Phases of labor
Labor consists of three stages: The first stage begins with regular uterine contractions until full dilatation of cervix. This is usually about 10cm - in clinical terms 5 fingers. This stage can take anywhere from one hour to twelve hours or more. The second stage begins with full dilatation of the cervix and ends with the delivery of the fetus. It takes an average of 30 minutes. The third stage consists of the delivery of the placenta, and takes about 10 minutes.
First Stage:
This is the day you have waited for for a long time Labor has begun, and your uterus is contracting in regular intervals. At the beginning the contractions are mild and well spaced – about every 15 minutes lasting about. As labor progresses, the contractions become stronger and more frequent. Closer to the end of the first stage, contractions will be every 2 minutes and lasting for 60 seconds. You can monitor your contractions by putting your hand on your abdomen and palpating your uterus. During the resting phase you will feel that your uterus is soft, and as the uterus contracts, you will notice it become harder. The hardened state will last for a short while, and as then the contraction ends and the uterus will be soft again. The contractions of the uterus pushes the fetal head towards the cervix, an also pull the cervix upward causing it to dilate and shorten. The stronger and more frequent the contractions are, the faster the cervix will dilate. At the beginning when the contractions are mild and less frequent you will be able to adapt to the pain, but when the contractions become strong and frequent, they become painful. At this point, the doctor will prescribe an anesthetic injection for to ease the pain.
The stronger the contractions are the faster the cervix will dilate, and the closer the delivery is. Despite the discomfort, you will find yourself longing for the next contraction during the uterine relaxations, as you will begin to adapt to the pain. It can also be helpful to focus on controlled breathing during the contractions, rather than on the contractions themselves: From the start to the end of each contraction, focus on deep, slow breaths. Fill your chest with air hold your breath for a few seconds, then exhale slowly. Repeat during the contractions. This does not only help you relax and moderate the pain, but it also ensures that both you and your baby are supplied with high volumes of oxygen - labor takes a lot of effort, and your body needs more oxygen than usually to do this efficiently. Ideally, you should be in bed in a semi-sitting position, with two pillows behind your back, or alternatively lying on your side.
Throughout this stage of labor, you will be examined vaginally at specific intervals to assess your progress and the dilatation of the cervical dilatation. The doctor will thereby be able to inform you about your progress.
Second Stage:
The second stage of labor - the descent of the fetus in the genital tract- is due the stretching of the birth canal and the perineum.
When the cervix is fully dilated and the uterus begins to push the fetus towards the outside, the fetal head begins to descend into the birth canal. To fasten and ease this process, the uterus needs your help to push your baby out. The doctor will tell you when to start pushing. When the second stage begins, you will notice that the contractions are stronger.To keep stay in control of yourself, your breathing pattern should change to shallow fast breaths with each contraction (rather than deep breaths that were done during the first stage). Only the upper part of your chest is now moving in each breath. As eachcontraction ends, go back to regular and deep breath; fill your chest with air and exhale slowly.
When the fetal head is about to finish its journey through the birth canal, you will feel the urge to push and defecate. At this point, you very close to delivery and to seeing the baby that you have waited the past nine months to see. The doctor or the midwife will tell you when the right time to push. Follow their instructions, and take a deep breath or two with beginning of each contraction to fill your chest with air and exhale. Withthe third breath, hold the air in, elevate your head, put your chin on your chest, move your shoulders forward and downwards, and flex your knees onto your abdomen. Put your hands behind your knees, tighten you’re your abdominal muscles as if you are blowing on a candle, andthen push with all your strength to push your baby out. Keep pushing for the longest possible period, as though you have constipation. If you feel tired or you can not carry on,that is fine. Exhale, then take a deep breath and go back to pushing. Keep on pushing until the end each contraction. As the contraction ends, you can take a short break until the next contraction begins. Repeat this sequence with every contraction until the delivery of the baby.
When the head begins to be delivered from the vagina, the delivery process should be slow. The doctor will ask you to take shallow breaths with the contractions, so as to gently deliver the headthrough pelvic floor muscles and the vagina.Remember to exercise control of the pelvic floor muscles; try to relax them at this point to ease the delivery. Be aware that the doctor may need to do an episiotomy for rapid delivery of the head. The cut will be made after the injection of a local anesthesia. After delivery, a few stitches closing the cut are usually enough to hold the tissue in the normal anatomical. Your doctor will give you directions for care of the healing episiotomy. In few days the wound will heal completely.
Delivery of the fetus head is followed by delivery of the shoulders, the trunk, and lastly the lower limbs. At this point, the badly has been delivered, but it is still connected to the placenta inside your uterus by the umbilical cord. You will see the baby still bluish, but it will turn quickly pink when it starts crying. The limbs may remain blue for a little time while longer. The baby will also be covered with greasy material and blood – this your blood from the uterus and delivery tract.
Now you can hear your baby crying. Congratulate yourself on this incredible achievement that has been so many months in the making. You have completed something incredibly difficult, but it is worth the effort, as there is no greater joy in life than a child.
Third Stage:
During this final stage, the doctor will place a clamp on the umbilical cord and cut it, and your baby will begin to breathe independently. It has begun its journey through life, and will first be taken to the nursery for cleaning and dressing.
Following the birth of your baby, the placenta is still inside the uterus. At this point, you will be given injections that cause the uterus to contract and close the vessels thatsupply the placenta. This will help stop bleeding. Moments after the delivery of the baby, the placenta separates from the uterine wall and it is delivered. By this, the delivery is complete. Congratulations!
Reducing pain in labor:
The pregnant feels labor pain in the lower part of the abdomen and back. The pain often extends along the hips and thighs (it can be stronger in one of the listed areas than in others).
Tolerance of pain differs between people, including from one expectant mother to another. There are several factors that affect the tolerance of labor and delivery pain. Fear of the unknown and anxiety might be one of the most important influences. The influencing factors should be taken into consideration when choosing the method with which to reduce pain. This will ensure the best possible outcome.
Often, the best results are achieved when the pregnant woman is fully aware of the labor stages and the labor progress, and when the patient trusts her doctor and the hospital staff. These lead to increased self-confidence and comfort of the patient, decrease the patients stress and anxiety, and increases the patients tolerance for pain. Therefore, it is very important to support the patient during labor, and provide her with comfortable conditions.
Easing pain during labor has a significant benefit for the mother and her baby, as pain exhausts mother both physically and emotionally. It also affects hernervous system, leading to increases in hormone secretions. This affects the blood vessels by decreasing their diameter, causing the blood supply to the uterus and placenta to decrease. This in turn decreases the amount of oxygen that reaches the fetus at a time when its oxygen needs are increased. Over a longer amount of time, this may have a negative impact on the fetus. There is scientific evidencethat an increased level of stresshormones canlengthenthe duration of labor.
The timingof the administration of medications to ease the pain is important. Giving the medications when the pain is at the highest point - where maternal emotional is also significant - reduces theireffectiveness.Therefore, do not wait until the pain becomes too significant to bearto ask your doctor for pain relief. This will help you remain calmthroughout all three stages of labor.