-: 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.
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!
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
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."