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Labor and Delivery - Signs and Stages

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Most women are worried and excited about labor. This article explains the signs and stages of labor, Braxton hicks contractions, and when to induce the labor.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Richa Agarwal

Published At October 10, 2022
Reviewed AtFebruary 8, 2024

Introduction

Labor is a natural process of delivery. It has three stages. Throughout the labor, the body uses contractions to dilate and efface the cervix to deliver the baby and placenta.

What Are the Signs of Labor?

Labor can happen at any time; it is not predictable. The due date the doctor gives is a point of reference. The labor can occur as early as three weeks before that due date or as late as two weeks after it.

The following are signs of labor:

  • Lightening occurs when the baby's head drops down into the pelvis in preparation for delivery. The belly may drop to a lower position, and breathing may be easier because the baby no longer puts pressure on the lungs. But there will be an increased urge to urinate because the baby is pressing on the bladder. This can happen a few weeks to a few hours from the onset of labor.

  • Bloody Show - A blood-stained or brownish discharge from the cervix is the released mucus plug that seals the womb from infection. This can occur days before or during the onset of labor.

  • Ruptured Membranes - Fluid gushing or leaking from the vagina happens when the amniotic sac membranes that protect and surround the baby have ruptured. This typically occurs hours before labor starts or during labor. After the amniotic fluid rupture, most women go into labor within 24 hours. If labor does not occur naturally within 24 hours, the doctors may induce labor to prevent delivery complications and infections.

  • Diarrhea - When diarrhea happens frequently, it can be a sign of labor.

  • Contractions - Irregular contractions are usually expected when the labor nears. The contractions frequently occurring in less than 10 minutes are generally a sign of labor.

What Are the Stages of Labor?

Labor and delivery are divided into three stages.

1) First Stage of Labor

Early Labor

  • This is usually the most prolonged phase of labor with mild and irregular contractions. Early labor is also called the latent phase of labor. During this period, there will be thinning of the cervix, and the cervix dilates to 3-4 cm. It can happen over several days, weeks, or a few short hours.

  • During this phase, there might be a clear pink or slightly bloody discharge from the vagina, backache, or cramps.

  • Contractions vary during the early labor phase ranging from mild to strong and occur at regular or irregular intervals.

  • Most women will be in the hospital or preparing to go to the hospital during this period.

To promote comfort during early labor:

  • Go for a walk.

  • Listen to relaxing music.

  • Try breathing or relaxation techniques.

  • Change position.

Active Labor

  • During the active phase, the cervix dilates from 3-4 cm to 7 cm. There will be stronger contractions, closer together and regular.

  • The symptoms during this period are leg cramps, backache, feeling nausea, and the water break that happens if it has not already broken.

  • Ask for pain medication or anesthesia from the health care team if wanted.

Transitional Labor

  • The transitional phase of labor is the most intense phase of labor, and it causes sharp and increased contractions, which occur about two to three minutes apart. The last 3 cm of dilation normally occurs in a short period.

2) The Second Stage of Labor

Delivery

Delivery is the second stage of labor, and the cervix is fully dilated. Some women may urge to push right away or soon after the dilation is full. It may take some time for the baby to come down with contractions. Women who did not take an epidural typically have an overwhelming urge to push when the baby is low enough in the pelvis. At the same time, women with an epidural may still have an urge to push but not as intensely. During contractions, it is best to take rest and stay relaxed.

When it is time to push, the mother can experiment with different positions which they feel are comfortable and best, like squatting, sitting, and kneeling. Pushing more gently is required at some point, giving the vaginal tissues time to stretch rather than tear. After the baby's head is delivered, the baby's body will follow shortly.

The baby's airway will be cleared if necessary. The health care provider may wait seconds to minutes to cut the umbilical cord. Delaying clamping and cutting the umbilical cord increases the flow of nutrient-rich blood from the placenta and the cord to the baby. This causes an increase in the baby's iron stores, reduces the risk of anemia, and promotes healthy development and growth.

