First Stage of Labor

The first stage of labor is the longest and involves three phases:

  • Early Labor:  The onset of labor until the cervix is dilated to 3-6 centimeters
  • Active Labor Phase:  Continues from 3 cm until the cervix is dilated to 7 centimeters
  • Transition Phase – Continues from 7 cm until the cervix is fully dilated to 10 centimeters

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Each phase is characterized by different emotions and physical challenges. Think of it as a big adventure with some important guidelines.

Early Labor Phase

What to do:

During this phase, you should just try to relax. It is not necessary to rush to the hospital or birth center. Try to enjoy the comfort of the familiar surroundings at home. If early labor occurs during the day, do some simple routines around the house.

Keep yourself occupied while conserving your energy. Drink plenty of water and eat small snacks. Keep track of the time of your contractions. If early labor begins during the night, it is a good idea to try to get some sleep. If you are unable to fall asleep, focus on doing some light activities like cleaning out your closet, packing your bag, or making sack lunches for the next day.

What to expect:

  • Early labor will last approximately 8-12 hours
  • Your cervix will efface and dilate to 4 centimeters
  • Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions
  • Contractions are typically mild and somewhat irregular but become progressively stronger and more frequent
  • Contractions can feel like aching in your lower back, menstrual cramps, and pressure/tightening in the pelvic area
  • You may see a mucousy vaginal discharge with a trace of blood. This is known as bloody show as is normal.
  • Your water might break – this is known as amniotic sac rupture and can happen anytime within the first stage of labor

When experiencing contractions, notice if they are:

  • Growing more intense
  • Following a regular pattern
  • Lasting longer
  • Becoming closer together

When your water breaks (amniotic sac rupture), note the following:

  • Color of fluid
  • Odor of fluid
  • Time rupture occurred

Tips for the support person:

  • Periodically time the contractions
  • Be a calming influence
  • Offer comfort, reassurance, and support
  • Suggest simple activities that draw her focus from the labor
  • Keep up your own strength. You will need it!

Active Labor Phase

What to do:

Now is time for you to head to the hospital or birth center. Your contractions will be stronger, longer and closer together. It is very important that you have plenty of support. It is also a good time to start your breathing techniques and try a few relaxation exercises between contractions.

You should switch positions often during this time. You might want to try walking or taking a warm bath. Continue to drink plenty of water and urinate periodically.

What to expect:

  • Active labor will last about 3-5 hours. If this is your first baby, or if you have an epidural, labor could last longer.
  • Your cervix will dilate from 4cm to 7cm
  • Contractions during this phase will last about 45-60 seconds with 3-5 minutes rest in between
  • Contractions will feel stronger and longer
  • This is when you can receive pain relief such as an epidural

Tips for the support person:

  • Give the mother your undivided attention
  • Offer her verbal reassurance and encouragement
  • Massage her abdomen and lower back
  • Keep track of the contractions (if she is being monitored, find out how the machine works)
  • Go through the breathing techniques with her
  • Help make her comfortable (prop pillows, get her water, apply touch)
  • Remind her to change positions frequently (go with her on a walk or offer her a bath)
  • Provide distractions from labor such as music, reading a book or playing a simple card game
  • Don’t think that there is something wrong if she is not responding to you

Transition Phase

What to do:

During this phase, the mother will rely heavily on her support person. This is the most challenging phase, but it is also the shortest. Try to think “one contraction at a time” (this may be hard to do if the contractions are very close together). Remember how far you have already come, and when you feel an urge to push, tell your health care provider.

What to expect:

  • The transition will last about 30 min-2 hrs
  • Your cervix will fully dilate from 8cm to 10cm
  • Contractions during this phase will last about 60-90 seconds with a 30 second-2 minute rest in between
  • Contractions are during this phase are long, strong, intense, and can overlap
  • This is the hardest phase but also the shortest
  • You might experience hot flashes, chills, nausea, vomiting, or gas
  • Some babies descend earlier and the mom feels the urge to push before she’s fully dilated. Other babies descend later and the mom reaches full dilation without feeling pressure.

Tips for the support person:

  • Offer lots of encouragement and praise
  • Avoid small talk
  • Continue breathing with her
  • Help guide her through her contractions with encouragement
  • Encourage her to relax between contractions
  • Don’t think that there is something wrong if she seems to be angry – it is a normal part of the transition

Want to Know More?

Compiled using information from the following sources:

1. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 17.

2. Pregnancy, Childbirth and the Newborn: The Complete Guide. Simkin, Penny, P.T., et al, Ch. 9.