Elaine Baca—lanebphotography.com

Disclaimer: Some natural birth proponents are trying to change the vocabulary of birth. They admonish those of us who use the term contraction, preferring terms such as wave or rush. While I admit that contractions are wave-like, waves don’t have the same progression as contractions. I’d rather tell it like it is: the uterus is indeed contracting. Calling it a contraction reminds us that only the uterus should be contracting, while the other muscles need to stay relaxed. The body needs to let the uterine muscle, which is doing a lot of work, have all the oxygen and nutrients in order to do its job well. If we tense up other muscles, getting the baby out will be harder. Staying relaxed, even through contractions, is the key to an easier labor. So pardon me as I continue to use the term contraction.

It may help us to know that an average labor burns over 7000 calories! It’s hard work, hence the name labor. The first stage of labor is divided into three parts: 1) latent, early, or prodromal; 2) active first stage; and 3) transition.

Latent, Early, or Prodromal Labor

This happens when cervix is dilated from 0 to 5 cm. Contractions are short, mild, and regular, but far apart. Mild irregular contractions are called Braxton-Hicks and are not considered part of labor, although they still do some good. It is best to continue normal routine activities, including working, eating, and sleeping during this stage. It can take minutes, days, or, rarely, even weeks—so business as usual is the way to go, for as long as you can!

Active 1st Stage

The cervix is past 5 cm dilation and contractions are coming regularly. Things will most likely go faster now! The contractions are getting longer and stronger. It is harder to stay relaxed or focused on chores. But remember, as a wise midwife told me “Every contraction you stay relaxed through is one closer to your baby. Every contraction you tense up for is one you have to do over.”

You are now entering the magical kingdom of “laborland”! Time gets warped, like Salvador Dali’s famous clock. This is when your support person—partner, mother, sister, friend, or doula—can be a big help. A support person can be the timekeeper, telling you when it’s time to eat, pee, sleep, etc., and can track the length and spacing of contractions, to report to the midwife, hospital, or other health care provider. She can notice if you are not staying relaxed and help you focus on maintaining relaxation, massaging you in areas that tend to hold tension. Many laboring women, even if they don’t have back labor, appreciate someone giving them firm lower back counter-pressure during contractions. She should also know what kind of music you would like to hear and keep your environment peaceful and unencumbered. Checking blood pressure in early to mid-labor, for a baseline, is another important task.

Labor burns a lot of calories, so remember to eat nutritious foods as long as they are staying down. Your stomach will tell you when to stop. Two notes about food here: in labor, you will have a heightened sense of smell, so no matter how good liver with bacon and onions smells to you normally, it is not the thing you would want to smell, let alone eat, in labor! Pick nutritious foods with little or no odor. If you eat nothing, besides running out of energy, you will probably get the dry heaves, so you might as well have something in your stomach unless a c-section is probable. Avoid citrus fruits like oranges or grapefruits because the acid does not sit well in a laboring stomach, unless neutralized by milk or yogurt. Actually the vitamin C in the citrus helps strengthen capillary walls, (slightly) reducing blood loss, and the calcium in the milk or yogurt, along with the vitamin D, raises your pain tolerance. I love a real homemade “Orange Julius” in labor.

By the time you are actively working to stay relaxed and can no longer focus on other chores, someone should occasionally be checking fetal heart tones (FHT) at the end of contractions. The closer, longer, and stronger contractions get, the more frequently FHTs should be checked. If any “funky” tones are heard, closer monitoring should be done and you should prepare for transport if they get worse—although most of the time, a “funky” beat from time to time is not a reason to panic, just to be more astute. Most health care providers want to be notified during this part of labor, if they haven’t been earlier. A homebirth midwife will want to come to you, so she can track your BP and baby’s heart rate and rhythm. Most hospital providers will want you to come in when contractions are coming every five minutes and lasting a minute.

The amniotic fluid, more commonly referred to as “water” (even though chemically it more closely resembles a saline solution) can break at any time. It can break days before labor, or baby can be born en caul, that is, still inside the unbroken amniotic sac. Or it may break at any time in between. Nobody “needs” to have their water broken; it will happen in good time. Some health care providers like to break the waters to speed up labor. (What’s the hurry? Relax!) Others say they break it because they want to know what color the amniotic fluid is.

