Made for This. Mary Haseltine

a specific pattern. Some women describe them as a “tightening,” some as menstrual cramps that increase in intensity, and others like back pain that wraps around to their abdomen. Part of how they experience a contraction can be influenced by the baby’s position (whether the baby is anterior or posterior) as well as whether this is their first birth or not. The contractions (or “surges,” as some people prefer to call them) increase in intensity, working to pull the uterus muscle up and stretching the cervix open. The cervix, again, is simply the opening to the uterus. Before birth, it is thick, tightly closed, and sealed with mucous, protecting your baby until the time of birth. If you picture the uterus as a balloon with the opening pointed down, the contractions are first thinning out that opening, then pulling the opening wider, dilating it until it is about ten centimeters wide and big enough to allow the baby through. Contractions usually occur in a “wave.” You can begin to feel it coming, it grows and reaches a peak, and then slowly releases. In a natural labor, there are breaks in between the contractions, allowing you to rest and reenergize for the next one. There are three stages of this opening: early labor, active labor, and transition.

       The First Stage of Birth — Labor

       Early Labor

      In early labor, the cervix is thinning out and beginning to open. You may begin to see lots of mucous or what is called “bloody show,” which is part of or possibly the whole mucous plug, sometimes tinged with a bit of blood, that was sealing up the cervix and protecting the baby. Contractions may be consistent or sporadic. You usually can go about your day in between these early contractions and should eat and drink and rest if you can so you have the energy you will need for later. It’s important to know that for some women this stage can last for days. If you can talk between contractions, you’re still in early labor. If you plan to birth at a hospital, it’s not time to go in yet. If you can sleep, do so!

      Early labor is usually defined as the cervix dilating from zero to about four centimeters, but it’s helpful not to have numbers in mind. Just let your body do what it needs to do. Many women find the best coping strategy during this time is to go about their normal day as much as possible, “ignoring” the labor in a way. Keep a good attitude, knowing that the process could take a while and that the time frame between contractions can be all over the place.

       Active Labor

      As the surges pick up in intensity, you may find yourself gradually getting more and more serious. Your mood shifts, and your body begins to buckle down more in the work of labor. You are no longer excited and may find it more difficult to talk during or even between contractions. You are less likely to be joking around and aren’t able to go about your normal tasks anymore, even when trying your best. You find the surges cannot be ignored. You need to breathe deeply through each one and focus. When a contraction comes, you will find yourself focusing inward, perhaps needing silence, your body swaying or leaning, or sometimes needing to be completely still, breathing deeply and intentionally.

      Many women talk about the phenomenon of “labor land” during this part of labor, where reality seems to shift a bit. Time is strange and almost feels suspended. You are mentally, emotionally, physically, and spiritually in a different place. The time between contractions usually begins to lessen. The muscular walls of the uterus are pulling up and “collecting” at the top. The contractions grow in intensity, and many women begin to vocalize in moans or sighs.

       Transition

      Transition is usually defined as the cervix opening from seven to ten centimeters. It is the hardest work of labor, but, thankfully, for most women it is usually the fastest. This is the time many women begin to feel as if they cannot do it anymore, and they often say so. Surges can seem to come one on top of another, and they are most often very painful as the cervix opens that last bit to allow the baby through. At some point, as the contractions progress through transition, you will begin to feel slight pressure that continues to build. The pressure often comes at the peak of the contraction and feels like the urge to have a bowel movement. Most women unconsciously begin to grunt, and a skilled provider or attendant will know that you are getting close to pushing. The contractions build until you are fully dilated and the pressure is causing you to push.

       The Second Stage of Birth — Pushing

      When you are fully open, your body will begin to switch over into pushing mode. All of that uterine muscle that has stretched to open the cervix is now collected on top and ready to literally push the baby out. You can push along with your body, but even if you don’t, your body would push anyway: this is called the “fetal ejection reflex.” Your body is designed to do this. For many women, there is a period of rest between being fully dilated and being ready to push. For some, contractions may ease significantly as the body transitions to the pushing stage. Typically, there is no reason to hurry or to push before you feel that pressure and have the urge. This could be the body’s way of building up some more energy for the big work ahead. When it comes time to push, if you have not had any anesthesia, you will most likely feel an uncontrollable urge to bear down as though you are having a bowel movement. In fact, that is exactly the way you will push. You will usually experience intermittent pushing contractions with breaks in between, just as before, but this time your body is bearing down with the contraction. As your body pushes, the baby moves down the birth canal, your vagina. The speed is determined by how hard your body is pushing, how the baby is positioned, and how you are positioned. For some women this can take hours, for others just a few minutes.

      Often, especially if this is your first birth, the baby’s head will take “two steps forward and one step back” as it opens up the birth canal for the first time, coming down a little bit lower with each push, but going back up in between. This is totally normal. The baby’s head is beautifully designed to fit through the birth canal. In fact, the skull bones of a newborn are separate and able to overlap for the journey, allowing the baby’s head to fit as needed. For some babies, a longer pushing stage will leave them with a little bit of a “conehead” after birth, but it will eventually round out in the hours or days after birth. For an ideally positioned baby, the crown of his or her head will move its way down the vagina first, gradually coming into view. The baby’s head reaches the labia, called “crowning,” and the woman will usually feel a burning and very intense stretching of the skin of her labia and perineum. Slow pushing is often encouraged at this point to allow the skin to stretch gradually and avoid a tear.

      At this point she is so close to meeting her baby! As the head, the biggest part of the baby, crowns and is born, the relief is immense. Usually it takes just one or two more contraction pushes for the rest of the body to slide out.

       What about That Water Breaking?

      Every woman is different regarding her amniotic sac releasing. For some women, their water releases before they’ve felt any contractions, and it does prompt gentle contractions that gradually lead to birth. For others, their water breaks, but contractions don’t start for hours or even days. For the majority of women, the membranes will rupture sometime during active labor or transition. There are even rare instances of a baby being born “in the caul,” or still in the amniotic sac! Some cultures consider it good luck (and it certainly is neat to see). For some women, the release is a big “pop” and a gush of fluid; for others it is a slow trickle.

      The amniotic sac serves an important purpose for the baby throughout pregnancy, holding the fluid and protecting him or her from germs and bacteria. During labor, it helps provide a cushion for the baby and for the mother during contractions. The water also makes it easier for baby to move around to get into a good position for birth. Many women notice a significant increase in intensity when their water releases, although some experience it as a huge release of pressure, especially if they are in transition. If a woman’s water does break before active or any labor, she should be in communication with her provider. The release of her water means that baby will need to come out within the next few days to keep him or her safe from infection. Different providers have different recommendations about how soon after a woman’s membranes have ruptured the baby should be born.

       The Third Stage of Birth — The Afterbirth

      While