The first stage is usually the longest
and the hardest part of labor. During
this stage the cervix gradually opens
to allow the baby to make its way
down into the birth canal. This stage
typically lasts 10-14 hours with the
first baby; in subsequent pregnancies
the first stage is likely to be shorter,
close to 7 hours.
Labor Facts..
• The first stage is divided
into 3 phases; the latent phase,
the active phase and the transitional
phase.
• Typically the first stage
lasts for up to 12 hours on the
average with anything more considered
as slow progress
• The latent phase is the
longest; contractions though frequent
and intense are not too appalling.
During this phase the mother should
conserve her energy for the more
intense phase which is to follow.
During this phase expect dilation
to measure up to 4cm
• The active phase is shorter
lasting about 3 to 5 hours. Expect
contractions to be more forceful
and painful. Dilation can progress
to measure at 8cm. You may seek
pain relief now. It is your choice.
• The transitional phase is
the shortest but the most intense
of all three phases. It lasts for
not even an hour and its timing
is just before the delivery
Contractions
• Initial contractions can
be likened to intense period pains
for some women while for others
they can be compared to intervals
of sharp energy rushes. For some
it can be a mild backache. In true
labor the contractions are more
regular, intense with the pain traveling
and tightening around the lower
abdomen
• Each contraction comes gradually,
peaks, and then fades away. The
uterine muscles harden and tighten
when the contraction peaks and the
pain diminishes when the muscles
relax. With time when the contractions
are spaced with shorter intervals,
the relaxation time before and after
each contraction lessens considerably
leaving the mother to recall the
peak only.
• At the start one contraction
can be felt every 10 minutes lasting
for 40-50 seconds. Finally it reaches
a stage where the contractions will
last longer than a minute with a
gap of less than a minute. The resting
time decreases quite a bit. It is
normal if one strong contraction
is followed by a weaker one as it
is normal to feel one strong contraction
after another.
• The effect of each contraction
is two-fold - first it restricts
the space in the uterus forcing
the baby into the softened section
of the cervix.
• Second, the muscular fibers
of the cervix shorten and pull upward
with each contraction. This is termed
effacement. Simultaneously the cervix
muscles are widening the opening;
this is also known as dilatation.
• The purpose of contractions
is to force the baby down into this
opening. Every contraction causes
the cervix to open up and pull back.
By the end of the 1st stage, the
cervix would have totally effaced
and will be fully dilated in preparation
for the birth.
• At first labor progresses
very slowly. Several hours may pass
by where nothing seems to happen.
Contractions come and go, and with
time gain momentum and intensity.
Yet dilation is no more than half
a cm. Don't panic - this is normal.
Waters
break
• Waters usually break spontaneously
near term. In some cases the sac can
break prematurely.
• The rupture is painless and
usually occurs towards the end of
the first stage. Fluid either leaks
or gushes out depending on the site
of the rupture and the size of the
sac.
• Once the amniotic sac breaks
on its own, labor contractions normally
set in within 24 hours
• If labor doesn't occur it
could be due to baby not being engaged
or if it is presenting abnormally.
Delay occurs in normal cases too.
The cervix
• Usually the cervix is about
2 cm long and is firmly closed. In
the last weeks, pregnancy hormones
will cause the cervix to soften.
• The contractions will cause
the cervix to thin and dilate. Dilatation
is measured in cm from 0-10.
• The cervix will dilate to
about 4cm during the latent phase;
dilatation will progress to 8cm in
the active phase.
• Eventually the cervix becomes
fully dilated (10cm) during transition;
the whole cervix will open up and
become one with the uterus forming
a continuous passage through which
the baby will make its way out
What is
going on with the Baby
• During the first stage, baby
continues to receive nourishment and
oxygen from the placenta. Baby has
been experiencing contractions in
the past so labor contractions are
nothing new for the baby.
• Baby's responses to contractions
can be monitored. With each uterine
contraction the blood flow through
the placenta slows down. The flow
normalizes when the contraction passes.
• This slow down in blood flow
will cause baby's heart beat to dip
at the peak of each contraction. The
heart beat picks up after the contraction
fades away. The fall in heart rate
has no side effect on the fetus.
• Baby's heart beat during this
stage averages at 120-160 beats per
minute. It can sometimes fall to 110
or rise to 170 which is nothing to
be concerned about. Minor variations
are normal as they show the heart
is functioning and coping well under
labor conditions. However if decelerations
or slow down in heart rates persist
and do not rise, it may be indicative
of baby not coping with labor pressures.
Transition
• As mentioned this is the most
excruciating and also the most distinct
of all the three phases. Contractions
will last between 60-90 seconds with
intervals of only 30-60 seconds
• Relaxation periods become
scarce as contractions become more
intense. Your threshold for pain is
put to the ultimate test now.
• The urge to push becomes very
strong though it may not be the time
to push unless full dilation is achieved.
Conversely although the cervix is
fully dilated you may not feel the
urge to push
• Transition is the phase for
the last 2-3 cm to happen and can
last from 15 mins to an hour.
• Expect to feel nausea, the
urge to open your bowels, extreme
fatigue
• Expect contractions to last
longer, build to extreme intensity
and come more frequently. The mother
becomes less aware of the coming,
peaking and waning of contractions
in this phase; to her contractions
seem to peak all the time.
• Expect to experience all the
negative emotions your brain can summon:
irritability, anger, feelings of despondency,
fear and the urge to give up.
• It will help if you can relax
between contractions and maintain
your breathing pattern. Find a comfortable
position. Handle the contractions,
and remember it will all be over soon!
End of
the 1st stage
| 8cm
dilation |
the
doctor will be able to feel
a slight lip of the cervix on
both sides of the baby's head |
| 9cm
dilation |
contractions
are coming fast and furious
as the pressure of the baby's
head works to complete dilatation |
| 10cm
dilation |
when
fully dilated the cervix is
totally effaced and the baby's
head fits well |
