all. Still, if your water does break, whether you are having contractions yet or not, you’re in labor!

3. False Labor Braxton Hicks contractions Things to try:
Common during the last trimester (sometimes earlier)
Irregular
Things to try:
Change activity (lie down or walk)
Drinking water
Before we move on to the stages of labor, let’s take a minute to talk about false labor.
It’s common for women to experience Braxton Hicks contractions during the third trimester (or sometimes even earlier). These are sort of warm-up contractions. They’re typically not as intense as true labor contractions (though, they can be intense at times), and they’re not consistent. Braxton Hicks contractions might vary in length, intensity, and frequency, whereas true labor contractions will be fairly consistent, gradually increasing in length, intensity, and frequency.
If you think you may be having false labor contractions, you may want to try changing your activity to see if they go away. For example, if you’re up and moving around when you experience them, you might want to lie down. Or, if they happen when you’re sitting or lying down, maybe try going for a little walk. Dehydration can also cause contractions to occur, so if you are experiencing contractions, make sure that you’re hydrated. Drink plenty of water, and see if the contractions stay or go.

4. Stages of Labor Stage 3 Stage 2 Stage 1 Early labor Active labor
Transition
Stage 2
Pushing
Delivery of baby
Stage 3
Delivery of placenta
Once labor has begun, you can generally expect to progress through the three stages of labor.
While labor does vary considerably from one woman to another, and from one pregnancy to another for the same woman, there are some aspects of the process that are pretty universal.
Please keep in mind, as we go through the stages of labor, that while these are typical characteristics of the stages of labor, your experience may be a little different.

5. Stage 1, Early Labor Contractions Cervix
5 to 30 minutes apart
Lasting 30 to 45 seconds each
Gradually stronger and closer together
Cervix
Thins (effacement)
Dilates to about 4 centimeters
Lasts 8 to 12 hours, on average
Early labor is typically the easiest and longest part of labor. In fact, it may be difficult to pinpoint exactly when early labor truly beings because it can ramp up so gradually.
At this point, contractions can be anywhere from 5 minutes to 30 minutes apart, with each contraction lasting about 30 to 45 seconds. Over time, the contractions will grow stronger, longer, and closer together, but most early labor contractions are not terribly intense. What these contractions are doing is helping to thin and dilate your cervix so that the baby can pass through. By the end of early labor, your cervix will be dilated to about 4 centimeters.
The time span for early labor varies significantly, but on average, first-moms’ early labor lasts about 8 to 12 hours.

6. Stage 1, Active Labor Contractions Cervix
3 to 5 minutes apart
Lasting 45 to 60 seconds each
More intense
Cervix
Thins more (completely effaced)
Dilates from 4 to about 8 centimeters
Lasts 3 to 4 hours, on average
Early labor then progresses into active labor.
At this point, contractions are becoming more frequent (about 3 to 5 minutes apart), lasting longer (about 45 to 60 seconds), and are more intense. These contractions are working to thin your cervix completely. You might hear your doctor or midwife tell you that you’re completely effaced. And, during active labor, your cervix is dilating from 4 centimeters to about 8 centimeters.
Again, labor times vary considerably, but on average, first-time moms are in active labor for about 3 to 4 hours.

7. Stage 1, Transition Contractions Cervix
1 to 3 minutes apart
Lasting 1 to 1½ minutes each
Very intense
Cervix
Dilates to 10 centimeters
Lasts 15 minutes to 1½ hours, on average
At that point, active labor leads into the transition phase.
Transition is the shortest phase of the first stage of labor, and it’s also the most intense. Contractions during transition are about 1 to 3 minutes apart, with each contraction lasting a minute to a minute and a half. These contractions are extremely intense, and they work to dilate your cervix from 8 to 10 centimeters.
During transition, the intensity of the contractions causes many women to feel sick. Some experience diarrhea, nausea, vomiting, sweating, hot and cold flashes, or shaking. This is common.
Fortunately, transition typically only lasts for about 15 minutes to an hour and a half.

8. Stage 2 Pushing & delivery of the baby Contractions
May be less intense
May be farther apart
Urge to push as baby’s head descends
Stinging or burning sensation is common as vagina stretches to accommodate the baby
Lasts 1 to 1½ hours, on average
Following transition is the second stage of labor. This stage includes pushing and the actual delivery of the baby.
When you enter into the second stage of labor, you may experience a break in your contractions. That is to say, your contractions will continue, but they may be less intense and a little farther apart. You may feel increased pelvic pressure and an urge to push as the baby’s head descends. It’s also common to feel a stinging or burning sensation as your vagina stretches to accommodate the baby on his or her way through.
We’ll talk more about pain management options next week, but it’s worth mention here that an epidural can sometimes interfere with the urge to push and can prolong stage 2. Without an epidural, though, the second stage of labor typically lasts about an hour to an hour and a half for first-time moms, ending in the delivery of the baby.

9. Stage 3 Delivery of the placenta Contractions continue but are milder
Expels the placenta
Helps to control bleeding
Nurse or midwife may “massage” your uterus to help it contract further
Lasts 5 to 30 minutes
Contrary to our Hollywood picture of birth, labor does not end with the birth of the baby. It actually ends with the delivery of the placenta, which happens during stage 3.
During stage 3, you will continue to experience some contractions, but they’ll be milder than those you had experienced. These contractions work to expel the placenta from your uterus and to help control bleeding. During this time, your nurse or midwife may firmly “massage” your uterus through your abdomen to help it contract further. This can actually be quite uncomfortable, but it is important. If your bleeding is heavy or your uterus is not contracting enough on its own, your healthcare team may also administer pitocin or another medication to help increase your contractions and slow the bleeding.
This third stage of labor typically only lasts about 5 to 30 minutes. You might even be so focused on your new baby that you’re barely aware of the third stage of labor at all, but the labor process is not actually complete until your placenta has been delivered.

10. Going to the Hospital Ask your doctor or midwife
When contractions are:
3 to 5 minutes apart
Lasting a minute each
For an hour
When your water breaks
If in doubt, call labor & delivery to ask
So when, during labor, should you go to the hospital if you’re planning a hospital delivery?
The answer here may vary depending on your individual situation and whether your doctor or midwife is concerned with any potential problems. Be sure to ask your healthcare provider, as you near your due date, when they would like you to report to the hospital.
For first-time moms without any known complications, the general rule is to go to the hospital when your contractions are consistently 3 to 5 minutes apart and a minute long for at least an hour. Many doctors and midwives also advise that you head to the hospital if your water breaks before you reach this point.
If you are concerned at any point during labor or in the weeks leading up to labor, it’s best to call your labor and delivery unit to ask. Labor and delivery units can answer many questions over the phone or may recommend that you come in for an evaluation. In any case, don’t hesitate to contact your labor and delivery unit!

11. References
Mayo Clinic. (2013, July 18). Stages of labor: Baby, it's time! Retrieved from Mayo Clinic:
Office on Women's Health. (2010, September 27). Pregnancy: Labor and birth. Retrieved from Womenshealth.gov:
Sears, W., & Sears, M. (1997). The pregnancy book: A month-by-month guide. New York, NY: Little, Brown and Company.