The labor of childbirth

The hectic life has taken away from many women the ability to consciously manage the stages of their pregnancy close to labor. Knowing how to distinguish the different signs that indicate that her body is preparing for labor and knowing what happens in the hours and days preceding the birth can help the pregnant woman experience the final stage of pregnancy with greater serenity and awareness. Given these introductory premises, in this article we will talk about labor focusing mainly on the initial stages. In fact, in the final ones, the pregnant woman is mostly followed by the obstetric staff while, while it is at the beginning that the pregnant woman feels more undecided about what to do and when to contact the hospital.

The stages and phases of labor

Temporally – starting from the moment of the first regular contractions and up to the moment of expulsion of the placenta – the following stages and phases can be distinguished.

  1. The first stage of labor: with a latent or prodromal phase; and with a dilating active labor phase.
  2. The second stage of labor or the expulsive period.
  3. The last one, that of cutting the umbilical cord, the first prenatal checks, and the expulsion of the placenta.

1) The first stage of labor

We have said that the first stage develops in two phases: in a latent phase and in an active phase.

a) the latency phase, or prodromal to labour

The latency phase, or prodromal to labor, is characterized by painful uterine contractions that lead to changes in the uterine neck (or uterine cervix): smoothing out and slow progression of its dilatation up to 5 centimeters, both in primiparous and in pluriparous.

Its duration can vary from one woman to another even a lot.

This phase heralds the beginning of labor and ends when the cervix is ​​more than 3 centimeters dilated, when the woman enters the active phase of real labor.

We can thus summarize the development of this first phase.

  • The contractions gradually open the cervix (dilated).
  • These contractions progressively dilate, shorten, soften and thin the cervix.
  • The baby can then move slowly through the birth canal.
  • This is usually the longest stage of labor and could last many hours or even days.
  • In this phase the mucous plug is expelled.

The loss of the cork does not automatically mean that the birth is imminent but, precisely because of the change that the uterine neck is undergoing, it indicates that the pregnancy is coming to an end. In this case, it is advisable to go to the hospital for hospitalization or to the emergency room, depending on whether the rupture of the water (membranes) occurs after or before the thirty-seventh week of pregnancy.

During this prodromal phase it would be good to continue eating and drinking because the woman needs energy for active labor.

In this initial period, breathing exercises, massage, a warm bath or shower can relieve pain.

b) the active phase of labor and the dilating phase

The active phase of labor is characterized by painful uterine contractions gradually more intense, increasingly regular, with significant progressive cervical flattening and complete dilatation of the uterus neck.

The average duration of the active phase of labor:

  • on average it lasts 5 hours;
  • in primiparas it usually does not exceed 12 hours;
  • in pluriparous it usually does not exceed 10 hours.

The active phase of labor is also called the dilating phase as it evolves up to the dilatation that is necessary for the passage of the baby: the dilatation of the cervix will reach 10 centimeters (in the first pregnancy the dilation is about one centimeter per hour, in the following ones it is faster).

The closer this measure gets, the more the contractions will become more intense, painful and frequent until they reach a frequency of one every two minutes: these contractions cause the baby’s head to be pushed against the neck of the uterus in order to reach the complete dilatation, necessary for the passage of the child.

As for the contractions of the dilating phase, it must be said that,

  • they are intense,
  • last 60-80 seconds,
  • they show up every 30-90 seconds,
  • at this point it was time to go to the hospital

2) The second stage of labor or the expulsive period

The second stage of labor (also called the expulsive stage) is the period between the moment of complete dilatation of the uterus neck and that of the expulsion of the fetus and which ends with the expulsive period.

Its duration varies from one woman to another:

  • in primiparas it is generally less than 3 hours;
  • in subsequent calvings it is usually less than 2 hours.

In this phase, supported by the obstetric staff, the pregnant woman will have to support the uterine contractions with thrusts in order to help the baby to be born.

This phase lasts a couple of hours at most: in nulliparous it lasts longer, less in multiparous ones.

3) cutting of the umbilical cord, first prenatal checks, expulsion of the placenta

After the baby is born,

  • the umbilical cord is cut,
  • the newborn will be entrusted to the staff to be washed and for the first neonatal checks.
  • the placenta detaches and comes out after delivery.

