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Stages of Labor Part 1 (Birthing in the Time of COVID-19)

-: In this video we're going to

talk about the stages of labor.

And more specifically, we're going to talk about how

the baby passes through the pelvis,

how the cervix effaces and dilates,

and about the first, second, and third stage of labor.

So, this is our pelvis.

And I'm gonna name the parts of pelvis,

and you can feel some of them on your own body.

So these are your hip bones right here,

and you can feel those on your sides.

Down here are your sitz bones,

and you can feel those bones,

you're sitting on them right now, most likely.

And we have the pubic bone in the front

and the sacrum, or the tailbone, in the back.

Now most people don't realize this,

but the pelvis can actually move and shift

and be a little bit flexible,

especially during pregnancy.

During pregnancy, you're releasing a hormone

called, "Relaxin" and its effects sound just like the word.

It relaxes the joints in your body and

that helps makes it easier for

the baby to pass to the pelvis.

So the pelvis is a little bit flexible.

One of the parts that is flexible is the tailbone.

See here?

This?

Or we call it the sacrum.

The sacrum can change positions

depending on how you're positioned.

So if you're lying on your back

your tailbone moves up a little bit

and it makes this space, which

we call the pelvic outlet,

it makes that space smaller and

less room for the baby to come out.

So when you're in upright positions

there's more room here at the outlet,

or the bottom, of the pelvis.

So this is our baby and

the baby's head is actually flexible as well.

If you see these little spots here,

these are called, "fontanelles"

or the soft spots.

And if you've ever felt a newborn baby's head

you can feel those soft spots on their skull.

Those exists so that your baby's head

can change shape or mold as

it's coming through the pelvis.

If you've ever seen a picture of a newborn baby

with a cone shaped head that's because

their head molded to fit or flex through the pelvis.

And then the skull returns to its normal shape

several days after the birth.

So we have two flexible parts during the birth.

The pelvis and the baby's head.

Now when someone is pregnant with a baby

the baby's gonna be tucked up inside the uterus.

And this is my plush uterus from "I Heart Guts."

It says, "Uterus, get a womb."

And obviously I also have a little bit more realistic,

in terms of size, uterus for when you're pregnant

at the end of pregnancy with

the baby tucked up inside.

The other organ that's important to understand

with the stages of labor is the placenta.

And so I have a plushie placenta and it says,

"Placenta: Baby's first roommate."

The placenta is the body's only temporary organ.

The placenta supplies all the oxygen and nourishment

during pregnancy that your baby needs.

It also releases a lot of hormones

to protect the pregnancy and continue the pregnancy.

And so with my uterus here, the top of the uterus here

is the "fundus."

This is what they're measuring when

you're at a prenatal appointment

and they're feeling for the fundal height.

They're measuring the fundus, or the top of the uterus.

And this bottom part, this is cervix.

This is the "neck" of the uterus.

And inside we have our baby.

But between your baby and the uterus

there's actually another part and

that is the Amniotic sac.

So you have this amniotic membrane

that is serving as a protective barrier

to the outside world.

It also contains the amniotic fluid,

or your bag of waters.

So when someone says, "Your water broke."

What they mean is that there was a little tear

or rip in that amniotic membrane

and the fluid might leak out or

it might gush out depending on how big the tear is.

That fluid is in there for a purpose.

It helps your baby kind of move around.

They're kind of swimming around inside of you.

And also it cushions them, for example,

if you happen to fall or be in an accident.

That fluid that the baby's floating around in

is protecting them as well.

So if we take the baby out of the uterus

and just looked at the amniotic membrane

you can see how the baby is tucked up inside of there.

They're attached to their umbilical cord and

the umbilical cord is attached to the placenta.

This placenta then is adhered, or attached,

to the wall of the uterus.

So after the baby is born

the placenta's gonna have to be born as well.

Now earlier when I was talking about the uterus

and the fundus and the cervix,

the cervix here is gonna serve as

the sort of passageway out into the world for the baby.

So I want to talk a little bit about

the changes that the cervix will have to undergo.

