Labor at a glance..

Regular contractions with dilatation of the cervix define labor. Contraction sans the dilatation or opening of the cervix is considered as latent phase or early labor which is different from proper, established labor. There are 3 stages to it

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Stage 1	The toughest part of labor which starts with the onset of regular contractions with gradual opening of the cervix to reach full dilation of 10cm. First babies cause this stage to last an average of 10-14 hours. This stage shortens with subsequent babies.
Transition	Not a stage but a period between stages 1 & 2; it usually marks the last 2-3cm of dilatation and lasts from 15 mins to an hour. Women either feel the urge to push though not fully dilated (feeling that comes with contractions of the 2nd stage) or lose the urge to push despite being almost fully dilated.
Stage 2	Comparably an easier stage which starts with a fully dilated cervix to the birth of the baby. With the cervix fully open the mother will be able to push the baby down the birth canal. First babies take an hour on the average to make an entry into the world. This stage shortens with subsequent deliveries.
Stage 3	The final stage is essentially the delivery of the placenta and membranes or bag of fluid that contained the baby. This can be as short as 10 minutes.

What is happening in the first Stage











When contraction peaks, baby's heartbeat dips to its lowest level, and then quickly rises back to normal as the contraction subsides. Quick, shallow breaths help the mother cope with the pain at the peak of a contraction.

Labor Signs

Contractions

The pain associated with contractions has been described differently by women. These include severe menstrual cramp, persistent backache or a wave of discomforts that peak and subside in turns. Overall the contractions grow in frequency and intensity and last longer as birth approaches. When the placenta starts to perform inefficiently, the baby's brain responds by producing oxytocin which crosses into the mother's bloodstream. The mother's body responds by producing oxytocin as well which stimulates contractions. Additionally baby's adrenal gland secretes the hormone cortisol which again crosses into the maternal bloodstream triggering the release of hormone-like chemicals called prostaglandins. Prostaglandins are responsible for the softening of the cervix and this act causes the uterus to start the contractions.

The show

It is the release of the mucus plug which had sealed the cervix opening from the start of pregnancy. In some women the pinkish jelly like blob dislodges itself while in others the blob disintegrates into smaller pieces. It can appear in your underwear or when you wipe yourself with a toilet paper. Basically this is indicative of the cervix stretching a little in preparation of labor. Several days or sometimes only few hours may lapse before true labor kicks in. A show with slight bleeding indicates early labor. If you don't have a show or somehow miss noticing it, you may still be in labor.

The Waters

When the amniotic sac ruptures, the fluid may escape either as a gush down your legs but more often it comes out in trickle form. Most women don't even realize this because it feels more like a dribble of urine. Wear a sanitary napkin. Sometimes the trickle slows down and comes to a stop, meaning the rupture wasn't complete and the sac has sealed itself. Usually ruptures don't occur in first pregnancies. If the fluid continues to escape but there are no signs of labor within 24 hours contact your doc immediately. Baby is vulnerable to infection if waters continue to trickle out over a day in the absence of labor. Membranes are usually left to break on their own. There are times when it is necessary to break the bag e.g. when labor needs to be induced or speeded up or if baby is under duress.

Add-ons

Internal checks

Internal examinations during labor provide important information on the labor progress. They can be uncomfortable so it helps to empty your bladder and relax your muscles. Once labor is in established stage, an internal check will done every 4 hours or so. Being aware of the progress will help the mother decide on the form of pain relief she may need.

Monitoring baby

A cardiotocograph or a CTG consists of two transducers. The device will be strapped on the abdomen of the mother with a connection to a monitor. A print out from the monitor will indicate baby's heartbeat and the uterine contractions. It is a mobile device so movement by the mother will not affect the monitoring. Continuous monitoring is only required in instances such as premature labor, when oxytocin or epidural is used of if baby is in distress. On other counts when everything is going good with the mother and baby, there is no need to be strapped to this device.

1st stage

It is important to stay mobile between contractions by walking around as much as you can. Three things happen: the labor progresses, the mother's coping ability increases and contraction speed picks up. Women who remain mobile and sit upright during labor, stand and squat, instead of lying down on the whole have shorter labors and need to rely less on pain relief.