7 Elements That Effect Labor

The First Stage of Labor

The first stage of labor also known as the latent stage, consists of three phases and is considered the longest stage with the ability to last anywhere from 6-12 hours for first time moms, but is often quicker in subsequent pregnancies. 

The three phases in the first stage of labor:

1. Early Labor: from the onset of labor until the cervix is dilated to 3-6 cm.
2. Active Labor: from 3 cm. until the cervix is dilated to 7 cm.
3. Transition Labor: from 7 cm. until the cervix is fully dilated to 10 cm.

Early Labor

Early labor can last from 6-12 hours. During early labor contractions are mild, coming every 5-15 minutes and lasting 60-90 seconds. Bloody show; a pink or red bloody discharge is common at this phase and signifies labor progressing with further dilation of the cervix.

What to do in Early Labor?

Try to relax, taking deep breaths during contractions and labor down at home with a warm shower, position changes, figure eights and light bouncing on a exercise ball, walking, and finishing the last of nesting and making sure your hospital bag is packed. This is also a good time to contact your doula and/ or midwife and rely on your support person. 

Active Labor

Once contractions become stronger and longer in duration, beginning to come at regular intervals (4-5x within an hour span; 4-5 minutes apart), lasting for about 45 seconds you are in active labor it is time to head to the hospital or birthing center unless you are planning a home birth. Active labor can last from 4-8 hours. At this phase it is common to experience lower back labor, pelvic pressure, the urge to push, nausea, broken water.

What to do in Active Labor?

If you are at least 5 cm. you will be admitted into triage before being taken to labor and delivery.  Try to stay relaxed and focus on your deep breaths in for a count of four through the nose and out for a count of six through the mouth. If you have a birth plan, now is a good time to ensure that your birth team has it. Your birth plan can communicate your preferences such as the option to be mobile with intermittent fetal monitoring, labor and birthing positions, ambiance, etc. Continue position changes every 30 minutes, walk the hallways, stay hydrated, start thinking about pain management options and request if desired. 

Transition Labor

Transition labor is the toughest and most painful phase of labor, lasting from 15 minutes to an hour. Contractions are coming closer together, lasting from 60-90 seconds. It is common to feel the urge to push at this phase. Increased pelvic and rectum pressure is common at this stage as baby becomes more engaged in the pelvis. To push, the cervix must be 100% effaced and 10cm dilated.

The Second Stage of Labor

During the second stage of labor the cervix is fully dilated and ready for childbirth. This is the pushing stage and can last anywhere from  20 minutes to a few hours.  This stage tends to be longer for first time mamas and mamas with epidurals.

The Process of Labor

Did you know that there are approximately 7 different factors that affect the process of labor and delivery ?

The 7 Ps of labor and delivery are as follows:

1. 1. Powers
   2. Passageway
   3. Passenger
   4. Position
   5. Pain Management
   6. Psyche
   7. Patience

Powers refers to involuntary uterine contractions and voluntarily bearing down to expel the fetus. The functions of uterine contractions are dilation and effacement. Dilation refers to how open the cervix is while effacement refers to how stretched and thinned the cervix is.  In the first stage of labor the cervix opens or dilates and thins out or effaces to allow baby to move though the birth canal. The cervix must be 100% effaced and 10cm dilated prior to vaginal delivery.

Passageway refers to the size and shape of the pelvis. Cervical exams are normally conducted to determine dilation, effacement, station, positions, consistency, and status of membranes.  Station is a measurement of fetal descent, another sign of progression in labor. Consistency refers to the change in color and amount of vaginal discharge. Status of membranes refers to the bag of water. Occasionally, rupture of membranes occurs before the onset of labor, known as premature rupture of membranes.

Passenger refers to fetus size and position. For labor, the baby will ideally be positioned head- down, chin tucked to chest, facing the mother’s spine, with the back of the head ready to enter the pelvis. Throughout pregnancy, the fetus will move into a variety of positions, however, as time progresses, the fetus becomes larger, and space becomes limited the fetus will typically flip head down, moving down into the uterus, preparing to go through the birth canal. This position is referred to as cephalic presentation, and most babies will settle into this position between 32 and 36 weeks of pregnancy. During labor, contractions work to help the uterus further efface and dilate so that baby can pass through for childbirth.

There are several other positions baby can be in that may further complicate childbirth and they are as follows:

-Occiput/ cephalic posterior position or sunny- side up: baby is head down facing abdomen. This position can increase the chance of a more painful and prolonged labor and delivery process.

-Frank breech: Baby’s buttocks leads the way into the birth canal, with flexed hips, knees extended in front of abdomen. This position can increase the chance of an umbilical cord loop that causes injury during vaginal delivery.

-Complete breech: Baby is positioned with the buttocks first, hips and knees are flexed and folded under themselves. This position increases the risk of forming an umbilical cord loop that could cause injury during a vaginal delivery.