This bottle, if we hold it upside down,

could be like the neck of a cervix.

Whoa, it's leaking!

(laughing)

So I'm gonna make it a little bit tighter

so I don't get vinegar all over me.

So this vinegar bottle that just leaked all over me

has a long narrow neck and this kind of is like

the cervix before labor begins.

It's a long narrow neck.

What we need the cervix to do is

to turn more into this peanut butter jar.

Where there is a wide opening,

but also a very thin neck.

So that the neck is almost just continuous

with the rest of the bottle.

Now before the cervix can open

it has to start thinning first.

And the medical term for that is, "Effacement."

So we say, "That the cervix effaces."

So your cervix has to get soft and thin or efface.

And then eventually it will start opening.

We call this process of the cervix thinning and effacing,

we call that, "Cervical ripening."

So in medical terminology they might

talk about this in terms of percentages.

So if they say, "You're zero percent effaced,"

then you're gonna be more like a long narrow neck there.

If they say, "You are 100% effaced"

that means that the cervix will become thin here

and then that's called 100% effaced.

Now another thing you hear a lot of people talk about

in terms of labor and birth is cervical dilation.

So this gives us a visual of how the cervix dilate.

We've already talked about effacement

so now we're talking about dilation.

Which is basically the opening of the cervix.

There is a little plug at the bottom of your cervix.

I forgot to mention that, but

there is a little plug of mucus

that is gonna help stopper up the bottom of that uterus.

And at some point towards the end of pregnancy or

at the start of labor, that plug will fall out.

It's just like a little plug of mucus.

It looks like boogers you might call it.

And that falls out.

Another thing you might see when

you start dilating, or opening,

is something called, "Bloody show."

Bloody show is a small amount of blood

you might find in your underwear or on a pad.

And in some cases that's a sign that labor is starting.

So as you can see dilation happens progressively.

So this is one centimeter dilated.

And I can just barely not even really

get my fingertip in there.

And then you can see we have two centimeters.

And then with three centimeters

I can get two full fingers in there.

And we can go to four, five, six, seven, eight, nine,

and with a 10.

And obviously most people know that the goal

is to get to a 10.

And once the provider can no longer feel the cervix

it means that you've reached 10 centimeters dilated.

The only way to check for dilation

is through an internal exam.

Either a self exam or an exam provided by a care provider.

Some people prefer to this type of exam as a vaginal exam,

a pelvic exam, or a cervical exam.

I mentioned before that there are two flexible parts:

the baby's head and the pelvis.

The baby plays a really important role

in the progression of labor in this process.

In the case of dilation as the baby

is descending into the pelvis,

going deeper into the pelvis,

their head will hopefully be resting on that cervix

and putting pressure on the cervix.

And the pressure from the baby's head

actually assists with effacement and dilation.

Now let's talk about contractions of the uterus.

For a lot of people it's normal

to have contraction in late pregnancy called,

"Braxton Hicks" contractions.

You might notice these starting at around 20 weeks.

These contractions do not dilate the cervix,

but they might feel like a tightening of uterus.

I like to call them, "practice contractions."

And usually they do not cause pain.

Although sometimes they can be intense.

When labor begins the person who's given birth

will experience regular contractions

that get stronger, longer, and closer together.

And those contractions cause progressive

changes to the cervix.

So the difference with Braxton Hicks contractions

is that those do not change your cervix.

Now the word contraction can have bad connotations.

A lot of people automatically

associate the word, contraction, with pain.

So a lot of people choose to call contractions

something different.

This is a technique from something called,

"Cognitive Behavior Therapy."

Where you give something a different name

or label it differently,

so that you start to think about it differently.

Some people choose to call contractions,

"waves" or "surges" or "pressure waves"

In our Evidence Based Birth® childbirth class

we encourage parents to consider

using a different term like wave

instead of the word contraction.

And we talk more about that more about that more in-depth

in the Evidence Based Birth® childbirth class.

So when the uterus starts contracting

and the cervix is changing,

this when Stage One of labor begins.

Stage One begins with the onset of labor

and it ends when you get to that 10 centimeters of dilation.