Once the waters are no longer intact, most hospital providers put you on a time clock, saying that the longer they wait, the greater the chance of infection. While that is somewhat true, infection is more closely aligned with how many vaginal exams one has, as well as the number of hours elapsed. Now there is less feeling of pressure, but there is a sharper sensation rather than a duller, fuller one. Labor is more likely to go faster once the bulk of the water has gotten out of the way. Remember, your body will continue to make more amniotic fluid until the baby is out, so each contraction will squeeze out a little more fluid, no matter how long you are in labor. Once the baby’s head is well engaged, the water may build up behind the baby, only releasing as the baby emerges. Due to the increased risk of infection if water breaks before or in early labor, it is wise to track your temperature to make sure no infection is setting in.

This is also time to decide if you want an enema. While many don’t like the thought, it can help make more room for baby to come down and can speed up a long labor. As baby comes down the birth canal, the force of contractions pushing the baby down massages the colon, pushing little pieces of stool out in front of baby. Unlike the big soap and water enemas on Call the Midwife, modern enemas are smaller, ready-made, and disposable. At home, without drug enhancement, an enema may be a welcome relief from the pressure you’re feeling. It often speeds up labor considerably. Plus, you never know in what position you may end up delivering.

Sometimes the water breaks with a great gush, so there is no question what it is. Other times it leaks out slowly, so you may just think you are sweaty or leaking urine. This can be determined by checking the pH of the fluid. As long as the water is intact, the baby is cushioned, making it easier to maneuver into a good birthing position. If your waters are broken or leaking before or early in labor while you are still mobile, adult pullups are a godsend.

The amniotic fluid should be nearly clear, like a small spoon of milk poured into a glass of water. Often there are flecks of white- or cream-colored vernix floating around in the fluid. If the baby is overdue or in distress, it is more likely to be colored with a pale yellowish brown or pale green tinge. If the fluid has color, heart tones should be taken more frequently, to assure that baby is not in distress. If it is darker green or brown, or pale but getting darker, you should be in or heading to the hospital because of the increased risk of having a distressed baby who needs to be resuscitated or put on supplemental oxygen. The color is caused by meconium, baby’s first poop. While colored water may be a sign of distress, it is not always so. The more overdue you go, the more likely it is for meconium to be in the water. Also breech babies’ butts get squeezed coming out, so they are also more likely to pass meconium as they exit.

Transition

Transition occurs in the last few centimeters of dilation and effacement (7–10 cm). It may last minutes or up to a few hours. Contractions are now lasting over a minute and are coming every two to three minutes. Again, some natural birth proponents don’t like the word transition, because it sounds scary to them. They want the moms to stay relaxed. But the term need not be scary. I find it encouraging to know that the worst is behind me and the best is yet to come. This is a transition between first stage and second stage, so why not call it what it is? Transition is the hardest part, sure, but that means it gets better from there.

What had worked up to this point no longer works, yet it’s not quite time for pushing yet. Now your entire focus is on staying relaxed and doing slow, deep breathing through contractions. Everyone present (yes, even the kids and midwife, if at home, or the hospital staff, if in the hospital) should respect your hard work. They should maintain silence during the contractions and speak only between contractions so as to not break your concentration and relaxation. (Note: some women say they like complete silence, while others say they like to hear others talking or music. Whichever a mom prefers, her wishes must be paramount.) A birthing mother should not be expected to partake in conversation, answer questions, or even think about answering a question. She needs to stay focused on her labor. Asking questions is okay between contractions, but not during!

If you are having a homebirth, your midwife should be with you by now. If you plan on a hospital birth and aren’t yet at the hospital, you had better get going!

This is the time when you will lean heavily on whichever relaxation method you have practiced prenatally. Lamaze, Bradley, HypnoBirthing, and all the other off-shoots of those techniques each have pros and cons. It is good to look into the differences prenatally and choose whichever method suits your needs the best and then learn it well.

If you are having a hard time relaxing your muscles during transition, let your support person know. Better yet, the support person should have a keen eye on you, see where you are holding tension, and help you relax—before you even have to ask. She should also be offering water and other sustenance frequently and reminding you to keep your bladder empty (between contractions, of course).

Having a support person to encourage you, assure you things are normal, even if intense, is a big help. Most women labor better with a support person. A few prefer being alone. In bygone days, men were excluded from birth; it was considered a woman’s role. Nowadays, men are expected to be by their mate’s side throughout it all. But what is most important is that you birth in the way most comfortable for you. Partners shouldn’t feel pressured into being there nor should they feel excluded. A couple needs to do it whichever way feels right to them, without caving to the pressure of society’s expectations. It should be a matter of personal preference who your main support person is or which sex they are.

Once you have reached 10 cm, the worst is over. You are now entering second stage, almost ready to push. You will have a few more minutes between each contraction and you will be able to feel your progress more as baby comes down the birth canal. But we’ll save the rest for the issue on second stage.