3) The Third Stage of Labor

Delivery of the Placenta

After the birth of the baby, the placenta will also be delivered. There will be mild, less painful contractions that are close together. These contractions help to move the placenta into the birth canal. A gentle push is needed to deliver the placenta. The doctor will check if the placenta is intact or not. Any placenta remnants must be removed from the uterus to prevent bleeding and infection. Stitching to repair a tear or surgical cut will occur after the placenta is delivered. If no anesthesia is provided, the health care provider will inject local anesthetic in the area to be stitched.

What Are Braxton Hicks Contractions?

A Braxton Hicks contraction is an irregular contraction that will feel like a sudden, sharp tightening of the abdominal muscles. Many women experience Braxton hicks contractions sometime after 20 weeks of pregnancy. It is triggered by an increase in either baby's or mother's activity or a full bladder. The Braxton Hicks contraction's role in pregnancy is not fully understood.

They may promote blood flow, prepare the uterus for childbirth, or help maintain uterine health during pregnancy. Even though this is similar to how a contraction feels, Braxton hicks contractions do not follow a pattern or progress over time. They may also stop when there is a change in position, lie down, or relax. Braxton Hicks contractions do not cause the cervix to dilate.

What Are the Methods to Induce Labor?

Labor does not start naturally or progress as it should. The doctors might induce labor. This is a medical procedure where the doctors start labor.

This could happen if you:

  • When a pregnancy has gone into 42 weeks.

  • Presence of complications with the mother or baby.

  • The water broke, but labor did not start.

  • Low levels of amniotic fluid.

Labor can be induced in several ways. Labor induction can take more than spontaneous labor because of the cervical ripening process. The healthcare provider will advise the best and safest option depending on the mother's health.

Inducing labor can be done by using:

  • Medications are given through an IV (directly into the vein).

  • Breaking the amniotic sac (water).

  • Separating the amniotic membrane from the uterine wall.

  • Softening the cervix and opening it with a medication that can be placed directly in the vagina.

What Should Be the Fetal Position During Labor?

Doctors regularly check the baby's position during prenatal visits. Babies normally change head-down positions between week 32 and week 36. But, some babies may not turn at all, and others turn into feet- or bottom-first position. Most doctors will try to turn a fetus into a head-down position by gently applying their hands to the mother's abdomen, using an ultrasound as guidance external cephalic version (ECV). The baby will be monitored during the procedure. ECVs are mostly successful and can reduce C-section delivery.

Conclusion

During pregnancy, most mothers will be excited and nervous. It is normal. And when nearing labor, they will be confused about what to expect. Discussing the signs and symptoms with the doctors can help the mother to know what to expect. If any signs of labor occur, reach the hospital as soon as possible.

Frequently Asked Questions

1.

What Are the Signs of Labor?

The belly may drop to a lower position, and the baby no longer puts pressure on the lungs, which will allow easy breathing. Since the baby is now pressing on the bladder, an urgency to urinate may be felt. A blood-stained or brownish discharge can be seen from the cervix. A vaginal leakage may be present when the amniotic sac membrane ruptures, and there will be increased contractions when the labor is near.

2.

How to Identify the Labor Stage by Yourself?

During the first stage of labor, there will be dilatation of the cervix of up to three to four centimeters, and a clear pink or bloody discharge may be seen from the vagina. Symptoms include leg cramps, backache, nausea, and sometimes the water breaks. Delivery is the second stage of labor, and the cervix is dilated fully, and the women tend to push their baby in whatever position they are comfortable in. The third stage is the delivery of the placenta, and there will be a mild, less painful contraction at this stage.

3.

What Happens if the Water Breaks?

Water breaking refers to the rupture of the amniotic sac membrane which surrounds the fetus. It usually breaks before labor or during labor. This sac is responsible for keeping the baby warm and helping in the organ development process but only until the 23rd week. After this, the baby receives nutrients from the placenta.

