Stages and Management of Labor

What you need to know

Evaluating Labor Progress

-Contraction frequency: how often do contractions begin?
-Contraction intensity: how strong?
-Contraction duration: how long do they last?
-Mom’s emotional state
-Level of physical and social modesty (politeness and/or embarrassment)
With a normal pregnancy, to have the fewest interventions, go to the hospital after you are showing a good collection of Active labor signs. Early labor signs can also be practice labor and can fade. Labor does not usually fade with Active labor signs.

Managing Normal Labor

3 primary ways to cooperate with labor and
manage the intensity:
1. Let go of all physical tension. It takes effort to release your muscles and areas you want to clench when something hurts. Practice helps you “become friends” with the heavy feeling of release.
2. If your brain is focused on something comforting, messages from the uterus have to “get in line” and are not as strong.
3. Hormonal assistance: if a mom is letting go of tension (#1) and focusing on comfort (#2), as the labor intensifies, the body increases endorphins and other hormones and mom begins to focus inward and look loopy.

Early Labor

Early labor often begins slowly and continues to build.-Eat and drink: Mild foods are often good. Fruit is the highest form of hydration and will fuel your body for the energy needed during this time. Keep grazing as long as you can. Don’t leave for the hospital hungry; you may not be allowed foodonce you check in. Mom needs to be well hydrated for the sake of the labor. It will also help with blooddraws and IV/heplock placement.Loose bowelsContractions: May begin as far apart as 10–20 minutes. Will gradually get closer together and more consistent. By the end of early labor they will begin every 3–5 minutes. Contractions usually begin light and short as well and will gradually intensify and get longer.Dilation: By the end of early labor many moms are at about 3–4 cm dilation.Bloody show: If the mucus plug has not fallen out already, it may do so. The darkish, gloppy bloody mucus of labor does not usually begin before 3–4cm of dilation.Level of physical and social modesty: Most moms still act like themselves in early labor. They still have their usual sense of physical modesty, politeness, and level of embarrassment.Emotional state: Mom is still reacting like herself.She may have some excitement or anxiousness. She often chats between contractions. Early Labor contractions and signs can fade until another day. Contractions are more common when the sun goes down or in the evening. Once labor gets to Active Labor it generally keeps going.

Managing Early Labor

Mom will use #1, “floppy- soggy,” and #2, comforting thoughts, to manage the building intensity of Early Labor as needed.
Do not pay attention too soon. Denial is a great way to manage really early labor.
Nap or sleep as much as possible. Partners should sleep as well. If mom wakes in the night, go back to sleep and rest as much as possible. Do not wake a partner until really needed. Practice contractions that fade are most common in the evening. Go to bed and see if they fade or wake you later as stronger contractions.
No bracing! Mom must lean (partner, chair,
counter, couch) and let go of her tension. Think of breathing down into whatever is supporting her.
Stay calm: Adrenaline from emotions (excitement, anxiety, tension and bracing) causes the cervix to stay closed and prevents labor from moving forward.
Other ideas: Walking is always good to move along labor. Read, watch TV, talk. A shower or bath is good to feel clean. Warm water can calm a labor, so only stay in if you want you labor to calm down or to manage the intensity of the end of Early labor. Also
Consider the time of day, energy level, etc. Early morning contractions after a good night’s sleep: eat breakfast, shower, go for a walk, encourage labor, see what happens — vs. contractions starting late at night: eat, shower/bath, warm drink and go to bed, see what happens overnight or in the morning. Some moms need to rest before
labor can move along.

