The first stage of labor begins with regular uterine contractions that cause cervical change. It continues until the cervix is fully open, reaching a dilation of 10 centimeters. This initial phase is the longest part of labor, serving to gradually thin and open the cervix for the baby’s descent.
The Three Phases of the First Stage
The first stage of labor unfolds through three distinct phases: Early Labor, Active Labor, and Transition. Each phase brings unique physical sensations and emotional experiences, progressively preparing the body for birth. This journey involves a gradual intensification of uterine activity.
Early labor, also known as the latent phase, marks the beginning of the process with mild and irregular contractions, occurring every 15 to 20 minutes and lasting 60 to 90 seconds. As this phase progresses, contractions become more regular, spacing out to less than five minutes apart. They may feel like menstrual cramps or lower backache. This phase can last six to twelve hours for first-time mothers, sometimes extending over a few days. During early labor, individuals often feel anticipation and excitement, and it is common to remain at home.
As labor progresses into active labor, contractions become stronger, longer, and more frequent. They occur every three to five minutes and last 40 to 70 seconds. The intensity often makes it difficult to talk or walk through them. Individuals may experience pressure in their lower back or legs, and some might feel nauseous. Active labor spans four to eight hours, and this is generally when individuals are advised to go to their birthing facility.
The final part of the first stage is transition, often the most intense yet shortest phase of labor. Contractions become very strong and close together, occurring every one to three minutes and lasting 60 to 90 seconds, with minimal breaks. This phase is characterized by intense pressure in the lower back and rectum, often with a strong urge to push. Nausea, sweating, or shaking are also common.
Physical Changes During the First Stage
During the first stage, specific biological changes occur to prepare for birth. The two primary processes are cervical effacement and cervical dilation. These actions prepare the birth canal for the baby’s passage.
Cervical effacement is the thinning and shortening of the cervix. During pregnancy, the cervix is firm and elongated, about four centimeters long. As labor progresses, uterine contractions and pressure from the baby’s head cause the cervix to stretch and thin. This process is measured in percentages, with 100% effacement meaning the cervix is paper-thin.
Cervical dilation is the opening of the cervix. It is measured in centimeters, from zero to 10 centimeters. A cervix at 10 centimeters is considered fully open, marking the end of the first stage. Effacement and dilation occur together, though their progression rate can vary. The expulsion of the mucus plug, sometimes tinged with blood, known as “bloody show,” can also occur as the cervix thins and opens.
Managing Comfort and Progression
Coping with labor sensations involves various strategies to promote comfort and support contraction progression. Many non-medical approaches can be utilized at home and in a birthing facility.
Various non-medical measures can help manage comfort and progression during labor:
- Breathing exercises can help manage discomfort during contractions.
- Changing positions and movement, such as walking or using a birthing ball, can alleviate pressure.
- Hydrotherapy, including warm showers or baths, offers a soothing environment and helps relax muscles.
- Massage and counter-pressure applied to the lower back can be beneficial, especially for back labor.
- Resting between contractions, staying hydrated, and consuming light foods can help maintain energy.
Medical pain relief, such as an epidural, is typically available during active labor.
When to Seek Medical Care
Knowing when to contact a healthcare provider or go to the birthing facility is important during the first stage of labor. Specific indicators signal when to seek medical evaluation, ensuring timely and safe care.
The “5-1-1 Rule” is a common guideline for timing contractions. It suggests contacting a healthcare provider or going to the hospital when contractions occur every five minutes, last one minute, and have been consistent for at least one hour. Some guidance extends this to two hours of consistent contractions.
Other circumstances warrant immediate contact with a healthcare provider:
- If the amniotic sac ruptures (“water breaking”), go to the hospital to reduce infection risk. Note the fluid’s color and odor.
- Any significant vaginal bleeding, heavier than spotting or a menstrual period, requires prompt medical attention.
- A decrease in the baby’s movement, such as fewer than 10 kicks within two hours, requires immediate evaluation.