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 it may seem as if you should be done after pushing out that baby, you still have one important step of birth left. Your body will usually give a good rest as you meet and hold your baby for the first time, and then it will begin to contract again, this time a bit less intense than it was as the baby was coming out. The placenta after birth begins to close off the blood vessels that were securing it to the uterine wall and prepares to release. Once it is completely detached, it will slide to the uterine opening. You will be exhausted, but you will need to push a bit more to get the placenta out. This is not nearly as much work as the baby, thankfully, and the placenta usually comes out in one or two pushes once you feel the contractions again. It is important to wait until the placenta has completely detached from the wall of the uterus. Unless there is a serious concern, no one should be rushing the placenta along, but it is also important to make sure it comes out soon after birth and is intact. Many women want to see the placenta, and it truly is an amazing thing, this organ that has been the constant supply of oxygen and food and blood to your baby!
After the Birth
After birth, your body will immediately begin the process of recovering and healing. The uterus will continue to contract so that it can return to its pre-pregnancy size. These postpartum contractions are important for stopping the blood flow from the site where the placenta was attached. If the placenta is pulled out before the blood vessels have time to begin to close off, or if your uterus is not sufficiently contracting, it can cause a loss of blood that may be dangerous.
This is where that oxytocin knowledge helps again. Oxytocin is what causes the uterus to contract again. Remember the third time that oxytocin is released in huge amounts? When a baby is nursing! When the baby begins to suck at the breast, the released oxytocin not only helps stimulate your body to produce colostrum and then milk from your breasts, but it stimulates the uterus to keep contracting. This is one of many reasons why it’s important to keep you with your baby and
