When Push Comes To Shove
Not sure what to expect during childbirth? Here, our guide from your first contraction to your baby’s first breath.
While your birth experience will be as unique to you as your new baby, the phases of labor and delivery are the same for everyone. During pregnancy the opening of your uterus, the cervix, is firm and closed. As your due date approaches, you may experience mild contractions that help prepare your cervix for delivery: It becomes soft, stretchy and thin, a process called effacement. These early contractions also help your baby engage, or move into position to come through the birth canal, says Chris Kenlan, a certified nurse-midwife at Legacy Medical Group-Midwifery in Portland, Ore.
Many women experience these for hours, or even days, before actual labor begins, with contractions coming at irregular intervals. “Latent labor can be uncomfortable, exhausting and confusing. Patients rush to the hospital thinking, ‘This is it!’ then get sent home,” says OB-GYN Catherine Harth, M.D., an assistant professor of obstetrics and gynecology at the University of Chicago. You can help your labor progress by taking walks, but be sure to stay hydrated and well nourished and get some rest.
Kenlan advises her patients to follow the “511 Rule” before heading to the hospital. “Contractions should be strong, consistent and approximately five minutes apart, lasting one minute, for at least one hour,” she says. If you lie down to rest or take a bath and the contractions slow down, you’re not yet in actual labor. Your “bag of waters” can break spontaneously or your doctor or midwife can rupture the membranes any time before or during labor. (Note: If you are less than 37 weeks and having regular contractions, your water breaks with or without contractions, you experience vaginal bleeding that is heavier than spotting or you have severe constant pain, go to the hospital immediately.)
Real labor starts You’ll know you’ve progressed to true labor when your contractions get closer together, longer and don’t slow down when you’re resting. Labor actually consists of three stages: dilation, pushing (and the birth of your baby!) and, finally, delivery of the placenta.
Stage 1: The cervix opens Your cervix will dilate from zero (closed) to 10 centimeters (fully open). On average, you can expect it to change 1 centimeter an hour. “Early labor—before 4 centimeters—feels like ever-increasing cramping, and women sometimes experience diarrhea, spotting and discharge,” says Kenlan. “Active labor— after 4 centimeters—means contractions are regular and strong and cause cervical change.”
During active labor your contractions will be two to three minutes apart, lasting about one minute each. Most women say contractions hurt, though some describe them as a feeling of intensity, pressure or tightening. To help manage the pain, Kenlan recommends patterned breathing—rhyth- mic, slow and deep—or try a warm shower or bath, walking or changing position, e.g., lying on your side or moving onto your hands and knees.
If you want pain medication, request it now. “The best time for analgesia is when a woman is in active labor,” says OB-GYN Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital. “Early in labor when there are contractions but no cervical change, an epidural could slow down the process.” If you’re planning a natural birth without drugs, expect the intensity of your contractions to increase at this point.
As your cervix reaches 8 centimeters, you’ll enter the transition phase. “It’s intense but brief,” says Kenlan. “Many patients ask for epidurals now or will feel breakthrough pain if they already have had an epidural.”