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  • The Signs and Stages of Labor

    As your baby’s birth approaches, it is normal to be both anxious and excited. Knowing what to expect can help to calm your nerves. Read about the signs of imminent labor and the stages of labor and delivery .
    A spicy meal, a long walk, house cleaning, jumping jacks… There seems to be no end to the old wives’ advice for coaxing your little one to come out into the world. While these superstitions add comic relief to your pregnancy, they will not start labor. Every baby is different and every pregnancy is different. But that does not mean you have to just sit and wait. As your body prepares for birth, there are many signs that you can watch for. The better you understand these signs, as well as the stages of labor that will follow, the more confident and relaxed you can feel going into the delivery room.

    Signs of Labor

    Your due date is your doctor’s best estimate, but is by no means a guarantee of the date of your delivery. It is perfectly normal for your labor to begin two weeks before or two weeks after that date. You may or may not notice any of the signs of labor. When they occur, how long they last, and how they feel can also vary greatly among women. The signs that labor is coming include the following:

    Dropping or Lightening

    When the baby drops or "lightens," he or she moves lower into your pelvis. This move decreases the pressure on your lungs and stomach. You may find it easier to breathe. If you had heartburn , it may occur less often. This move also increases the pressure on your bladder. You may need to urinate more often.
    During a pelvic exam, your doctor can describe how far your baby has dropped using “stations.” The term “-3 station” means that the baby’s head is not yet in the pelvis. “0 station” means that the head is at the middle of the pelvis. This is also called engaged. When the head is beginning to emerge from the birth canal, the term “+3 station” is used. +3 occurs during delivery and is also called crowning.

    Effacement

    Effacement is the thinning of your cervix in preparation for delivery. The cervix is the opening to the uterus (or womb) where the baby is carried during pregnancy. You cannot feel effacement, but your doctor will measure it during a pelvic exam. Effacement is reported as a percentage. If you are “50% effaced,” your cervix has thinned to half of its original thickness. When you reach “100% effaced,” the cervix is completely thinned out and ready for a vaginal delivery (when full dilation has been achieved).
    Changes in the Cervix During Pregnancy
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    © 2011 Nucleus Medical Media, Inc.

    Dilation

    The cervix must open, or dilate, to allow the baby to pass through and be born. Measured in centimeters (cm) from 0 to 10, dilation tells you how far the cervix has opened. Dilation may begin slowly, without apparent contractions, in the days or weeks before birth. Once active labor begins, the cervix dilates to 10 cm. You will not feel dilation, but your doctor will measure it. If the baby is preterm and smaller than a full-term baby, then delivery can occur prior to 10cm dilation.

    Show, Bloody Show, or Loss of Mucus Plug

    During pregnancy, a thick plug of mucus fills the cervical opening. This plug is here to keep bacteria out of the uterus. As the cervix thins and opens, this plug may fall out. When it falls out, you may notice stringy mucus or a thick discharge that is brown, pink, or reddish. Labor usually begins within 72 hours of this “show.”

    Nesting

    Some women have an urge to clean and organize their homes. This is called nesting and is thought to be an instinct to prepare your home for birth and the baby. These feelings may occur any time during pregnancy, but are strongest just before labor. Be sure to save some energy for delivery and baby care.

    Water Breaking or Rupturing of Membranes

    During pregnancy, your baby is cushioned and protected by a fluid-filled sac called the amniotic sac. This sac can break before labor begins. You may feel water running out of you or your underwear may be constantly wet. The flow can be dripping (if you are standing up) or gushing (if you are lying down). If you think your water has broken, call your doctor immediately.

    Braxton Hicks Contractions (False Labor)

    These are contractions that occur toward the end of pregnancy. As your due date approaches, they may become stronger and more painful. Your doctor may ask you to time your contractions to determine if these contractions are the start of labor. Time from the beginning of one to the beginning of the next. There are a few ways to tell Braxton Hicks (false labor) contractions from contractions of early labor:
      Timing
      • True labor contractions come at regular intervals and get closer and closer together
      • Braxton Hicks contractions are irregular and do not get closer together
      Change with movement
      • True labor contractions continue no matter what you do, including walking
      • Braxton Hicks contractions may stop when you walk or change positions

    Stages of Labor and Delivery

    Once true labor contractions begin, you have entered the first stage of labor. While there is great variation in each woman’s experience, labor and delivery progress through three stages.

