First Stage is where contractions of your uterus will cause the cervix to efface and dilate.
Second Stage is pushing or delivery of your baby.
Third Stage is the delivery of your placenta.
The Fourth Stage is postpartum recovery.
Effacement refers to the shortening and thinning of the cervix which is expressed as a percentage from 0% (long and thick) to 100% (completely thinned out).
Dilation refers to how open the cervix is. This is expressed in centimeters. 0cm is closed to 10cm complete dilation.
You may also hear the term station which indicates the progress of you labor and refers to the position of your baby's presenting part (usually baby's head) in relation to the ischial spines in your pelvis. A 0 station means your baby's head is inline with the spines. Plus (+) numbers refer to cm's baby's head is below the spines. Minus (-) numbers refer to the cm's baby's head is above the spines. If baby's head is at 0 station it is usually considered to be engaged into the pelvis. Vaginal examinations by your medical team will asses the progress of your labor, measuring effacement, dilation and station.
How does labor begin?
The lungs of your unborn baby are coated in a substance that allows baby to absorb oxygen (cool!) the proteins in this substance trigger a inflammatory response in the mother which starts labor. In addition, baby releases a hormone which stimulates the release of Cortisol and then Oxytocin. Oxytocin is absorbed by the Mother at receptor cites on the uterus. The placenta then absorbs the adrenal hormones and converts them into Estrogen and increases Prostaglandin production. Gradually, this process increases the amount of Oxytocin released by the Mother and causes contractions. Essentially, Mother and Baby work together to get labor going.
This process might give you mild cramps, on and off for several days, you may feel like something is happening and start to get excited. Sometimes this is called prodromal labor.
Let's get back to the stages of labor. The first stage of labor is divided into three phases: early, active and transition.
1st Stage: cervical effacement and dilation
Early Phase
In very early labor contractions may be irregular and mild gradually building to a more consistent pattern. Some labors will start and stop over several days sometimes called 'prodromal labor'.
Contractions around 0-3cm last around 30-45 seconds, 10+ minutes apart and are often mild enough to allow for sleep. Sleep is encouraged so that you conserve energy for later stages of labor. Snacks and hydration are also encouraged for the same reason. You might be feeling frustrated and confused, wondering labor is actually starting, if that's the case try to rest and hydrate anyway.
You might be feeling a range of emotions from excited, anxious and uncertain. You may start getting your hospital bags ready and last minute cleaning/organising. Typically you can talk through your contractions and joke or laugh at this very early phase.
As labor progresses to early active labor around 4-6cm, contractions will get more intense and consistent. Typically 4-10 minutes apart. Your partner might have started timing contractions and you will know that labor has started. You will need to use comfort measures, request support and focus through contractions. Any conversations outside of your labor will need to stop and all focus will be on keeping you calm and feeling safe. Remember to rest during contractions and calm your mind using techniques you learnt during pregnancy.
Active Labor
At 6-8cm contractions will become more intense and frequent around 70-90 seconds long and 2-3 minutes apart. Your baby might be descending past engagement (0 station) unless you are having twins. You might begin to feel more serious and apprehensive and you might rely on positive affirmations to stay calm as labor intensifies "every contraction brings me closer to meeting my baby", "me and my baby are working as a team". You might begin to express doubts in your ability but remind yourself that you are "capable".
Transition
The cervix dilates from 8-10cm and completes any effacement that might not have completed. This is the shortest phase but the most intense. Contractions are lasting around 90 seconds every 2 minutes with multiple peaks or immediately peaking. Your baby is descending through your pelvis and you might experience early urges to push. This is the most challenging phase and you might express the desire to give up, say you ‘cant do it’, ‘how much longer’, ‘I want to go home’ but remember you are so so close! Transition might cause you to panic, snap, scream or many other emotions of intensity. Try to release tension in your jaw, lower your scream to moans and surrender to the energy of your baby descending.
2nd Stage: Pusing/Delivery of Baby
Moving into the pushing phase you may experience a pause in contractions. You might be feeling the sensation of needing to poop and you might start to spontaneously bear down or start pushing involuntarily.
Pushing contractions are typically 5 minutes apart and last around 1 minute if unmedicated. Entering the second stage you might feel excited, empowered and ready to do something active with your contractions. Even with an epidural you can feel an intense amount of pressure.
Effective pushing might not be instinctive for some and you may require coaching, changing positions or even seeing progress with a mirror to feel more confident.
3rd Stage of Labor: Delivery of Placenta
The second stage ends with the birth of your baby and the third stage is the birth of your placenta, this stage can last 1-20 minutes. This will be at the time you are doing skin-to-skin with your baby. As the uterus shrinks down the placenta shears off the uterine wall and needs to be pushed out (this is nothing compared to the birth of your baby so don’t be worried). Your provider might push on your stomach to make this happen, speak with them first if this is not your wish. In hospitals it is common practice to give pitocin at this time, your midwife may perform fundal massage to ensure the uterus contracts well. Skin-to-skin and breastfeeding causes the uterus to continue to contract and shrink down after birth. You are likely to be focused on your baby at this stage, feeling elated and exhausted at the same time.
Good job Mama. You are in your postpartum stage. You can now focus on your recovery, healing and bonding with your baby.
If you need guidance on how to return to movement and exercise in your postpartum stage, be sure to check out my 6-week Early Postpartum Recovery Program.
