Active Labor. (Active Phase of Stage 1)

 

What’s happening: Cervix is completely effaced, goes from 4-8 cm dilation. Contractions 3-5 minutes apart, lasting 40-70 seconds. Contractions become more painful.

Duration: 30 minutes to 10 hours. The physician’s expectation for progress during this time is 1 cm dilation per hour; if you’re dilating at less than half that rate, a physician may prescribe pitocin.

However, a recent study indicates that at non-augmented births, the average / normal amount of time between 4 cm and 10 cm is 7˝ hours, and that abnormal progress shouldn’t be declared unless it has taken over 19˝ hours for first-time moms (that’s less than 1 cm for every three hours). Abnormal progress shouldn’t be declared until 13˝ hours for a woman who has given birth before. (Albers) If mom is doing fine, and baby is doing fine, then parents can ask the caregiver whether pitocin is essential or whether it is possible to let labor proceed at its own pace.

Mom’s Mood. One of the biggest indicators that active labor has begun is a big change in mom’s mood: she becomes much more serious. During a contraction, the contraction takes all of her energy and concentration: she can’t walk and talk during a contraction. She doesn’t like distractions in between contractions; just wants to focus on labor.

This can be a good time to go to the hospital. A standard rule is 5-1-1. Contractions are less than 5 minutes apart, 1 minute long, and have followed that pattern for at least an hour. Plus mom’s mood has changed, as described above. If they’re more than 5 minutes apart, they’re generally not changing the cervix much yet. If mom is still chatty between contractions, even in contractions are intense, she’s generally not yet in active labor.

When asked “How do I know I’m in active labor?” people say “Oh, believe me, you’ll know!” But I find women have false positives… it’s like falling in love. You may have had crushes that felt like love at the time, but then when “the real thing” came along, you knew it, and realized the earlier ones were just practicing for this moment.

Comfort Techniques for Active Labor

·    Warm water: Baths are wonderful. Generally, don’t stay in bath for more than 1 ˝ hours at a time. Submerse belly, or have support person pour water over your belly during contractions.

·    Breathing: Accelerated Chest, Hee-Hee, Hee-Hee Blow

·    Positions: Walking, sitting on a Birth Ball, “Slow Dancing” with partner rubbing your back, Hands-and-Knees, Sitting up, leaning over, lunge, squatting, supported squat.

·    Eat, if desired. Only mild, easily digested foods. Not fatty or spicy foods. Many hospitals do no allow you to eat once you arrive there.

·    Drink water after every contraction. If liquid makes you nauseous, try ice chips, popsicles. (Note, nausea and vomiting are fairly common during active labor. Vomiting isn’t pleasant, but can be part of a normal labor, and generally isn’t cause for concern.)

·    Go to bathroom at least once an hour. (A full bladder can block baby’s descent.)

·    Vocalization: Moaning, Chants, Mantra, Songs. If you find yourself making high-pitched cries, try to bring the tone down to deep belly moaning. This helps you breathe from your abdomen, staying more centered, and less anxious.

·    Visualization. Especially images like buds opening up into flowers…

·    Touch: Effleurage, Counter-pressure, Massage

·    Sensory Distraction: Music, Focal Point, Counting, etc.

·    Heat and Cold: Heating Pad or cold packs on back or belly. Cold cloth on head

·    Positive feedback. Important not to give negative messages: she’s very receptive and will accept as true whatever you say to her, so make the messages positive. . Say “You’re doing a great job of relaxing your body, now release the tension around your eyes.” Don’t say “you look really stressed; don’t be so tense.”

·    Ritual is very important: doing the same thing on every contraction can help keep things calm and familiar.

Progress of Labor: Plateaus

Cervical dilation does not happen in a straight line of progress, with any guarantees like: every hour of labor is guaranteed to give you 1 cm of dilation. During early labor (latent phase of stage 1), cervical dilation tends to happen very slowly. Sometimes women labor for several hours, and finally decide to go to the hospital, and find out they’re only 3 cm dilated. It’s possible to feel discouraged at this point, and feel like they’re not even halfway there. It’s important to know that during active labor, dilation will go much more quickly. I include Friedman’s Labor Curve here to illustrate the shape of the curve: the idea of the ‘normal’ progression of labor, beginning slowly, and speeding up later on in labor. It is important not to take the exact data on this chart too literally. These are averages only! Some labors may take less time, some perfectly normal labors may take much more time.

Often women ‘plateau’ for a while: some women will dilate quickly to 4 cm, and then stay at 4 cm for a long time before shifting into active labor. This is normal, and it’s important for partner to reinforce that this is a reasonable way for labor to progress.

Another common plateau is when the cervix is almost completely dilated, sometimes there will be a “lip” – just a little bit of the cervix left to efface and dilate before pushing begins.

6 Ways to Progress in Labor

If the laboring woman ever has a vaginal exam and then gets discouraged over her “lack of progress” based on cervical dilation alone, it’s important for her support people to remind her about the normal plateaus in labor, and also about the 6 ways to progress in labor. Dilation is only one measurement. Also significant: the position of her cervix, effacement, ripening, and the baby’s position, or fetal rotation and station.

 

Compiled by Janelle Durham. Sources: Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler (2001 edition). Family-Centered Maternity and Newborn Care by Celeste R. Phillips (Fourth edition, 1996). And others.

 

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