Current maternity practice focuses on the stages of labour and the phases within each of those stages.
While many women experience a ‘textbook’ labour, others might have a labour that throws the book out the window!
Most healthy, low risk women will have a normal and fairly ‘routine’ labour.
The medical management of birth has traditionally placed an emphasis on timeframes and parameters. These interfere with the unique process of birth, and don’t take into consideration the fact that each woman is different and her labour is influenced by her background, her beliefs, and the care she receives.
What Are The Stages Of Labour?
In the 17th century, medical men decided birth needed to be more efficient than it had been to date. Female bodies were regarded as machines, and labour was divided into stages, measurements and timelines. Birth became a mechanical process, rather than the natural physiological process it had been for millennia.
The medical model determined there were three stages of labour:
- First stage: regular contractions begin dilating the cervix (neck of the uterus).
- Second stage: when the cervix is fully dilated, pushing contractions move the baby down through the vagina.
- Third stage: after the birth of the baby, the uterus contracts and causes the membranes and placenta to be expelled through the vagina.
Current maternity practices in hospital settings also attach timeframes to each stage of labour. These timeframes assume every woman labours in the exact same way, but they are based on average times, worked out over sixty years ago.
The First Stage Of Labour
The first of the three stages of labour is usually the longest, but it builds up over time so your body can adjust. There are three phases within the first stage of labour:
- The latent phase begins with mild, irregular contractions that might feel like back ache, or period cramps. They can be 20-30 seconds long and about 20 minutes apart. You might also experience some low pressure, diarrhoea, bloody show, or waters breaking. This phase of labour can happen over a period of weeks or days and you might not even be aware of the contractions, thinking they are more intense Braxton Hicks. During the latent phase, your cervix will soften, shorten and thin (efface). Over time it will open (dilate) to about 3cm.
- The active phase of the first stage begins when contractions become longer and more regular, dilating the cervix more rapidly to about 7cm. There will be a shorter space between contractions, which will become more intense. They will begin to require your focus and possibly your coping techniques will come into play. You might experience more backache, aches in the buttocks and tops of thighs, tiredness, more bloody show, and waters breaking.
- The transitional phase is the last and most intense part of the first stage of labour. It is generally the shortest phase and usually lasts between 15 and 60 minutes. The cervix completely dilates to 10cm, and contractions can become very intense and about 60-90 seconds in length. They will feel as though they are coming thick and fast, with perhaps 2-3 minutes between each contraction. During the transitional phase, you will probably experience intense pressure in your back and bottom, and there’ll be increased bloody show as the dilation of the cervix increases. You will feel hot and sweaty, or cold and shaky, nauseous, extremely drowsy between contractions, and exhausted.
The Second Stage Of Labour
The longest stage of labour is complete. The second stage of labour lives up to the word ‘labour’ as pushing takes more effort from you than the first stage of labour, which happens without much physical input. Again, there are three phases within this stage of labour:
- The latent phase is when the cervix is completely dilated and contractions pause. During this phase, the baby’s head descends into the pelvic outlet and rotates, so the back of the head is facing your belly.
- The active phase occurs when involuntary expulsive contractions begin, pushing the baby through the cervix and into the vagina. You will feel an overwhelming urge to push, with pressure on your rectum as well as your perineum (the area between your vagina and anus). You might also feel a stretching, tingling or burning sensation as the tissues of your perineum are stretched.
- The perineal phase is when the baby’s head stays on show, instead of moving back up the vagina after each contraction. The head is born with the forehead first, then the nose, mouth and chin. The burning sensation you might be feeling will probably ease as the head is born. Contractions might stop for a moment while the baby’s head rotates, allowing the shoulders and body to be born, in a wet slippery gush. You might also feel your baby kick, as some babies do on their way out.
The second stage of labour varies in length, but is usually completed within 3 hours. Women who have previously had babies tend to find the second stage is much faster than in their first pregnancy.
The Third Stage Of Labour
Your baby has been born and begins the amazing transition from womb to world. You are probably feeling an immense sense of relief and might be in a daze, hardly taking notice of anything around you. Your baby will most likely be placed on your belly or chest, depending on the length of the umbilical cord, and both you and your baby will be covered, to keep you warm. The third stage of labour lasts from the moment your baby is born to the expulsion of the placenta and membranes.
A huge surge of oxytocin at the moment of your baby’s birth causes the uterus to contract, and the placenta begins to sheer off the uterine wall. Further contractions clamp down on the blood vessels and push the placenta out. Some women need to push actively with the contractions, others might find simply moving into an upright position or a squat will help push the placenta out. If the umbilical cord is not severed immediately, the baby’s circulation will transfer the large volume of placental blood into his body, increasing his own blood volume, red blood cells and antibodies.
This final stage of labour can last between 10 and 30 minutes but can extend up to an hour. Many hospitals have a standard policy of administering a synthetic oxytocin injection at birth, to expel the placenta forcibly. You might choose to have a natural third stage, if that is your preference; you can read more about the third stage here.
Women’s bodies have been perfectly designed to birth babies; evolution has honed the process over millennia. While there are certain situations where medical assistance is needed for birth to be safe for mothers and babies, the normal process of labour has its own rhythm.
The three stages of labour provide overall guidelines for how the average, undisturbed labour might unfold. As most women give birth in hospital settings which aren’t conducive to undisturbed labour, it is not surprising many labours don’t meet the expectations of normal labour. Being aware of how your labour can unfold is great preparation, but always bear in mind your labour is unique to you and your baby.
Recommended Reading: Undisturbed Labour – What Is It And Why Aim For One?