Summary of Normal Labor

There are 3 stages of labor with early labor not included in any of the stages.  The first stage of labor corresponds to active labor and cervical dilation.  Second stage is indicated by a fully dilated cervix and ends with the birth of the baby and third stage labor coincides with the delivery of the placenta.  Each stage of labor, including early labor, consists of numerous physiological and emotional factors that differ throughout each stage.  Although all three stages of labor are different in their own ways, the major similarity throughout them all is the benefit of a calm, relaxed laboring woman.  Allowing the release of emotions and fears enables labor to progress while releasing endorphins and oxytocin.  This, in turn, aids in the relief of pain and discomfort, creates a peaceful birthing environment and allows labor to advance.  It is a common thought that emotions are separate from the body’s physiologic functions.  During labor, this couldn’t be farther from the truth!

Signs of early labor include “the show,” regular contractions no more than 20 minutes apart and/or spontaneous rupture of the membranes.  “The show” is the release of the cervical mucous plug and presents as pink tinged mucous discharged from the vagina. Although an exciting sign, labor may not begin for a few days.  Regular contractions that increase in intensity and occur more closely together indicate the beginning of true labor.  An accurate indication of this is cervical, or menstrual-like cramping.  By 2-3 centimeters of cervical dilation, intense cramping can be felt.  Contractions one minute long occurring every 5 minutes signals the onset of active labor.  As labor progresses, the body will produce endorphins to help ease pain and make discomfort easier to withstand.  Oxytocin also plays a very important role at this time and throughout all stages of labor.  Fear and anxiety disturb the natural course of labor so it is best to encourage an environment where oxytocin can flourish to help counter the effects of adrenaline and aid in the progression of labor.  An environment that is dimly lit, private, warm and safe is one that encourages the flow of oxytocin. Sex is a great way to assist labor and get oxytocin flowing but only if the membranes did not rupture.  If the membranes, or amniotic fluid sac, rupture the uterus is subject to infection as the protective barrier from the sac is no longer present.  To minimize the risk of infection, it is best to not have anything inside the vagina once membranes have ruptured.

            First stage labor concurs with cervical dilation and contractions that can be compared to extremely intense menstrual cramps that come in waves, building up slowly.  Feelings of pain and restlessness will need to be addressed at this time.  Although it may seem impossible, the best way to move through pain is to surrender and relax into it.  This will allow endorphins to do their job and offer relief.  The degree of pain a person experiences in labor is strongly affected by their emotional state, environment and the attitudes of attendants present.  In order for endorphins and oxytocin to flood the system, the “thinking” brain, or neocortex, must be turned off.  Talking, bright lights and feelings of being observed activate the neocortex.  In opposition, a quiet, intimate and peaceful environment help bring on endorphins and oxytocin and therefore move the laboring woman into an alpha brain wave state.  Having calm and loving attendants is a physiologic necessity at this time.  According to Ina May Gaskin’s Sphincter Law, cervical, vaginal and rectal sphincters work best in an atmosphere of privacy.  The laboring woman may also need to slow down for integration at 7-9cm cervical dilation as contractions become so long and overwhelming that new fears arise surrounding the confusion between relaxing and bearing down.  It is helpful to encourage emotional release and keep the oxytocin flowing.  At this time, the woman moves into a theta brain wave, the deepest brain wave in a waking state.

            Second stage labor begins when the cervix is fully dilated.  Contractions usually ease and are further apart.  As pushing urges begin, a surge of adrenaline prompts the woman to be upright.  If standing/kneeling and leaning forward, the baby’s head contacts the G-spot, triggering the opening of the rhombus of Michaelis.  This is a kite-shaped area of the lower back which increases the front to back dimensions of the pelvis by several centimeters.  As this occurs, the woman will instinctively move into the “fetus ejection reflex” to bring the baby down.  The fetus ejection reflex include actions such as grabbing forward for support, spreading the knees and letting the belly sag and arching the back while wriggling the lower body.  If the membranes have not ruptured, they may rupture along with the first few pushes.  In second stage labor, pain is no longer an issue.  There is great distention of vaginal tissues, but pressure from the head causes a certain degree of numbness.  The “ring of fire,” or burning experience of crowning, is another integration moment in which the woman may need to slow down in order to accommodate the new sensations.  Focus on breathing the baby out and letting go.  Second stage labor ends with the birth of the baby.

            Third stage labor incorporates a drop in adrenaline levels and the need for the woman to rest.  Facilitating an environment conducive to oxytocin production is still very important at this time.  If adrenaline levels remain high, they can disrupt placental separation by opposing oxytocin.  Now is the time for non-disruptive parent and baby bonding.  The placenta usually delivers approximately 20-30 minutes after the birth, although it may take an hour or more and will usually separate all at once.  The mother will likely shift attention from the baby as there is a new sensation.  This is an opportune time for her to squat, as delivery of the placenta is best while being upright.  This position aligns the internal organs in such a way that they compress the fundus and discourage the formation of clots within the uterus.  Clots within the uterus can cause distention, retention of the placenta and bleeding. As soon as the placenta is delivered, the uterus should remain contracted and there should be no concerning bleeding.   At this time, the woman should be comfortable, warm, and clean.  Once relaxed and alert, nursing and bonding can occur more readily, further keeping the uterus well contracted.