The first stage
First signs of labour
For most women, the first stage of labour is usually the longest and most intense. During this period, your uterus produces a series of strong contractions to open the cervix (the muscle between the uterus and the vagina) a full ten centimetres so that your baby can be born.
The First Signs of Labour
Every woman’s experience of labour and birth is very different and there are a number of ways that your labour might start. It’s easy to confuse ‘pre-labour’ signs (like Braxton-Hicks contractions) with the real thing.
A few signs that indicate labour has started:
When the mucous plug sealing the cervix is released, you will experience a discharge that often contains a small amount of blood and mucous; for some women this happens at the beginning of labour, for others it might occur a few days or even weeks beforehand. If you have any bleeding – even if you suspect it is probably the ‘show’ it’s best to call your caregiver straight away to check.
When the membranes of the amniotic sac rupture, the fluid that your baby is surrounded in will start to leak. You may experience a sudden big gush of fluid or a constant trickle. Once the waters have broken, you will be leaking fluid for the duration of your labour, so it’s wise to keep a stock of heavy-duty pads that you can wear, or a collection of old towels with you Pre-labour rupture of membranes only happens in around five to ten percent of pregnancies; and ninety percent of the time, women then go into labour naturally within 24 hours. But there is a small risk of infection or complications with the cord if labour doesn’t start soon, so do call your caregiver for advice immediately your waters have broken.
Early contractions feel like period pain – slight cramping across the abdomen and may be accompanied by backache. Grab a notebook and pen – and a watch or clock with a second hand – and start timing the length of your contractions, from start to finish, and the frequency of them, to see if they remain consistent. You’re probably in labour if the contractions last more than half a minute and start to come closer together and get stronger. Use our Timing Your Contractions sheet to help you track the progress of your labour.
In order to pull the strong muscle of the cervix at the bottom of the uterus apart, the web of muscle fibres surrounding the uterus pulls up and tightens towards the top of the uterus. These fibres are at their shortest at the peak of the contraction, then they release and the contraction eases off, leaving the cervix a little more open each time.
Most women experience contractions quite intensely and most women describe them as painful. Labour is well-named, as your body’s effort in opening the cervix is indeed hard work.
Contractions are usually experienced as a gradual tightening across the abdomen – and are often described as a similar feeling to period pains or cramps – but much stronger.
When a ‘real’ contraction happens, it’s usually difficult to speak or move until it has passed – so if you are not sure if you are in labour, you probably haven’t started yet.
When labour begins, contractions will go for about 40 seconds and are around ten minutes apart. By the time you are ready to give birth, each contraction usually lasts for more than a minute and they are less than a minute apart.
First Stage of Labour
The first stage of labour is usually the longest part of the birth by far.
With your first child, labour is generally longer than second and subsequent births, with ‘average’ labour for first-time mothers around 12-14 hours, although anything from two to twenty hours is pretty normal.
The first stage of labour is often described as having three distinct phases.
Early phase of labour
In the early phase, contractions are comparatively light and start around thirty minutes apart. Over time (often a number of hours) the contractions will become closer and stronger until they are about five minutes apart.
Most women are able to labour comfortably at home during this time; there is time to recover between each contraction and you will be able to get ready for the trip to hospital, if that is where you are having your baby. Keep in touch with your caregiver by phone at this stage for advice about when you might be ready to make your journey.
Moving around freely is often the best way to cope with labour at this stage; many women find that walking around and breathing through the contractions is effective in the early phase.
Although you do want to conserve energy, your labour is likely to progress far more quickly (and therefore be much shorter) if you try to stay upright and moving as much as possible during this time.
However, the early phase may go on for many hours, so it’s also fine to have some rest where you can. Lying down on your left side is usually more comfortable.
In this early phase of labour, you may want to eat a light snack – easily digested carbohydrates are best, avoid fatty or acidic foods. It’s very important to keep your fluids up, but stick with water and non-sugary drinks such as unsweetened tea to avoid nausea.
Active phase of labour
In the ‘active’ phase of labour, contractions will be four to five minutes apart and last for a minute or so each time. At this point, it is wise to travel to hospital.
This phase may last for a few hours as the cervix dilates further, between about 4 to 8 cm.
Most women cope best with this stage of labour by moving into whatever position feels best at the time. Sometimes one position will work well for a few contractions and then you may need to move into a different position.
During the active phase of labour, upright positions with hip-swaying movements will help as gravity assists your body move the baby deeper into the pelvis.
Positions with some support are often helpful, like leaning against a wall or leaning forwards supported by a partner, or kneeling on all fours.
In the active phase of labour, most women are not able to walk or talk during contractions and usually want to spend the time between contractions focusing on the labour and preparing for the next contraction ‘wave’ rather than being distracted by other concerns.
Most women find that breathing can help them to manage the flow of the contractions; use deep abdominal breathing through the beginning of the contraction, with sighing-out breathing over the peak of the contraction. Breathe slowly and calmly to relax between contractions.
The end of the first stage is marked by movement into the ‘transition’ phase.
Contractions will be longer, more intense and closer together – usually lasting for around 90 seconds and two or three minutes apart.
This is a very intense period in labour and many women feel overwhelmed, scared or angry. It’s not uncommon to be shaking and nauseous, and feel very hot or cold at this time.
Fortunately transition tends to last for a much shorter time than other phases of labour – anything from ten minutes to an hour or two is common. It is during this time that the cervix will dilate to ten centimetres.
By the end of first stage, the cervix is fully open; enough to allow the baby to pass through and into the birth canal (the vagina). This is described as being 10 centimetres dilated or fully dilated.
Labour tends to speed up as it progresses. It normally takes far less time for the cervix to dilate its second five centimetres, compared to its first five.
During labour, your caregiver will keep monitoring your baby’s response, usually by measuring her heart rate.
This can be done by regularly checking against your abdomen, using a special instrument called a Pinard stethoscope; or you may wear a belt around your abdomen, linked to an electronic fetal monitor (EFM) that will display the baby’s heart rate and may also record it as a printout. Sometimes an internal monitor – using a small electrode clipped onto the baby’s scalp – will be used and signals transmitted to a radio pickup on the EFM.
Many women, particularly if they are able to move around through labour, find electronic fetal monitoring through a belt very uncomfortable and restrictive so if caregivers want to have EFM it will often be done just for a short period of time – eg 30 minutes or so – unless there are real concerns about the baby’s reaction to labour.
It’s important during the long first stage of labour to make sure that the labouring woman is as comfortable as possible and feels secure and supported.
Having your partner and/or a trusted close friend as well as a professional caregiver can help enormously, particularly if they have been well-briefed and have perhaps attended childbirth preparation classes with you.
By Fran Molloy – journalist and mum of 4