Early stage of labour

Pregnant woman sitting on sofaCongratulations: you're in labour. But as if waiting 40 (plus) weeks wasn't tough enough, you've now got three stages of labour to get through... and the early stage has three phases of its own, too.

If this is your first child you're probably wondering how on earth you'll know the difference between each of the three stages. So, to help you out, here's how the whole miraculous performance breaks down into an act of three parts.

Early phase
| Contractions in early labour | Active phase | Failure to progress


First stage of labour

The first stage of labour is when your cervix - the neck of your womb - dilates to a rather incredible 10cm (yes, we did say 10) so that your baby can squeeze his or her way out.

Understandably, this can take a wee while - typically, at least 12 hours in a first pregnancy (although it can be much longer). And this initial stage is divided into three separate phases: the early, active and transitional phases. 

Early phase

Also known as the latent period or pre-labour, this is the very start of labour when your contractions begin, eventually causing your cervix to fully efface and dilate to three to four centimetres in width.

Before labour, your cervix is like a long, firm, closed tube. As labour nears, your body releases hormones called prostaglandins, which make the cervix soften and 'ripen' in preparation.

These early stage contractions cause your newly softened cervix to become paper thin and drawn up into the uterus, ending up in a ring rather than tube shape - a process known as effacement.

"Eff'ing what?" we hear you cry. Well, imagine rolling down a turtleneck jumper before pulling the neck apart so that you can shove your head through - effacement's that first bit. It's measured in percentages, but getting from 0% (not at all) to 100% (fully effaced) - whereupon your cervix can start to dilate in earnest - can take anything from minutes to days. 

Contractions during early phase of labour

Typically, contractions during the early phase are mild to moderate (you can talk through them); last about 30 to 40 seconds and are irregular, coming anything from five to 20 minutes apart, and possibly even stopping for a while.

Contractions can be erratic for several days before things start in earnest. Some poor souls experience full-on contractions even though, particularly with first babies, there may be very little actual dilation action.

On average, for first-time mothers this early phase lasts from six to eight hours, but everyone's different and timings can differ wildly either way. It can be completely exhausting and demoralising to be in what feels like full-blown labour for ages and still only be 1cm dilated. Rest assured that if you turn up at the hospital only to be sent home for being way too early, you won't be the first.

Call your midwife if you have any concerns, but try not to get to stressed: remember these are not wasted contractions, they're preparing your cervix for established, active labour.

Things to do during the early phase

  • Relax - do whatever makes you more comfortable, whether that's a warm bath or pacing around the sitting room
  • Rest - you're going to need your energy in the hours to come
  • Eat - light, low-GI snacks such as wholegrain toast or cereal, pasta, rice, dried fruit etc, are best for slow-release energy
  • TENS machine - if you've hired one for pain relief, get wired up and whack it on now because it takes about an hour for your body to start releasing endorphins in response to the TENS machine's electrical responses
  • Time your contractions - you don't need to sit there with a stop-watch, but it's good to have a rough idea of what's happening, so if you're having a hospital birth and contractions are coming every five minutes or so (seven if this isn't your first baby) and lasting 30 seconds or more then it's time to think about heading off


What Mumsnetters say about the early phase of labour 

  • My labour started during the night, so I slept at home for the first five hours. Then it got pretty painful, very quickly. I found the TENS machine distracted me but it didn't dull the pain. Maxmissie
  • During the early phase I had very brief contractions, four minutes apart for 16 hours... and I got sent back home from the labour ward as I was only 2cm dilated! TotalChaos
  • I have no recollection of 'stages' with either of my births. With my first son, I was in hospital, under observation, when my contractions, started. They felt like vague period pains. Half an hour later my midwife examined me and then all hell broke loose as I was already 9.5cm dilated. I was taken straight to the labour ward where my son was born very quickly: from start to finish it took just three and three-quarter hours. BecauseImWorthIt

Active phase

Also called established labour, in medical terms this is when you're fully effaced and about 3-4cm dilated. Typically, it lasts around six to seven hours if it's your first labour, and finishes when you're about 7cm dilated.

Once active labour begins, contractions typically increase in frequency, length and intensity as the uterus boosts its efforts to open your cervix. If you haven't opted for pain relief, the contractions will soon be too strong for you to talk through them - although, strangely, you may be able to yell.

