The First Stage of Labor - dummies

By Joanne Stone, Keith Eddleman, Mary Duenwald

The first stage of labor occurs from the onset of true labor to full dilation of the cervix. This stage is by far the longest (taking an average of 11 hours for a first child and 7 hours for subsequent births). It is divided into three phases: the early (latent) phase, the active phase, and the transition phase. Each phase has its own unique characteristics.

Early or latent phase

During the early phase of the first stage of labor, contractions occur every 5 to 20 minutes in the beginning, and then increase in frequency until they’re less than 5 minutes apart. The contractions last between 30 and 45 seconds at first, but as this phase continues, they work up to 60 to 90 seconds in length. During the early phase, your cervix gradually dilates to about 5 to 6 centimeters and becomes 100 percent effaced.

The entire early phase of the first stage of labor lasts an average of 6 to 7 hours in a first birth and 4 to 5 hours for subsequent births, although recent data shows that this may in fact be longer. Often, the exact length of labor is unpredictable because knowing when labor actually begins is difficult.

In the beginning of the early phase, your contractions may feel like menstrual cramps, with or without back pain. Your membranes may rupture, and you may have a bloody show. If you have been admitted to the hospital, your doctor may use a small plastic hook to rupture your membranes for you, in order to help things along.

Early on in this phase, you may be most comfortable at home. You can try resting or sleeping, or you may want to stay active. Some women find they have an overwhelming desire to clean or perform some other household chores.

If you’re hungry, eat a light meal (soup, juice, or toast, for example), but not a very heavy one — in case you later need anesthesia to deal with labor complications. You may want to time your contractions, but you don’t need to obsess about it.

If you start to become more uncomfortable, the contractions occur with more frequency or intensity, or your membranes rupture (your water breaks), or you have vaginal bleeding, call your practitioner or go to your hospital.

Many women find walking around makes them more comfortable and distracts them from the pain during the early part of labor. Others prefer to rest in bed. Ask your practitioner whether your hospital has any restrictions on walking during labor.

Active phase

The active phase of the first stage of labor is usually shorter and more predictable than the early phase. For a first child, it usually lasts about 2 to 3 hours, on average. For subsequent babies, it lasts about 1-1/2 to 2 or more hours. Contractions occur every 3 to 5 minutes in this phase, and they last about 45 to 60 seconds. Your cervix dilates from 5 or 6 centimeters to a full 10 centimeters.

You may feel increasing discomfort or pain during this phase, and maybe a backache as well. Some women experience more pain in the back than in the front, a condition known as back labor. This may be a sign that the baby is facing toward your front rather than toward your spine.

By this time, you’re likely already in the hospital or birthing center. Some patients prefer to rest in bed; others would rather walk around. Do whatever makes you comfortable, unless your practitioner asks that you stay in bed to be monitored closely. Now is the time to practice the breathing and relaxation techniques you may have learned in childbirth classes.

If you need pain relief, let your practitioner know. Your partner may help ease your pain by massaging your back, perhaps by using a tennis ball or rolling pin.

Seeing an end in sight!

In addition to intense contractions, you may notice an increase in bloody show and increased pressure, especially on your rectum, as the baby’s head descends. During this last part of the first stage of labor, you may feel as if you have to have a bowel movement. Don’t worry; this sensation is a good sign and indicates that the fetus is heading in the right direction.

If you feel the urge to push, let your practitioner know. You may be fully dilated, but try not to push until your practitioner tells you to do so. Pushing before you’re fully dilated can slow the labor process or tear your cervix.

Potential problems during labor’s first stage

Most women experience labor’s first stage without any problems. But if a problem arises, the following information prepares you with the information you need to handle it with a clear, focused mind:

  • Prolonged latent phase: The latent or early phase of labor is considered prolonged if it lasts more than 20 hours in a woman having her first child or more than 14 hours in someone who has delivered a previous child. Your practitioner may not be able to determine when labor actually starts, so knowing for sure when labor becomes prolonged isn’t always easy, either.

  • Protraction disorders: Protraction disorders can occur if the cervix dilates too slowly or if the baby’s head doesn’t descend at a normal rate.

    If you’re having your first baby, the upper limit of time to dilate, according to this recent data, means than it can take up to 6 hours to progress from 4 to 5 centimeters, and more than 3 hours to progress from 5 to 6 centimeters, regardless of parity. After that, the average and upper limit to dilate 1 cm/hour.

  • Arrest disorders: Arrest disorders occur if the cervix stops dilating or if the baby’s head stops descending for more than two hours during active labor. Typically, arrest of labor is diagnosed when the cervix is at least 6 centimeters dilated and membranes are ruptured, and no cervical change occurs for at least four hours with adequate contractions, and six hours with inadequate contractions.