This is a process that can take up to an hour.

The signs that herald active labor (prodromal phase)

There are several indicative signs that the woman’s body has entered the prodromal phase of labor, that is, the phase that precedes its active phase.

In this latency stage, the cervix (or cervix) becomes soft and thin and begins to open for the birth of the baby. This can take hours or sometimes days, which is why during this (prodromal) stage you will probably be advised to stay home, while if you go to the hospital they may advise you to go home.

In any case, if you’re not sure or if you’re still worried, you can always ask your midwife for guidance on what to do.

The most important signals of this first phase are given,

    1. by prodromal contractions: not to be confused with the Braxton-Hicks contractions which appear without a regular rhythmic cadence, in the absence of pain, nor with the labor contractions which will arrive later and which will be extremely painful and very close to each other: less 3 minutes and often even less than 2;
    2. by the expulsion of the  mucous plug
    3. from the breaking of the waters;
  • from back pain and/or the need to go to the bathroom as a result of the pressure of the baby’s head on the intestines.

Let’s analyze the first 3 signals individually.

1) prodromal contractions

When you feel the (prodromal) contractions, your womb tightens and then relaxes. These are contractions that may feel like very intense period pains, but not necessarily. During these contractions the muscles contract and the pain increases. The contractions push the baby down and, in preparation for passing, open the entrance to the womb (the cervix).

Talk to your midwife or maternity ward for help if you think you may be in labor as contractions,

  • they are regular,
  • last at least 60 seconds,
  • they show up every 5 minutes.

Read  this article  for  more information on when to go to the hospital

2) loss of the mucus plug

The  mucous plug is a progesterone  -induced thickening   of the mucus and cells of the cervix that covers the uterine opening during pregnancy. At the end of pregnancy, just before delivery, this mucous plug is lost.

Compared to normal vaginal discharge, those from the mucous plug are more abundant and have a more viscous consistency.

Labor can begin soon after the mucus plug is passed, but it can also start after a few days. Particular attention should be paid if – together with the loss of the mucous plug – you have,

  • clear, warm and very abundant liquid losses: in this case a premature rupture of the amniotic membranes (PROM) may have occurred: the rupture of the pre-term membranes in fact predisposes to a premature birth;
  • green-colored losses: in this case there could be problems of suffering of the fetus;
  • a too abundant presence of blood: in this case it could be the placenta detachment.

Finally, if the mucus plug is yellow and smells bad, it could be an indication of an ongoing infection.

3) water breaking

The fetus develops and grows inside a sac which is called the amniotic sac . What is commonly known as “breaking of the waters” refers precisely to the rupture of the membranes of this checkpoint inside which there is the liquid that surrounds the fetus (amniotic fluid).

  • When the moment of birth arrives, the amniotic sac breaks and consequently the  amniotic fluid  comes out of the vagina: precisely because the water broke!.
  • Your water is likely to break during labor, but this break can also occur before labor begins.
  • In the presence of some particular conditions, even before labor begins, the midwife or doctor can let out the amniotic fluid that surrounds the fetus at any time (PROM – Prelabor Rupture of the Membranes – Premature Rupture of the Membranes).
  • If your water breaks naturally, you may feel either a slow trickle or a sudden rush of water that you can’t control: to prepare for this you should have a protective sheet on hand on the bed.

Amniotic fluid is clear and pale and is sometimes difficult to distinguish from urine. When the waters break, “the water” may be a little bloodstained. That said, contact your midwife immediately,

  • if these “waters” were to be foul-smelling or coloured,
  • if you are noticing that you are losing blood.

This could mean that you or your child need urgent care.

Normally, she goes into labor within 24 hours of the water breaking. If this does not happen, you will be offered an induction as, in the absence of amniotic fluid, there is an increased risk of infections for the baby.

If you have to wait for labor to start naturally, tell your midwife straight away.

  • if your baby moves less than usual;
  • or if there is any change in the color or smell of any fluid coming from your vagina.