Once you're in really active labour, contractions will be coming every couple of minutes and last around a minute.

But - and we can't keep repeating this enough - everyone's different, so don't get stressed if things go slower than the pregnancy books say. Contraction strength and the position of both you and your baby have a big impact on how quickly things will happen.

That said, if your waters haven't already broken by this point and your labour's progressing slowly, your midwife might suggest she break them as this can help speed things up. Called an artificial rupture of membranes (ARM), you will also have to have this done if your baby needs internal monitoring.

Things to do during the active phase

  • If you're having a hospital birth, go once you're having regular contractions (every five minutes if this is your first birth, seven if it's not) or can't cope with the pain
  • Try different positions - aside from finding a position you feel more comfortable in (downward-facing dog, anyone?) just like being cramped up on a long flight, moving around helps your circulation
  • Stay upright if possible - mobilisation and gravity will help get your baby out so, if you're able to, squat, rock, use a birthing ball or get on all fours (then again, you might just want to lie back and yell at your partner)
  • Use your breathing techniques - they can help see you through each contraction and give you a focus
  • Request pain relief if you want it - pethidine, epidurals, or gas and air - their time is now
  • Labour in water - whether it's a bath or a birthing pool, being in water can help with this stage.
  • Make your demands known - don't be scared to ask for whatever you think might help you through, whether it's a back rub, lower lighting or a cold flannel
  • Keep your energy levels up - current medical thinking is that, provided labour's progressing normally and/or you haven't had pethidine or an epidural, you should be allowed to eat during active labour, but stick to light, non-fatty foods - banana sandwiches, low-fat yoghurts and plain biscuits are good - or nibble glucose tablets if that sounds too much
  • Keep your fluid levels up - even if you're not hungry, it's vital to stay hydrated by drinking clear, non-fizzy beverages or suck on ice chips

What Mumsnetters say about the active phase of labour

  • The early phase was like wind, but stopping and starting - I laughed through contractions. But the active phase hurt a lot. I had a home birth and nothing helped... I got in the bath and out again, nothing was really of any use. FlightAttendent
  • I remember throwing up and refusing to get out of the bath and generally being chastised by midwives for being a wilful patient. Cornsilk
  • I had my daughter at home, with a birthing pool. Labour was quick to establish and progressed nicely... but the pool was so relaxing, everyone so helpful, and the gas and air so effective that everything slowed down when I got to about 8cm. I demanded my waters were broken, jumped back in the pool and instantly got back to work. Stage one of labour took five hours... but stage two comprised just two contractions and then my daughter was born, fit and well! Missingtheaction
     

Labour dystocia

This is medical jargon for when a baby's descent down the birth canal and/or the cervix's dilation stops or significantly slows down. Labour dystocia is also called failure to progress, abnormal labour, dysfunctional labour or difficult labour (terms all guaranteed to make a knackered mum feel completely useless) and usual causes include:

  • Weak, uncoordinated contractions
  • A poorly positioned baby
  • Design shortcomings - ie the baby's too big or mum's pelvis is too small

Pregnancies complicated by dystocia often end with assisted deliveries, including forceps, ventouse or caesarean section

If your labour's going slowly, try to stay calm: rather cruelly, fear and anxiety cause an increase in adrenalin, which relaxes the womb, and a decrease in oxytocin, the hormone that causes contractions.

Where weak contractions are the cause your midwife might suggest an artificial rupture of membranes if your waters haven't already broken. You may also be offered an intravenous Syntocinon drip - this is artificial oxytocin to stimulate the uterus and increase and strengthen your contractions.

Subsequent stronger contractions can also help to turn a baby into the right position.

What Mumsnetters say about failure to progress

  • I had my waters broken, and then I had to have a Syntocinon drip because I failed to progress after having diamorphine. I'm under the impression it was the diamorphine that made things grind to a halt. TotalChaos
  • I wasn't making much progress so they stuck a drip up: cue a desperate urge to push, which I spent the next couple of hours fighting as my cervix wasn't ready. Then I was given an epidural to stop me pushing: cue nothing for several hours. Eventually my daughter was yanked out with forceps, which was OK. I was so knackered by then I didn't care if the baby was hauled out of my nostril so long as she got born. Slouchy 

 

Image: Shutterstock

Last updated: 06-Mar-2013 at 3:24 PM