An OB/GYN’s Guide to Labor

Labor is one of the most natural human experiences. Women have been doing this for centuries. In 2021, there were approximately 11,000 births per day. And yet, labor remains one of the scarier experiences for some women. For most, it’s the fear of the unknown that makes the idea of labor scary.

As a first-time mom feeling anxious about labor, you can relieve your worries if you’re equipped with information on what to expect. Today, we’re doing just that. We’re sharing all the basics of labor to ensure that you’re more knowledgeable and relaxed when you deliver your little one.

As OB/GYNs, we categorize labor into three main stages – dilation, birth, and delivery of the placenta.

Stage 1: Dilation

The first stage of labor occurs when you start feeling consistent and persistent contractions. They get stronger, more intense, and more frequent. The cervix also starts to open and soften. It thins out, and your baby moves into the birth canal. This stage can be subcategorized into two phases – early labor and active labor.

Phase 1 – Early labor

Early labor starts with contractions. How the contractions feel will vary because everybody has different pain tolerance levels. The main thing to look out for is the tightening of the uterus. Usually, contractions start from the bottom of the uterus. As the uterus rises, it gets very tight and feels crampy. This feeling comes in waves. A lot of women look for intense cramping, but contractions become more rhythmic and regular as you go to the active phase. During early labor, you may be able to distract yourself from the contractions. As they get more intense, you may need to breathe through the cramping. The early labor contractions may be sporadic and non-rhythmic. Some may be shorter than others. You may also notice a bit of bloody mucus, bloody show, or amniotic fluid as the cervix starts to dilate. Some women have none of these signs. So, early labor looks different for everyone. It can even look different across different pregnancies. Early labor for a first-time mom may be long and sporadic. Some may notice that the contractions get more consistent, and then everything sort of shuts down. It depends on your environment and how relaxed you are. Things to do when you’re in early labor

Go for a walk
Take a shower
Get into a warm bath
Listen to relaxing music
Practice the breathing and relaxation techniques you learned in your child birthing classes
Change your position
Get some rest

A lot of women get so excited to time their contractions that they lose out on valuable rest. If you're having an uncomplicated pregnancy, you can do a lot of early labor in a comfortable environment.

Phase 2 – Active labor

In our practice, we use the 4-1-1 or 5-1-1 rule. We wait for contractions to be about four to five minutes apart, lasting for about a minute for at least an hour before a patient can get to the hospital. This would be considered active labor. We consider active labor from about 6 cm dilated with regular rhythmic contractions to 10 cm dilated. At this stage, the contractions tend to be more intense. You tend to have a rhythmic pattern, and you can’t distract yourself from the contractions. For women who have had kids, this phase can happen very quickly. But for first-time moms, the active phase can last longer. This will depend on factors such as the mom’s level of comfort and the baby's position. At this point, moms who want anesthesia may request IV medication or an epidural for pain management. Pain management medications can also lengthen your active labor. If you can be mobile, there are several ways to make your active labor more comfortable. Things to do during active labor

Change positions
Use the peanut ball
Sit on the yoga ball
Get into the bath or shower
Walk
Squat

Stage 2: Birth of the baby

At this stage of your labor, you are 10 cm dilated. You’re feeling pressure and the urge to push. Many women love this stage because they’re getting one step closer to meeting their baby, and they feel more proactive.

There’s open glottis pushing and closed glottis pushing. A lot of first-time moms need to bear down to protect their pelvic floor. Other women can breed the baby down. So, it’s important to try and find what works best.

Some people like pushing on their side, whereas others like to be on their hands and knees. A lot of times, we’re delivering on the back. Some people prefer a squatted position. Your pushing position will depend on what you’re comfortable with and whether you’ve had pain medicine.

Moms who get an epidural may have less mobility, meaning they may have to bear down more. Typically, we will have you bring the baby to the perineum to let it stretch. So, it’s very important to listen to your provider so that you hopefully don’t tear.

Once the baby’s head is out, it may require a little suctioning at the perineum. We use a little bump suction if needed. The shoulders and body typically easily come out after. Then, the baby comes to you.

In our practice, we do a lot of delayed cord clamping when mom and baby are doing fine. The baby can lay on you with the cord still intact, especially if you’re not doing cord blood collection. This will get that nutrient- and oxygen-rich blood to the baby. It also increases the baby’s iron store and reduces their risk of getting anemia.

After the delivery, most moms are shocked and in awe. So, we allow you to enjoy the moment and feel empowered that you actually did that.

Stage 3: Delivery of the placenta

Once the cord stops pulsating or is clamped and cut, we look for signs of placental separation. Typically, there’s a gush of blood, the cord lengthens, and there’s a rise in the uterus. That’s usually a sign that the placenta is separated.

When you can feel the placenta in the vagina, we may have you bear down to deliver it. Once the placenta separates, we must make sure you’re bleeding. We make sure that your bleeding is well-controlled and your uterus is clamped down through a fundal massage.

A lot of moms will then try to get the baby to latch. Breastfeeding the baby early will also allow the uterus to contract and control bleeding. One of the initiatives by the state of Florida is to give Pitocin after delivery to prevent postpartum hemorrhage.

Stage 4: Mom-baby bonding

This stage encompasses the postpartum period. The bonding stage includes making the sure baby can latch, as well as managing all endorphins and hormones. If there’s tearing or laceration, your provider will ensure that you’re well anesthetized. If you didn’t have an epidural, we use a local anesthetic before repairing any type of laceration.

My name is Delisa Skeete Henry (MD), and I am a board-certified OB/GYN. I’ve been practicing in South Florida for 20 years. You can contact our team at Serene Health here: https://skeetehenryobgyn.com/contact/ for a consultation. Be on the lookout for our Facebook Lives https://www.facebook.com/SereneHealth4U every Thursday, where we answer all your reproductive health questions.