Labour, Delivery, and Postpartum Period

Stage One Labour: Early, Active, and Transition Phases

The birthing process is known as labour and delivery. No one can predict when labour will start. One woman can have all the signs that her body is ready to deliver, yet she may not have the baby for weeks. Another woman may have no advance signs before she goes into active labour. First-time deliveries are more difficult to predict.

Signs of approaching early labour

Signs that early labour is not far off include the following:

• The baby settles into your pelvis. Although this is called dropping, or lightening, you may not feel it.
• Your cervix begins to thin and open (cervical effacement and dilatation). Your health professional checks for this during your prenatal examinations.
• Braxton Hicks contractions become more frequent and stronger, perhaps a little painful. You may also feel cramping in the groin or rectum or a persistent ache low in your back.
• Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after labour has already started. In some women, this happens before labour starts. Call your health professional immediately or go to the hospital if you think your membranes have ruptured.

Early labour phase (latent phase of labour)

Early labour is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Uterine contractions:

• Are mild to moderate (you can talk while they are happening) and last about 30 to 45 seconds.
• May be irregular (5 to 20 minutes apart) and may even stop for a while.
• Open (dilate) the cervix to about 3 cm (1 in.). First-time mothers can experience many hours of early labour without the cervix dilating.

It's common for women to go to the hospital during early labour and be sent home again until they progress to active labour or until their "water" breaks (rupture of the membranes). This phase of labour can be long and uncomfortable. Walking, watching TV, listening to music, or taking a warm shower may help you through early labour.

Early labour that is progressing

If you arrive at the hospital or birthing centre in early labour that is dilating and effacing the cervix or is progressing quickly, you can expect some or all of the following:

• In the birthing room, you will change into a hospital gown.
• Your blood pressure, pulse, and temperature will be checked.
• Your previous health, pregnancy, and labour history will be reviewed.
• You will be asked about the timing and strength of your contractions and whether your membranes have ruptured.
• Electronic fetal heart monitoring will be used to record the fetal heart rate in response to your uterine contractions. Fetal heart rate is an indicator of whether the baby is doing well or is in trouble.
• You will have sterile vaginal examinations to check whether your cervix is thinning and opening (effacing and dilating).
• Depending on your own physical needs and your health professional's preference, you may have an intravenous (IV) needle inserted in case you need extra fluids or medication later on.

Most hospitals and birthing centres have birthing rooms where women can labour, deliver, and recover. Providing that you have an uncomplicated birth, you can probably be in the same birthing room for your entire stay. If your delivery becomes complicated, you can be quickly moved to a delivery room equipped to handle the problem.

After you have been admitted to the hospital and you have had your initial examination, you will be:

• Encouraged to walk. Walking helps many women feel more comfortable during early labour. Although walking is thought to help labour progress, recent research suggests that walking doesn't actually speed or slow labour.⁸
• Briefly monitored every hour or so (at the least) to check your contractions and the baby's heart rate. You may be monitored throughout your labour.
• Allowed visitors. As your labour progresses and you become more uncomfortable, you may want to limit visitors to your partner or labour coach.

Active labour phase

Active labour starts when the cervix is about 3 cm (1.2 in.) to 4 cm (1.6 in.) dilated. This stage is complete when the cervix is fully dilated and effaced and the baby is ready to be pushed out. See a picture of cervical effacement. During the last part of this stage (transition), labour becomes particularly intense.

Compared with early labour, the contractions during the first stage of active labour are more intense and more frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing centre. If your amniotic sac hasn't broken before this, it may now.

As your contractions intensify, you may:

• Feel restless or excited.
• Find it difficult to stand.
• Have food and fluid restrictions. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted, because the stomach digests food more slowly during labour. An empty stomach is also best in the rare event that you may need general anesthesia.
• Want to start using breathing techniques, labouring in water, acupuncture, hypnosis, or other calming measures that you've chosen to manage pain and anxiety.
• Feel the need to shift positions often. This is good for you, because it improves your circulation. You may not know which birthing position is right for you for a while.
• Want pain medication, such as epidural anesthesia.
• Be given intravenous (IV) fluids.

Should I use epidural anesthesia during childbirth? (For more information about pain medication options, see the Labour and Delivery: Your Birthing Options section of this topic.)

Transition phase

The end of active labour is called the transition phase. As the baby moves down, your contractions become more intense and longer and come even closer together than before. When you reach transition, your delivery is not far off. During transition, you will be self-absorbed, concentrating on what your body is doing. You may be annoyed or distracted by others' attempts to help you but, nevertheless, feel you need them nearby as a support. You may feel increasingly anxious, nauseated, exhausted, irritable, or frightened.

A mother in first-time labour may take up to 3 hours in transition, and a mother who has vaginally delivered before will usually take no more than an hour. Some women have a very short, if intense, transition phase.

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Author:	Bets Davis, MFA Kathe Gallagher, MSW Ralph Poore	Last Updated: February 26, 2008
Medical Review:	Sarah Marshall, MD - Family Medicine Adam Husney, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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