Breith Athas Childbirth Support Services

Understanding and Coping with Labor in Every Stage

	The Signs for Each Stage		Physical changes	Emotional changes	Coping Techniques and Comfort Measures
<>Pre-Labor        Can last several hours, days or weeks
	Mild, irregular contractions, soft stools, some bloody show		Cervix is moving into position, thinning out, softening and may even dilate a little; baby is getting into position	Anxiety, excitement, may experience a “nesting urge”	Rest, eat, drink well; be patient and continue with normal, non-strenuous activites
First Stage
Early Labor		Lasts 2-24 hours
	Mild to moderate contractions felt mostly in lower abdomen, sometimes in the lower back, occur 7-12 minutes apart		Cervix is thinning, softening to 70-80%, dilates to 4 to 5cm; baby moves into pelvis if ze has not already done so	Excitement – “this is it” the baby’s coming; sociable, like having other people around; somewhat easily distracted from contractions; can become discouraged if this phase lasts too long	Be patient – every labor has its own schedule; create a calm, relaxed atmosphere, try to settle in; conserve energy and relax, take care of yourself, eat lightly, drink fluids; find comfortable positions; try not to focus too much on the contractions
<>Active Labor       Lasts 2-12 hours<>
	Contractions are 2-5 minutes apart, stronger and more intense, lasting 60 seconds or more and coming in more regular pattern; increase of pressure on the cervix; strong sensations in lower abdomen/lower back; appearance is flushed – working hard		Cervix thins to 100%, dilates to 8-9cms; baby moves further down into the pelvis; water may break (if it has not done so already); increase in bloody show	Getting more serious, focused inward; concentrating on getting through contractions, can’t be distracted from them; desires to have trusted people close by for security; may be uncertain about ability to do this	Trust your body, learn to go with the flow; relax between contractions; use focus/breathing to get through peak of contractions; let go of expectations and/or need to be in control; change position frequently, stay upright, use movement; stay in the present, focus on one contraction at a time
<>Transition          Lasts 15 minutes – 4 hours (this is the shortest, but most intense time in labor)
	Contractions are 1-3 minutes apart, lasting 60-90 seconds, becoming slightly unpredictable, may have double peaks; feel pressure, sharp sensations as cervix dilates fully; hot/cold flashes, legs/body shake; perspire, breathe more heavily		Cervix dilates to 10 cm and thins out completely; baby moves down significantly; water very likely to break (if it has not already done so)	May be irritable and grouchy, scared and vulnerable; wanting it to end, may feel unable to continue; very sensitive, sensory overload happens easily; may be tired and sleep between contractions; difficult to get comfortable; very dependent on others to feel safe	Moaning and groaning, vocalizations help alleviate stress/fear, take focus away from intense sensations; patterned breathing helps get through peak of contractions; use focus: visual, auditory, sensory (look in someone’s eyes, listen to their voice, pay attention to their touch/massage); rest between contractions; use shower or tub; decrease stimulation, dim lights, etc; rest between contractions and remember to take them one at a time!
<>Second Stage         Lasts 10 minutes to 4 hours
	There may be a pause in contractions; contractions resume about 2-4 minutes apart, lasting about 60 seconds; surges of rectal pressure; urge to push or bear down; lots of pressure/tightness as tissues stretch in vagina, labia, perineum		Baby moves down through the vagina, rotates through the pelvis, crowns at the perineum and is born	More alert and aware, renewed energy; change in contractions is a relief; may be startled or overwhelmed by urge to push; renewed strength and determination; excitement that baby is almost here; may be exhausted and discouraged if labor has been very long and/or difficult	Rest between contractions and wait for the urge to push; find a comfortable position that uses gravity, may need to change a few times; make every contraction count, use the energy of the contraction to push that baby out; ease up at crowning to prevent tears; reach down and touch baby’s head at crowning, ask for a mirror to help you see; push through intense sensations, don’t hold back
Third Stage          Lasts 10-30 minutes
	Mild contractions; slight urge to push		Placenta separates from uterine wall and uterus clamps down	Relieved, tired; distracted by baby; may be unsure of what is happening or where to focus attention	May or may not need to do patterned breathing to cope with contractions; breastfeeding stimulates uterine contractions; many women hardly notice the third stage

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