Stages of labour - stage 1
Updated: Jan 8
Labour can be split into 3 main stages, this blog post aims to explain the physiology taking place and what you may be feeling during the first stage, alongside some handy tips you might find helpful to make the whole experience as peaceful and positive as possible! I feel it’s important to preface this blog with a little message to just remind you that everybody’s labour and birthing experiences will look completely different, and that’s perfectly normal, the information in this post is based on the most probable outcomes for labour but it’s important to remember that that doesn’t mean this is how yours looked or will look. There are a huge range of variables involved in the birthing process and what works for one person may not work for the next, what might be a serene 30 minute stage for one might be an drawn out 20 hour stage for another and neither makes you a failure or better/worse at birthing.
The first stage:
Labour is generally split into three stages, although some count a period of recovery as the fourth stage too. The first stage is typically the longest stage and can be split into three phases, latent labour, established or active labour and transition. Labour is triggered by a change in hormone levels, oxytocin is released in large quantities which stimulates uterine muscles to contract and increases the production of prostaglandins which ensure labour moves ahead as intended. These contractions pull and push on the cervix to help open it up so that baby can start descending, the pressure of the baby’s head during contractions against the cervix can also help it to open up and to thin (effacement).
Latent labour can be very stop and start, it’s a time when you might be thinking “oop is this it!” and then an hour later all signs are seemingly non-existent. During this time your cervix is becoming long and thin and contractions are present but irregular, for some people this stage lasts days and for others just hours. In regular circumstances where there are no risks or concerns this is a time to relax, conserve your energy, boost your oxytocin and get comfortable. If your waters break whilst you’re in latent labour you should call your midwife and let them know (if you’re planning on being attended by a midwife), if you are choosing to labour in a hospital or midwife led unit setting it is unlikely that they would call you in at this stage so you can make the most of your home comforts. Latent labour lasts until you are around 4cm dilated, as this progresses your body releases beta endorphins to supress the immune system (important to protect the baby), the more stressed you are during labour the more beta endorphins you will release which is actually detrimental to labour as it diminishes the level of oxytocin you produce and thus slows labour right back down again. Below are some tips of how to remain calm and avoid this!
-eat a nourishing meal(s) and stay well hydrated
-try to have a nap or if it’s the middle of the night, go back to sleep
-think about what gets your oxytocin flowing and use it, watch your favourite film, call a friend, play with your other children, cuddle your partner in bed
-bounce on birthing ball or take little walks to help baby lower into your pelvis to further push on your cervix, gentle activity is good for this stage but make sure you’re not doing anything too strenuous as active labour could start at any time and that is where you’ll need all of that reserved energy
-if contractions are starting to become more painful ask for a massage, use heat (hot water bottle, heat pads), take a bath or shower, take paracetamol
Active labour is generally classed as being the time when you are around 4cm dilated to 8/9cm and when your contractions are roughly 3 per every 10 minute period, but it’s important to remember as aforementioned that the stages look different for everybody and your contractions may be closer together or further apart and at this stage the most important thing you can do is really listen to your body and not focus too much on the numbers. To establish if you are in active labour you may be offered a vaginal exam by a midwife or HCP, remember it is completely your choice whether or not you choose to accept this! To quote the Midwifes Labour and Birth Handbook “vaginal exams in labour are an invasive, subjective, intervention of unproven benefit” as even finding out how dilated you are really has no bearing on how close you are to meeting your baby, not to mention the small infection risk they can pose and how disheartening they can be if you find out you’re not where you thought you’d be. If you choose to decline VE’s but would like to get an idea of how dilated you are you could choose to use the purple line method which you can find more about here - https://www.lamaze.org/Connecting-the-Dots/the-redpurple-line-an-alternate-method-for-assessing-cervical-dilation-using-visual-cues
Physiologically your muscles are working in the same way as during latent labour but in a much more regular pattern and much more efficiently. During this stage you want to make yourself as comfortable as possible, if you’re having a home birth then you might wish to make your way over to the area you feel guided to give birth in, if you’re birthing elsewhere then now would be the time to head in to that setting. Positioning will be helpful at this stage and it’s a good idea to find positions that allow you to remain upright, forward facing and open such as bouncing on or leaning over a birth ball, straddling a chair, standing against an object swaying hips as these positions help baby to move down.
Some tips for dealing with labour pains in active labour
-breathing through contractions (in for 4 out for 8, or a variation that works for you)
-light touch massage from a birth partner of midwife
-positive affirmations, relaxation tracks, visualisations
-water (birth pool, bath, shower, cold flannel for head)
-TENs machine set to boost during contractions
-medical options – paracetamol or codeine, gas and air, pethidine, epidural
Transition is exactly how it sounds, the transition from the final 1 or 2 cm of dilation to the second stage of labour! This stage usually only lasts between 10 – 20 minutes but can in some cases last an hour or 2, contractions tend to become a lot more intense and closer together and many birthing people experience a “wobble” in confidence and sometimes physical symptoms such as shaking or vomiting. During transition your body is changing from your body working to open the cervix, to your body working to get the baby out. Whilst this might sound scary, it is all a really good sign that you’re super close to meeting your baby and there are things you can do to prepare, see below.
-Make sure your birth partner(s) understand what to look out for so that they can recognise you being in transition and give you gentle support and guidance
-Moving around and changing position can help you get comfier
-Reminding yourself that this stage is only temporary
-Positive affirmations such as “each surge/contraction brings me closer to meeting my baby”
-Concentrate on breathing techniques mentioned above