labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Friday, October 12, 2007

Stages of Labor, Part 1

When I was new to ob nursing, the most confusing and befuddling concepts were the stages and phases of labor. I couldn't keep them straight. It took me some time to get it figured out in my head, and it certainly helped when I began L&D nursing and actually witnessed the phases and stages with my very own eyes. I think the easiest way to approach this topic is with each phase/stage by itself. So I'll be talking only about the Latent Phase of the First Stage of Labor in this post.

But, to give you an overview, the stages of labor are:

  • First Stage
    • Latent Phase
    • Active Phase
    • Transition Phase
  • Second Stage
    • Pushing until birth of baby
  • Third Stage
    • Delivery of placenta
Some will even include a fourth stage, which would be the immediate postpartum period, but I'm going to skip that for now.

So on to Latent Phase labor in the first stage.....

I'll tell it like it is: it's long and tiring for first time moms. Sometimes it can be long and tiring for moms having their second (or more) baby because of the fetal position within the pelvis. But I'm jumping ahead of myself.

Latent phase labor is when the cervix dilates from closed to 3cm. The "books" will tell you that it typically takes an average of 8 hours for this to happen. But I've seen both ends of the spectrum here. Contractions during this phase are short (less than 60 seconds) and typically begin with mild pain. On average the contractions last about 30-40 seconds long, and are spaced about every 5-10 minutes apart. Many women can talk through these contractions, or breathe easily with them. Over the course of how ever many hours latent phase labor is for any particular woman, the contractions get stronger, longer, and closer together.

As the cervix starts to open, a woman will notice some bloody show...mucous from the cervix that is mixed with bright red blood. I've seen many women get freaked out by the sight of bloody show, and my response every time is "It's lovely!" Why? Because it means your cervix is changing... something I'd imagine she'd want. Bloody show does not always present itself in this phase, so don't panic when you don't see it.

Latent phase labor is tricky. It can be confused with false labor, and vice versa. Many times when a woman presents to the L&D with a question of labor, and we are unsure of whether its false labor (some really active braxton-hicks contractions) or real labor, then we keep her for an hour or two and reevaluate her cervix. Because, remember, true labor = cervical change. The proof will be in your cervix!

And here is when it gets even trickier.... latent phase labor can occur without much cervical change. It is when contractions are regular for hours on end (and I mean hours) with no break but the cervix isn't doing diddly squat yet. This is then classified as prodromal labor, and in my opinion I'd never sign up for it. It tires these poor women out.... even though the contractions may be short and mild (in comparison to active labor contractions), when you have them non-stop for 18 or more hours all coping mechanisms have gone out the door, and the perception of pain tends to heighten. For women who end up with this prodromal labor, there are options. I've seen doctors give sleeping pills to help the women get some rest at home. I've also seen them get admitted and given an injection of morphine to put them to sleep, and I've seen them given IV fluids to either space the contractions out or give the mom a little extra "pep" to help her cope. Frequently women are scared to take any sleeping medications because they will be asleep... well, ya, that's the point...and trust me.... you'll wake up when active labor kicks in. I've seen two things happen with the sleeping medication scenario: the woman sleeps for hours and wakes rested and full of vim and vigor with a quiet uterus, or get a little bit of sleep before waking up in rip roaring labor. And yes, that medication does cross the placenta and make the baby sleepy as well.

Regardless, when latent phase labor starts, most women are excited and feel like calling everyone under the sun (at least the first time moms... ask a second time mom and she'll say screw calling people) to tell them real labor has begun. But (and I can't stress this enough) conserve your energy! Rest at home. Have light snacks. Drink lots of fluids.

As far as when you should call your doctor or midwife... ask them. Everyone has different guidelines and those guidelines can be different for each woman. So I won't be telling you that. I can tell you that from experience most healthy women do best at home during this time, and those who run to the hospital end up with more interventions because its hard for some providers to sit on their hands and let nature take its course. But again, listen to what your provider advises.


girl_in_greenwood said...

I'm thrilled that you're writing this series now! I'm a nursing student just about to start my labor & delivery clinical practicum - I've read the textbooks but I apreciate your practical experience in describing what happens when during labor. Thanks!

kristina said...

Do you ever recommend a hot shower or bath for women with a lot of prodromal labor as an alternative to the sleeping pills? I've been taught that very warm water can slow labor and of course help with pain.

Labor Nurse said...

kristina, yes we certainly recommend (and offer) showers and baths. We have jacuzzis on our unit that many women find very relaxing. It may slow labor in the latent phase, but I believe it actually helps facilitate labor when a woman is in the active phase of labor. It also helps blood pressure, too.

Lil said...

Oo, so there's a word for it. I went into what FELT like active labor at 6:00 (or so) on Thursday night, went into L&D at 1AM- diddly squat. 1cm dilated, 50% effaced same as my last prenatal. Then didn't go back in until around 6:00 (or so) the next evening, where I was 7cm dilated. So I'm betting that a whole hell of a lot of those 24 hours were pretty much prodromal labor. I was sleeping in 30-60 second spurts during that time.

It *is* exhausting as hell, but I actually found that my perception of pain was dulled by the length of the labor. The sleeplessness meant more endorphins for me, and I spent a good deal of my labor high as a kite.

I did start falling asleep during the pushing stage, though. :p

I think that if I had taken a sleeping pill and gone to sleep, that my perception of pain would have been greater- fewer endorphins. But I can't know for sure. :)

BTW, during prodromal labor it was recommended that I have a glass of wine and take a warm bath. Didn't slow my labor any- but sure as hell made me giddy. :) (Made the contractions feel somewhat orgasmic)

lala said...

Prodromal labor, so that's what it's called. No one ever explained this to me and I can't recall ever reading about this. My experience began with contractions starting at 6pm on a Friday, went to the hospital at midnight only to be told I was a "fingertip" dilated and sent home. Contractions continued to range from 15 to 4 minutes apart. Needless to say I didn't sleep at all. We went back to the hospital around 10 pm on Saturday, only to be sent home again at 3 cm dilated. I was admonished for coming into L&D with nothing to show. I asked for something to help me sleep and was given Tylenol with Codeine and a 5 mg Ambien. Needless to say neither medication helped. I decided to wait until my next prenatal visit that Monday as it seemed nothing was changing, this served to freak out my poor husband. I was delirious come Monday's doctor's appointment, so I concur with the tiring out. Sheesh, no sleep for 72 hours! However, I did finally have a very healthy baby girl that Monday via C-Section. Apparently her head was not stimulating my cervix consistently enough to move labor along. Once I was admitted to the hospital, I stopped progressing. Maybe this was because of the epidural plus pitocin, but I needed that relief so much. Oh well, we're all individuals with original experiences, though, in the future I would like to have the nice, short labors that my maternal grandmother had. A girl can only wish.