Stages of Labor

The labor process has three stages, each of which is described below:

Stage One

Contractions occur during the first stage of labor, resulting in the opening (dilation) of your cervix (the opening between the vagina and the uterus). Up until this time, your cervix has been completely closed. This first stage usually lasts several hours, and has three phases.

During phase one, women usually experience contractions that start out spaced about 20 minutes apart and slowly increase in frequency. The contractions during this phase occur irregularly and are relatively mild. During this first phase, the cervix dilates to about 3 cm in diameter.

"Active labor" (phase two) begins when the cervix reaches 3 to 4 cm in diameter. Contractions usually become stronger, more regular, and more frequent during this phase, and the cervix begins to dilate faster as well. For first pregnancies, the cervix dilates about 1 cm per hour during the active phase of labor. However, in subsequent pregnancies it happens faster.

The third phase of stage one labor is called "transition". During transition, the cervix dilates to between 7 and 10 centimeters. This is often the most difficult phase, but it is also the shortest in duration. By the end of the first stage, the cervix has fully opened to 10 cm, or about 4 inches in diameter, giving the baby enough space to pass through.

Body Position For The First Stage of Labor. Certain positions can relieve pressure and pain during the various phases of stage one labor. A few of the many options are described below:

• Standing. Using gravity to the advantage of the laboring woman, standing can help backaches and manage the pain of contractions. The problem is, it can also become tiring.

• Walking. Walking has the same benefits of standing, and can also encourage the baby's decent into the birth canal.

• Sitting. This position may allow a mom to rest. Sitting cross-legged may help to open the pelvic outlet. This position also takes advantage of gravity to help lower the baby into the birth canal.

• Hands and Knees. This position often takes the pressure off the lower back and relieves back aches. It can be tiring, but it an also be a nice change from other positions.

• Forearms and Knees. This is the same as Hands and Knees except the weight is shifted from the hands to the forearms. This position also helps with back pain.

• Lying On Your Left Side. Lying on your left side can help lower blood pressure. This is a great position for resting.

• Lying On Your Back. This position does little to help labor progress, but it may be necessary for fetal monitoring.

Stage Two

The second stage of labor occurs when the baby moves through the birth canal and is delivered into the world. This stage typically lasts between 20 minutes and two hours. During this phase, mothers are encouraged to push or bear down with their pelvic muscles when they feel contractions which are generally spaced between 3 and 5 minutes. It is important that you listen to your doctor's instructions during this stage, as you may feel a constant urge to push even when your doctor does not want you to.

Occasionally, completions occurring during this second stage of labor may require a procedure called an Episiotomy, which is an incision that is cut between the vagina and the anus to enlarge the vaginal opening so that the infant can more easily exit the vagina. Episiotomies are repaired with stitches following the birth. At the end of the second stage of labor you will be rewarded with the little person you have been waiting nine months to meet - your newborn baby!

Body Position For the Second Stage of Labor. Certain positions can relieve pressure and pain during stage two labor:

• Lithotomy. This position involves lying on your back with your legs in stirrups. This position is necessary for forceps or vacuum assisted delivery, in the event of an episiotomy, or during the delivery of a breech baby (baby who is not head first).

• Semi-lithotomy. This position is the same as a lithotomy, but with your the head and shoulders elevated at about 30-45 degrees.

• Squatting. Squatting works well if your partner or other assistant supports you under your arms. Squatting uses gravity and can help the baby descend.

• Lying On Your Left Side. Lying on your left side can decrease your blood pressure. This is a good position for relaxing between pushes and can relieve back aches.

• Hands and Knees. This position reduces back aches and can help rotate the baby.

• Forty-Five Degree Bed Angle. A compromise between lying down and squatting, this position uses gravity and relieves some pressure from the lower back.

Stage Three

The third and final labor stage occurs when the placenta (the sac of blood vessels that accompanied your baby in the uterus) is delivered. This final stage begins immediately after the birth of your baby, and continues until the placenta is removed from your body. Generally, your doctor will watch for small contractions to begin again, signaling that the placenta is separating from your uterine wall and is ready to be delivered. You may be asked to push gently to help expel the placenta. The process is typically fairly brief, lasting between 5 and 30 minutes in duration.