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Labor Information

Stages of labor

Labor is the work of the women's body to bring forth a baby (and placenta) into the world. Every women's labor progresses at its own pace and is never exactly the same, even in the same woman.

During labor, involuntary contractions of the upper uterus (the fundus) causes the lower part of the uterus (the cervix) to become effaced (shortened and thinned) and dilated (opened). These contractions gradually increase to size of the cervical opening until it is approximately four inches. When you are 100% effaced and fully dilated (10 cm), the baby is able to pass through the cervix to the vagina, the birth canal and to the waiting outside world.

Prelabor
Prelabor is a period prior to "the real thing" during which mom feels contractions, yet the cervix is not dilating. Contractions may be regular and strong, lasting for hours, however, they do not become longer, stronger and closer together. Prelabor may come and go over several hours, days, or even weeks. During prelabor, mom may feel excitement and anticipation thinking this is "the real thing" or she may be confused, wondering if she is in labor. Fear may be the prevailing emotion if mom is not prepared or feels the contractions are more painful than she expected.

As prelabor contractions become longer, stronger and closer together in a regular pattern and the cervix begins to dilate, mom is said to be in labor. Labor is usually divided into three stages. Early labor is the first stage, and it typically is the longest phase. During this period, mom should continue to drink fluids, eat foods that appeal to her (food that is easy to digest such as soups or jello) and do light activity. Walking is good during this period. Remember to rest as this is just the beginning, energy will be needed for the remainder of the labor.

Coaching
Coaching during the early phase consists of helping mom relax, timing her contractions and finishing any final preparations for time spent in the hospital (clearing schedule at work, sitters for other children, pets, etc.). Mom will always benefit from positive encouragement. As the contractions become stronger and closer together, other relaxation techniques may be started.

During the active stage of labor when the cervix dilates from three to eight centimeters, mom often feels the need to go to the hospital. Typically she is less talkative, less excited and may even begin to doubt her ability to cope. It takes more energy to stay on top of the contractions, and coaches will notice mom becoming more introverted. Contractions are lasting 45-60 seconds and coming every three to five minutes. Slow paced breathing may be useful during this stage. Mom may also request medication now.

Coaches will get a good workout during this phase. Try all of the "tools in your bag," some may work for short periods and others not at all. Massage, a cool cloth to the face, walking, position changes every half hour, breathing, fluids as ordered, showering, up to the bathroom regularly and positive encouragement with eye-to-eye contact are some of the tools at your disposal.

Transition
Transition is the final phase of the first stage of labor. The cervix dilates from seven to ten centimeters. It is the most intense phase, yet the shortest phase. Contractions last 60-90 seconds and come every two to three minutes. They may even have double peaks. Physically mom may experience nausea and vomiting, shaking of her arms and legs, sweating in her upper body and her feet may be cold. There may be pressure on the rectum and bladder and premature urge to push. During this phase mom may feel like giving up. It is difficult for her to rest between contractions, and she may be very irritable.

Because of the intense feelings, the coach's encouragement during this phase is vital. Remind mom to take the contractions one at a time; she does not have to deal with them all at once. When one is done it will never be repeated; she is coming closer to her goal of birthing a baby. Breathe with her, and talk to her in a quiet, firm voice. Don't take offense to anything she may say or do, and above all, do not leave her.

These phases complete the opening of the cervix. You may be able to visualize this process by thinking about putting on a tight turtleneck sweater. You pull and stretch the neck until you have it opened far enough for you to push your head through. Just like that, the uterus has to pull on the cervix, stretching it with each contraction until it is opened to the wildest diameter of the baby's head. Then you will be able to push the baby out.

Stage Two
The second stage is pushing the baby out into the world. Contractions continue to come but last 60-75 seconds and have decreased in frequency to three to five minutes. Mom may feel an irresistible urge to push, or she may have little urge to push. Pushing often feels good if the perineum is relaxed and the urge to push is present. Although mom may be tired, there usually is a burst of energy and determination as this stage progresses. Facial distortion and grunting sounds or moaning are normal. As birth draws near, excitement increases.

During the pushing stage, the coach may be physically supporting mom in her efforts to maintain a good position for pushing. Encourage her to work with her body and push when she has the urge. Position a mirror so she can see the baby's head. Praise, comfort and reassure her.

Final Stage
The final stage is the birth of the placenta. Following the birth of the baby, the mom may be unaware of the birth of the placenta or the repair of the episiotomy. The joy and euphoria following the baby's birth is the prevailing emotion. Mom may be hungry and/or tired, but does not notice. As the coach, rejoice with mom in the new baby and her accomplishment (and yours) of successfully bringing the baby into the world. Help her to breastfeed, if desired. A warm blanket and something to drink may be appreciated by mom. Enjoy your time together.

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