How long does this last?

Well, for someone who's giving birth for the first time

it's usual or common for it to last

anywhere from 12 to 24 hours.

However, it can take longer for some people.

Even two to three days.

And that is more common with a medical labor induction.

When they give you medications to start your labor.

Labor can be shorter for someone who's given birth before.

Also labor can be short for some people who experience

something called, "a precipitous birth."

A precipitous birth is when

you give birth very very quickly in less than three hours.

And it's more common if you've had a baby before

to have a precipitous birth.

It's less likely in a first time parent.

However it can occasionally happen to

someone who's giving birth for the first time.

In fact it's happened to a few students

who've taken our evidence-based birth childbirth class.

And they've come on the EBB podcast

to talk about their experiences.

The first stage of labor can also

be divided into additional phases.

So we have early labor, active labor, and transition.

Early labor is also sometimes called late labor.

And the purpose of contractions, or waves,

during this phase is to gently

push the baby down and pull up on the cervix

to help open the cervix.

So the contractions are helping push the baby down

and ripen the cervix, or efface.

And start to open the cervix.

During early labor people are able to cope pretty easily.

You might be able to watch a TV show

or talk on the phone or go on a walk

or do things around your home or work on a project.

During early labor the contractions or waves

last only about 30 to 40 seconds

and they happen anywhere from every five

to every 30 minutes.

Now I want to give you a newsflash.

In many movies or TV shows they portray labor

as one long never ending extremely painful contraction.

But in reality you get a break in-between each wave.

Also, another important note for you to understand

when we're talking about contractions

is that when you time contractions

you time them from the beginning of one

to the beginning of the next one.

So that's how they're timed.

So in that early phase of the first stage of labor

your cervix is effacing or thinning and it's dilating.

It's going from a one to a two to a three to a four.

And believe it or not,

this is still considered very early labor.

And you dilate to a five and a six.

And by the time you get to six

this is considered, "the active phase"

of the first stage of labor.

They use to think that active labor

started around four centimeters,

but now there's pretty much a consensus

among researchers and medical groups

that for most people six centimeters

is the start of what we call the active phase of labor.

Once you get to the active phase

you're gonna be experiencing a contraction or wave

that lasts about one minute.

They last about 60 seconds long

and they're occurring every three to four minutes.

And with active labor you're gonna move on

to seven and then eight.

And when you get to an eight

this is what we call, "transition."

Now when we hit active labor for some people

when they reach six centimeters

things start moving really quickly.

Especially if you've given birth vaginally before.

But for most first time parents,

research shows it tends to be a slow steady progression

from centimeter to centimeter.

And in fact in this early phase it's normal

for you to have kind of where it takes hours

to get from one centimeter to the next.

So it's very normal for this early phase

to take a long time.

For some people it starts speeding up when you get to a six.

For other people it tends to be a slow steady progression.

So once we've reached eight and nine centimeters,

this is what we call, "transition."

Transition is an important phase because it means

you're getting really close to meeting your baby.

And some people actually like to call it, "transformation"

because you're transforming from someone

who had a baby on the inside to

somebody who has a baby on the outside.

During this transition phase here

when you're progressing all the way up to a 10

the contractions may last a minute and a half or 90 seconds

and they may be coming as frequently

as every two minutes.

So if you timed the contractions correctly

that means that you have a 90 second contraction

with 30 seconds of break and then

the contraction starts again.

During transition your body is flooding you with hormones

to prepare you and your baby for the moment of birth.

These hormones may make you feel nauseous, shaky.

You might feel very hot or very cold.

And you may have feelings of doubt like,

"I can't do this anymore."

You also might be feeling a lot of pressure in your bottom.

And you may be needing a lot of support

during this phase of labor.

All of these signs are pointing to the fact

that you're getting very close to the pushing phase.

And although this phase of transition may feel very intense

thankfully for most people it's the shortest phase of labor.

By the time we get to 10 centimeters

I can even fit my hand through here.

And once we get to a 10 we can say,

"That we are done with Stage One and

"we're gonna be moving on to Stage Two:

"The pushing phase."