Active Labor

All aspects of labor are stronger and more consistent.
No longer hungry: Keep giving mom sips regularly and keep her hydrated.
Contractions: usually begin every 2–4 minutes and last 60–90 seconds; stronger and more consistent.
Dilation and effacement: Generally goes from about 4–8 cm. 100% effaced is the thickness of paper or plastic wrap.
Common physical signs: These may begin in
Active labor or wait until Transition (or not happen in a labor) —
- Nausea, belching, vomiting
- Shaking (caused by the intensity of labor,
not from being cold, but warm blankets will
help calm the shaking)
- Feeling cold then hot, or hot then cold
- Cold feet
Rectal pressure during contractions: baby is
moving down and dilation is progressing. End of labor, rectal pressure often also happens between contractions.
Empty the bladder every hour, or at the very least every two hours.
Modesty level: Mom does not care nearly as much about physical or social modesty such as politeness or embarrassment. She cares less and less as labor progresses.
Emotions: Mom sinks into herself. Looks loopy and eyes are glazed. Less interested in chit-chat, jokes, etc. When mom uses #1 (floppy-soggy) and #2 (focus on comfort), the loopiness comes from the effects of #3: mom’s hormones.

Managing Active Labor

Turn inward: tune into your body; use mindfulness
Thigh squeeze: firmly squeeze mom’s thigh or calf and give her a point for focus of her breathing.
6 needs of the laboring mother, by Dr. Robert Bradley:
- The need for darkness and solitude.
- The need for quiet.
- The need for physical comfort.
- The need for physical relaxation.
- The need for controlled breathing; deep
abdominal breathing.
- The need for closed eyes and appearance
of sleep.
Vocalization Make the “dessert sound” low in the chest. It can help to have someone else vocalize with mom in her breathing pattern and with her intensity, and model keeping it down in the chest.
Movement: the little rituals of labor, rocking
motions, walking, repeated phrases or actions, comfort objects or pictures.
Massage and stroking (long, slow movement) for the body and head. Light or firm? No sanding!
Praise, encouragement, and progress talk.
Giving in and let your body be in control. Get out of your rational brain and let the instinct part take over.
Shower or bath: surrounding mom in water is very comforting.
Counter-pressure: Press on sacrum, hip squeeze, knee press.
Visualization: Happy place, visual patterns, picture contractions to see they have boundaries and only go so far.

Transition

The intensity of the last of the dilation can overlap the body getting ready to push.
Many chemical and hormonal changes at this time.
The physical signs may begin or may continue on and can be more intense.
Contractions: Begin every 2–3 minutes, last 60–90 seconds, sometimes double-peak. Mom may go to sleep between some contractions. Let her!
Mom may begin to feel “a little pushy” even as early as 8 cm if the baby is down to –1 to 0 station or further. Wait until mom HAS to push.
Sometimes mom will be “stuck” at 8 or 9 cm dilation for a while and later find that the baby’s head molded in that time. Encourage movement, stairs, lunges, pelvic rocks, etc., in case baby’s head is malpositioned.
Transition can feel overwhelming but usually for surges of about 10–30 minutes at a time. Most births are intense at the end but not all are overwhelming. Some feel like more active labor until second stage.
Emotion: Can be overwhelming — “I can’t do this anymore.” Self-doubt, confusion, inability to make decisions, wanting to give up and quit. Recognize that this is normal; mom is vulnerable. Turn “giving up” to “giving in” to the labor.

Managing Transition

Water: getting in the bath/shower/jacuzzi is very good here as well.

Can go from “land” to water or water to “land.”

Continue comfort techniques. Remind her this is normal.

Take one contraction at a time. Many ask “how much longer?” but there is no answer for that. Say “just take the next contraction.”

More praise and encouragement.

May need to be more directive. Can be as firm as mom needs to be able to respond.

May need some sugar, agave, coconut water or juice for energy.

“Half-hour deal”: a mom will often “hit the wall” like a distance runner and feel very overwhelmed. The half-hour deal means agreeing to keep going for another half hour while working to cooperate with

the labor. If it is normal, at the half-hour mark she will be back in a pattern. If not, she may be outside the range of normal. It helps to keep her from jumping to medication when it is a normal surge in intensity. It also usually takes about half an hour to get a bag of IV fluids on board before an epidural; a

mom can be given the option to start the fluids, work with labor, and make a decision later.

What You Need To Know: List