How to deal with this phase that precedes active labour

At the onset of labor, before entering its active phase you can:

  • walk or move, if you feel like it,
  • drink liquids,
  • have a snack, if you feel like it,
  • do relaxation and breathing exercises,
  • having a back massage, if this can help relieve pain,
  • take  paracetamol  (following the instructions on the leaflet),
  • take a hot bath.

When necessary, contact the birth center of the hospital

Call the hospital maternity ward if:

  • the waters break and you notice copious blood losses,
  • the baby moves less than usual,
  • you are less than 37 weeks pregnant and think you might be in labor.

Pain management during labor

Labor can also be very painful. There are several ways to manage this type of pain.

  1. Conscious relaxation.
  2. Taking nitrous oxide, liquefied medicinal gas.
  3. Iniezioni in the petidina.
  4. L’epidurale.
  5. Childbirth in water.
  6. Alternative ways to relieve labor pain.

1) conscious relaxation

You will likely feel more relaxed about dealing with the pain,

  • if you are aware of what is happening to your body: awareness accompanied by the knowledge of what is happening in your body could make you feel less fearful;
  • if you learn to relax, to stay calm, to breathe deeply.

2) taking nitrous oxide, liquefied medicinal gas

Taking nitrous oxide can be considered a safe and non-invasive alternative to epidural anesthesia. Its effect is rapid, and disappears as soon as the woman in labor stops inhaling it since it is not metabolized by the body and therefore is eliminated in a short time.

Nitrous oxide does not completely remove the pain, but it can help reduce it and make it more bearable. Many women like this regimen because nitrous oxide is easy to take and because they can control it themselves.

The gas takes about 15-20 seconds to act, so you can breathe it in just as a contraction begins. It works best if you take slow, deep breaths. Nitrous oxide has no harmful side effects for the mother or the baby.

3) iniezioni in the petidina

Pethidine is the most popular narcotic drug used in labor, although initial claims that it was without side effects proved false.

It takes about 20 minutes for it to work after injected. Its effects last between 2 and 4 hours, so it would not be recommended if you are approaching the (second) stage of labor.

There are some side effects of this drug that you should be aware of:

  • can create a dizziness in the pregnant woman,
  • if it is given too close to the time of delivery it can affect the baby’s breathing – if this happens, another medicine will be given to reverse its effect,
  • can interfere with the baby’s first feed.

4) l’epidurale

The epidural or epidural is a method of local anesthesia which is performed by means of a needle and/or a catheter positioned in the epidural space (the area of ​​the vertebral canal between the yellow ligament and the dura mater).

It numbs the nerves that carry pain impulses from the birth canal to the brain. It shouldn’t make you sick or drowsy. For most women, an epidural provides complete pain relief. It can only be administered by an anesthetist.

An epidural can provide excellent pain relief, but during labor it is not always 100% effective: in fact, one in 10 women who get an epidural during labor need to resort to other methods of pain relief.

There are some side effects to be aware of:

  • depending on the local anesthetic used, an epidural can make your legs feel heavy,
  • blood pressure may drop,
  • epidurals can prolong the second stage of labor
  • the midwife will have to tell you when to push if you can no longer feel contractions due to an epidural;
  • alternatively it may be necessary to apply forceps (obstetric instrument similar to a double spoon-shaped forceps) or a suction cup to the head of the fetus to facilitate delivery (operative vaginal delivery),
  • you may have difficulty urinating (in the short term),
  • the epidural could cause a headache (about 1 in 100 women have a headache after an epidural),
  • The woman’s back may be a little sore for a day or two, but epidurals don’t cause long-term back pain.

5) water birth

Being immersed in water can help women relax and make contractions less painful. Water birth is an alternative to the more usual ways of coping with labor and the phases that follow one another before the birth of a child: the water is kept at a comfortable temperature, but not higher than 37.5°C, while the woman’s temperature is monitored.

6) alternative methods of relieving labor pain

Some women opt for some alternative treatments such as acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology to relieve pain.

Most of these techniques are not very effective at relieving the pain of childbirth. Therefore, if you wish to use any of these methods, it is important that you discuss this with your midwife or doctor and inform the hospital beforehand.

Most hospitals do not offer these types of treatments for pain relief during labor.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

Leave a Reply

Your email address will not be published. Required fields are marked *