4.

How Does the First Contraction Feel?

Contraction feels like a pressure or pain that starts from the lower back leading to the lower abdomen. A tightening of the abdomen or cramp is mostly reported by pregnant women, and it also causes discomfort. However, the sensation of contraction is felt differently by every individual.

5.

How to Know if a Woman Is Dilating?

As the women near pregnancy, dilatation occurs in many women, which can also be a false sign of labor. Self-examination can be done to know if there is dilatation. Sit in a squatted position with the help of a person as support. After thoroughly washing the hands, try to insert the fingers as far as possible to reach the cervix. If one fingertip fits through the cervix, then there is a dilatation of one centimeter, and it is dilated for about two centimeters if two fingertips can fit in.

6.

How Long Does Early Labor Last?

The first stage of labor is early labor, and it can last from eight to twelve hours. The cervix will dilate up to six centimeters, and there will be contractions felt. Each contraction can last up to 45 seconds and occur intermittently every 5 to 30 minutes. The contractions can be felt like a backache, menstrual cramp, or abdominal tightening.

7.

Are Early Contractions Hurtful?

A dull ache is felt in the back, and there may be difficulty while breathing during the contractions. Pressure and fullness are felt over the pelvic area. Sometimes the contractions can be hurting and be felt as very strong cramps. The pain usually starts from the back and travels to the front lower abdomen.

8.

How to Break My Water?

Breaking the water means rupturing the membrane of the amniotic sac. If the water is broken under the supervision of a physician, it is totally a safe procedure. Labor pain starts immediately after the water is broken, and it should not be done at home without medical supervision. The procedure is done by a physician using a small hook to break the amniotic sac membrane.

9.

After the Water Breaks, How Long Can I Wait?

It is mandatory to bring it to immediate notice once the water breaks. If the baby is at least 37 weeks old, then it is absolutely safe to wait for 48 hours to seek medical advice. However, it differs in each individual and depends on the condition of the fetus. If proper medical attention is not given, fatal complications may occur in certain cases.

10.

Should I Go to the Hospital if the Water Breaks and There Is No Contraction?

Immediately after the water breaks, and if the pregnancy is less than 37 weeks, medical intervention may be required. Also, if it has been more than 24 hours since the water broke, immediately seek medical help. If water breaks, then it might be a sign of labor in many women. For first-timers, it can be due to early labor, and the actual contractions may occur after 12 to 18 hours.

11.

What Are the Causes of Labor Pain?

Labor pain can occur due to the distension of the cervix along with the uterus contraction. Due to the stretching of the cervix, vagina, and the tissues adjacent to the baby, while the baby is moving out, labor pain is produced. Pain receptors in the nerves supplying muscles and ligaments of the pelvis produce extreme pain sensations.

12.

Does Water Break First, or Do Contractions Appear First?

Usually, after the water breaks, labor pain starts. But it does not happen in all cases. Sometimes there can be a delay in the contractions after the water breaks. Contractions can occur 12 to 24 hours soon after the water breaks.

13.

How to Identify Slow Labor?

Slow labor, also called prolonged labor, is the failure of the progression of labor. It happens when the first and second stage of labor does not progress as planned. Slow labor can be due to the baby being large, if the baby has a large head, or if the baby is in a difficult position. Slow progress can be risky if the mother is overweight or if it is the first pregnancy.

14.

What Do I Feel Before Labor?

Before labor, contractions can be felt that are mild and in frequent intervals that can last for hours or even days. Many women compare the pain to be similar to menstrual cramps.

15.

How to Make the Baby Drop?

At the end of the third trimester, babies begin to drop, also known as ‘lightning.’ In some individuals, it does not happen normally. There are different techniques to make the baby drop and make the baby settle in the pelvis. Walking, squatting, and pelvic tilts can help the baby drop.
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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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