    Stage 1: Early and Active Labor

    During stage one, your cervix dilates and effaces to prepare for the passage of the baby. By the end of this stage, the cervix is 100% effaced and 10 cm dilated so that the baby can pass into the birth canal (vagina). This stage is divided into two phases. In phase one , called early labor or the latent phase, the cervix is dilated from 0 to 3 cm. You may have mild to moderate contractions every 5 to 20 minutes. You may be uncomfortable, with a backache, feeling of fullness, or menstrual-like pain. Phase one is the longest section of labor. It may last from hours to days for first-time moms. Women who have already had a baby average eight hours in this phase.
    Once your cervix is 3 or 4 cm dilated, you move into phase two , called active labor. The contractions are stronger and occur more often. It is important to time your contractions. Most doctors ask you to come to the hospital when contractions last more than 60 seconds, occur five minutes apart, and persist for at least one hour. Toward the end of this phase, your cervix dilates from 7 to 10 cm. These last few inches of cervical opening, sometimes called transition, occur fairly quickly, but can be quite difficult. Contractions are stronger and more frequent, putting pressure on your lower back and rectum. You may feel anxious, exhausted, and irritable. You may feel the urge to push, but your doctor may ask you to wait. Pushing too soon may cause your cervix to tear or swell.
    Stage one is the longest stage of labor and delivery. You may request pain medicine during this time. You should discuss the options and your preferences for pain control during your pregnancy. Some women also use relaxation techniques to ease discomfort.

    Stage 2: Your Baby’s Birth

    This stage can take a few minutes or a few hours. It tends to take longer for first time moms and women who have epidurals for pain control. During this stage, your doctor will encourage you to push, and at times, to stop pushing. First, the baby will crown. This means that the widest part of the baby’s head appears in the vaginal opening. As the head is pushed through, the vagina and perineum are stretched, which may cause a burning sensation. Once the head is out, the baby’s mouth and nose will be suctioned with a syringe to clear out mucus. Shortly after, the rest of the baby’s body is delivered and you may hear your baby’s first cry. The umbilical cord, which connects the baby to the placenta, is clamped and cut.
    Crowning of Baby's Head
    DW00035 96472 1
    © 2011 Nucleus Medical Media, Inc.

    Stage 3: Delivery of the Placenta

    This stage can take up to half an hour but usually takes only a few minutes. You may continue to have mild contractions. In addition, your doctor will massage your lower abdomen to help the uterus contract, and you may need to push one more time. The placenta comes out with a small burst of blood.
    While you are resting and greeting your baby, your doctor will examine your vagina. If necessary, stitches may be put in. You may also be given medicines to encourage uterine contractions and minimize bleeding.

    Postpartum Care

    You and your baby will be closely monitored while you are in the hospital. Now that you have made it through the delivery, take advantage of this time to get some rest, ask any questions, and prepare yourself for the next big challenge—motherhood.

    RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.org/

    Mayo Foundation for Medical Education and Research http://www.mayoclinic.com

    Smart Moms, Healthy BabiesUniversity of Michigan Health System http://www.med.umich.edu

    Women’s Health.gov http://www.womenshealth.gov/

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Childbirth. Women’s Health.gov. Available at: http://www.womenshealth.gov/Pregnancy/ . Accessed August 8, 2005.

    How to tell when labor begins. University of Michigan Health System website. Available at: http://www.med.umich.edu/obgyn/smartmoms/labor/labor/beginning.htm . Accessed August 8, 2005.

    Normal pregnancy, labor, and delivery. The Merck Manual of Diagnosis and Therapy online.Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter249/249a.jsp . Accessed August 8, 2005.

    The process of labor: labor stages. Sutter Health website. Available at: http://babies.sutterhealth.org/laboranddelivery/labor/ld%5Fstages.html . Accessed August 8, 2005.

    Signs of labor: know what to expect. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=7E57E034-98E4-49A9-84053CC4E2CC170A . Accessed August 5, 2005.

    Stages of labor. Palo Alto Medical Foundation website. Available at: http://www.pamf.org/pregnancy/labor/stages.html . Accessed August 8, 2005.

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