-Transverse lie: Baby lies crosswise in the uterus, shoulder entering pelvis first. This position will likely be delivered via C-section.

-Footling breech: One or both of baby’s feet are pointed down toward the birth canal. The risk of this position is increased chances of decreased blood flow to baby from umbilical cord sliding down the uterus.

A healthcare provider can attempt to turn the fetus prior to labor via external cephalic version (ECV) , however, it is not guaranteed. ECV is non-invasive and may improve chances of a vaginal birth. This procedure is preformed in labor and delivery and requires two healthcare providers, one to lift the baby’s buttock in an upward position, while the second provider applies pressure through the abdominal wall to the uterus to rotate the fetal head forward or backward. This procedure is typically performed between 36 and 38 weeks of pregnancy.

Things you can do at home to encourage baby to change position are as follows:

-Hands and knees position (gently rock back and forth)

-Lye on back and push hips up in the air with knees bent and feet flat on the floor (bridge pose)

-Place headphones on the bottom of mama’s belly and play music

-Place cool temperature items at the top of mama’s abdomen where baby’s head is

Other options are as follows:

-The Websters technique (a chiropractic technique) consist of chiropractic evaluation and gentle adjustment that aligns the pelvis and includes soft tissue release

-Acupuncture

Although these methods are not 100% guaranteed they are recommended because they could help avoid a C-section delivery.

Position refers to the position of the mother during labor. There are many positions to experiment with. Labor positions are used to ease discomfort, move the baby down through the pelvis, and encourage optimal fetal positioning.  Finding positions that work for you are vital for pain management if not otherwise utilizing medical pain relief options. Remember, every mama and baby are different and what may work for one may not be ideal for another.

Here are some recommended positions to try during the first stage of labor:

-Hands and knees

-Sitting/ squatting

-Side lying

-Walking

-Lunging

-Stair climbing

Here are some recommended birthing positions:

• • Squatting: using a stool, ball, or bar to assist with further dilation

• • Birth/ squat bar: an attachment that can be added to many labor beds to help support birthing positions (sitting up to squat while leaning on the bar for support, wrap a bed sheet/ rebozo/ towel around the bar for tug of war pushing position. An added benefit of the birthing bar is its ability to help further expand the pelvis.

• • Kneeling: Offers the mother a break as well as relieves the pain of contractions and back labor pains. This position is also helpful to help turn the baby into the proper position for birth.

Pain Management refers to how pain is perceived and managed. Strategies to manage pain can be both pharmacological (aimed to relive pain) and non-pharmacological (aimed to help cope with labor pain).

Labor pain can be managed through non-pharmacological methods such as practical breathing techniques, visualization, hydrotherapy, music/ affirmations, positions and poses.

Medical pain management methods include:

-epidural anesthesia: An injection to the spinal cord numbing from the waist down; most effective pain relief method. Risk associated include a drop in blood pressure causing a feeling of fatigue and nausea, being confined to the bed, lengthened second stage of labor and likelihood of normal vaginal delivery is reduced, itchiness, and the chills/ shakes to name a few.

-nitrous oxide: Also known as “laughing gas” is mixed with oxygen and administered through a face mask or tube held in the mouth. A breath from the mask or tube is taken when contractions begin, and the effect is quick. This pain management option does not eliminate the pain, but it will take the edge off the intensity of each contraction. This method will allow the mother direct control, taking breaths whenever needed, and it does not linger in the mother’s or baby’s body. Risks associated with this method include nausea and vomiting, confusion or disorientation, claustrophobic sensations from the mask, and possible lack of pain relief.

-pethidine: A strong pain reliever (associated with morphine and heroin) that is usually injected into the buttock muscle or intravenously. Effects can last from 2-4 hours. Risk associated with this pain management method include nausea, giddiness, disorientation and altered perception, reduced breathing, lack of pain relief, fetal exposure to drug via umbilical cord and reduced sucking and other normal reflexes.

-TENS (transcutaneous electrical nerve stimulation): Stimulation of nerves in the lower back using a small hand-held device controlled by the patient. There are no known side effects for mother and baby and this method can be used in combination with other pain relief methods or be used alone.

Psyche refers to the mother’s mental and emotional preparation for labor and birth and any previous birth experiences that may affect perception. Labor and birth progression can be adversely affected by fear, stress, and tension. Correspondingly, anxiety can further increase pain perception, leading to an increased need for medication pain management. Arming yourself with knowledge, the proper support and healthcare team can contribute to a more positive experience.

Patience is exactly what it sounds like. Remember to breathe, relax, and allow labor to take its course. The first birth experience typically is the longest whereas subsequent births tend to be shorter. However, with proper preparation involving gaining mental clarity and knowledge, managing emotions, finding the proper support, and having a plan you can achieve a positive birth experience. 

Takeaway

Wishing you a safe and enjoyable birthing experience. As always, happy birthing!

–Jas