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

Wednesday, May 7, 2008

Stages of Labor, Part 2

It's been a while since I've done any childbirth ed posts, and one that was kind of left swinging in the breeze was the Stages of Labor. I talked about latent phase labor here, so go ahead and review if you want. This post will be about active phase labor.

Remember the whole phase/stage thing? It's fairly confusing. There are 3 stages of labor (4 counting the postpartum period) and within the first stage of labor are the 3 phases. Latent phase is the first, active phase follows.

Active phase labor is when things really pick up. Latent phase labor is the longest phase, typically, and once a woman reaches the active phase things really move along. Here are some signs that active phase has kicked in:

  • Suddenly contractions become so intense that talking and breathing becomes very difficult.
  • When a contraction occurs, hearing other people talk can get annoying and you need to tell them to shut up.
  • Contractions become closer together and longer in duration.
Active phase labor is defined as cervical dilation between 4-7 centimeters and contractions that are 2-3 minutes apart lasting at least 60 seconds. That being said, not everyone is text book (rarely is anyone textbook!) so don't assume this is what needs to happen. What needs to happen is cervical change, so if contractions every 5 minutes apart are causing cervical change then so be it. I've seen some providers still want to augment labor with pitocin in this situation because they've got it stuck in their head that active phase labor means contractions every 2-3 minutes apart. Plus, in theory I guess, if the woman is contracting every 5 minutes with cervical change, then getting her to contract every 2-3 minutes will make her cervix change even faster; isn't that a nice bonus (typically for the provider, sometimes for the woman if it's emphasized by the provider that she could have a quicker labor- and when such a thing is dangled in front of a woman in labor like a carrot in front of a horse who wouldn't want quicker?). But the midwifery model of care says don't fix something that isn't broke, and I agree.

I think active labor is appropriately named; not only does this stage start picking things up and becoming "active", I think it's the phase to stay active. Walk, use a tub or jacuzzi, get on a birth ball, find different positions to use during contractions. This is also the time when providers offer pain medications and epidurals (some will offer it sooner). Discussion of that in itself is several posts, so I won't go into that much now. However, pain medications and epidurals can slow a labor pattern down. This can become problematic if cervical dilation stops, and it opens up a whole can of worms. And for others these things don't effect labor. But we can never predict who is going to have their labor affected by an epidural or pain medication, so no one can advise you one way or another if you are basing your decision on that factor.


Christa said...

I still find it ironic that during the active phase of labor with my daughter, I was having contractions every 4-6 minutes, dilating on schedule, etc. The labor was going beautifully. I didn't ask for or need any pain medication (I actually found it quite bearable.) Oh, the ironic part came in when the midwife suggested pitocin to speed up the labor. The midwife. The doctor didn't see a need (my practice provided both) but the midwife said that I was progressing too slowly. The saddest part of this was the fact that I had only been in active labor for about 4-5 hours at that point.

I feel really confident in saying that had I not had the pitocin, I think I would have had a vaginal birth (had a C). I'm not sad, nor do I feel as if I missed out. I had a healthy baby and we both recovered from birth rather quickly. That is all I wanted from my birth experience. A healthy child. Still, I wonder if things would have been different if it weren't for the midwife's interference.

Anonymous said...

I just had my childbirth ed. class this past week - and I actually have a question regarding effacement and dilation--maybe someone can help me....

Our instructor said that with your first child effacement occurs before dilation - and the effacement can take weeks - but once your body has gone through this process - like with your second child - the effacement and dilation happen simultaneously and much quicker.

First - I want to know if this is accurate - because the instructor was a complete nut.

And if it is true I wanted to know which to expect with this pregnancy (due in July)- it will be my first child - but I had a loss at 16wks about a year and a half ago and had to be induced to "have" the baby because it was too big for a D&C. How will the effacement/dilation progress - like that of a first or second pregnancy?

Labor Nurse said...

Anon, the instructor was right about dilation and effacement in primips (first timers) vs multips (not first timers).

As far as what to expect on dilation and effacement this time around, I can't say for sure. In regards your 16 week loss, you may not have needed to be fully dilated to deliver that baby so your cervix may act like a first timer; on the other hand it may not.

But either way, don't get caught up in the effacement thing and when it happens. Whether it happens or begins before dilation doesn't matter. What "matters" in labor is that change is happening.

Erin said...

I am probably the only woman that would have liked her labor to go slower! I was induced due to pre-e (I now realize it probably wasn't needed at that point, but...whatever). They used cervidil and the insertion took about 20 minutes and that exam triggered labor.

9pm - insertion 1cm
12am - 2cm, IV pain meds given to try to slow things down, baby having decels. (the meds worked for about an hour)
1:45am - 4 cm, ask for epi
2:20am - just before epi 6cm
2:45am - finish epi 9cm
Rest for awhile
3:15am - practice push
3:20am - start pushing
3:41am - birth

Did I need the induction? I'm not sure at this point. I did have lots of bad swelling, and protein, but my BP was fine and all blood work was perfect. Baby didn't react well to the contractions going from 'easy' to 'OMG DYING' well at all (I'd been contracting for weeks and had been on meds to slow them down). I had wanted a natural birth but missed my class because I was induced at 37 weeks and the nurses didn't tell me anything on what I was supposed to do (breathing wise to help pain) and I wasn't allowed to move around even after removal of the cervidil and before the epi. My midwife didn't really prepare me in any way besides recomending a book the day before the induction.

Anyway, sorry...I get on the topic and get frustrated. I'm almost 6 weeks PP.