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.
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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 |
