Active Labor
Active Labor, First Stage
The first stage of active labor starts when the cervix is about 3cm(1.18in) to 4cm(1.58in) dilated. This stage is complete when the cervix is fully dilated and effaced and the baby is ready to be pushed out. See a picture of cervical effacement . During the last part of this stage (transition), labor becomes particularly intense.
Compared with early labor, the contractions during the first stage of active labor are more intense and more frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing center. If your amniotic sac hasn't broken before this, it may now.
As your contractions intensify, you may:
- Feel restless or excited.
- Find it difficult to stand.
- Have food and fluid restrictions. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted, because the stomach digests food more slowly during labor. An empty stomach is also best in the rare event that you may need general anesthesia.
- Want to start using breathing techniques, laboring in water, acupuncture, hypnosis, or other calming measures that you've chosen to manage pain and anxiety.
- Feel the need to shift positions often. This is good for you, because it improves your circulation. You may not know which birthing position is right for you for a while.
- Want pain medication, such as epidural anesthesia.
- Be given intravenous (IV) fluids.
(For more information about pain medication options, see the Labor and Delivery: Your Birthing Options section of this topic.)
Transition phase
The end of the first stage of active labor is called the transition phase. As the baby moves down, your contractions become more intense and longer and come even closer together than before. When you reach transition, your delivery is not far off. During transition, you will be self-absorbed, concentrating on what your body is doing. You may be annoyed or distracted by others' attempts to help you but, nevertheless, feel you need them nearby as a support. You may feel increasingly anxious, nauseated, exhausted, irritable, or frightened.
A mother in first-time labor will take up to 3 hours in transition, and a mother who has vaginally delivered before will usually take no more than an hour. Some women have a very short, if intense, transition phase.
Active Labor, Second Stage
The second stage of active labor is the actual birth, when the baby is pushed out by the tightening uterine muscles (contractions). During the second stage:
- Uterine contractions will feel different. Though they are usually regular, they may slow down to every 2 to 5 minutes, lasting 60 to 90 seconds. If your labor stalls, changing positions may help. If not, your health professional may recommend using medication to stimulate (augment) uterine contractions.
- You may have a strong urge to push or bear down with each contraction.
- The baby's head is likely to create great pressure on your rectum.
- You may need to change position several times to find the right birthing position for you.
- You can have a mirror positioned so you can watch your baby crown and emerge from the birth canal.
- When the baby's head passes through the vagina (crowns), you will feel a burning pain. The head is the largest part of the baby and the hardest part to deliver. If this is happening quickly, your health professional may advise you not to push every time, which may give the perineum, or area between the vulva and the anus, a chance to stretch without tearing. Or he or she may make an incision in the perineum (episiotomy). This is not recommended unless there is a medical need.
- Your medical staff will be ready to handle anything unexpected. If an urgent problem comes up, people will move quickly. You may suddenly have more people and equipment in the room than before. This is a time when your doctor or nurse-midwife will be deciding what is best for you and your baby.
This pushing stage can be as short as a few minutes or as long as several hours. You are more likely to have a fast labor if you have given birth before.
