How Does My Body Work During Childbirth?

Learning how your body works at the end of pregnancy and during childbirth is very helpful as you prepare for birth. When you understand what is happening, you can interpret your body's signals more effectively and participate more fully in your labor and birth.

What do things look like inside?

Let's review the basic anatomy of your pelvis, uterus, and cervix and the structures surrounding them and your baby. 

• The bones and muscles of the pelvis provide support for the growing uterus and baby, and provide a passage through which your baby emerges during birth.
• The uterus surrounds the baby, growing as the baby grows.
• The cervix is actually a part of the uterus, but made up of different tissue. During pregnancy, the cervix is thick and closed. As you approach the time of birth, your contractions draw the cervix up into the body of the uterus, and it becomes thinner (called effacement) and opens (called dilation).  When the cervix is fully dilated (about ten centimeters), contractions help the baby begin to move from the uterus into the vagina.
• The vagina leads from the cervix to the outside of your body. The inside of your vagina has many folds, called rugae, which unfold as the baby passes through.

What happens in my body before labor begins?

Your body prepares for childbirth throughout your pregnancy, but in the last few weeks, it does some final preparation. 

• Hormones work to soften the ligaments between the bones in your pelvis, which gives your pelvis additional room for birth. During this time, you might feel a shift in your sense of balance, your joints might feel looser, and you might feel sore and achy.
• Other hormones begin to soften your cervix, which is the neck of the uterus. Throughout most of pregnancy, your cervix is closed, holding the baby inside your uterus. Much of the work of labor is in opening the cervix to the passage of your baby. However, your cervix may begin to soften, thin, and open even before labor begins. This varies from woman to woman, and from pregnancy to pregnancy. Some women may have closed cervixes until labor starts. Others may have pre-labor contractions that dilate their cervix to three or four centimeters (or even more) before labor begins. Your doctor or midwife may offer to check your cervix at your prenatal appointments as your estimated due date approaches, but remember that this is not a good prediction of when you will go into labor.
• Your baby may begin moving lower in the pelvis, which is called engagement. You might notice this as increasing pressure in your low abdomen, or you might notice that breathing becomes easier. Your family or friends may comment that you look different, or that your "baby has dropped." For first time mothers, this may take place up to a few weeks before the birth. For some second- or subsequent-time mothers, engagement may not occur until after labor begins.
• You may experience the passage of stringy, perhaps blood-tinged mucous. This "mucous plug" has been in place inside the cervix during your pregnancy, and as the cervix begins to soften and open, this mucous loosens and may begin to pass from the vagina. Some women may notice this increased mucous passage for a few days (or even weeks) before labor begins, others may not notice it at all.
• The breaking of the bag of waters (ruptured membranes) may also occur before labor begins. For most women, contractions will follow within a day. (You will want to notify your midwife or doctor if you think your water has broken.)

What about pre-labor contractions?

Any of the changes mentioned above may be accompanied by pre-labor contractions. Although all women have contractions during late pregnancy, some women do not notice them intensely until labor starts, while for others they may be more painful, disrupting sleep or other activities.

Pre-labor contractions are irregular and may or may not be painful. (You might have heard these contractions referred to as Braxton-Hicks or false labor contractions.) Changing activity might cause the contractions to go away or occur more often. You might experience them for several hours before they subside, or you might have them off and on for several days.

One tip to coping with pre-labor contractions is to try to get as much rest as you can, even if the contractions wake you. Stay well hydrated and continue to eat. Position changes, warm baths or showers, and massage might be helpful.

Ginny's baby started moving lower in her pelvis about three weeks before her due date. She started noticing a little stringy mucous a few times a day. She felt a lot of pressure in her pelvis, shifting positions in bed got harder, and sitting for any length of time became uncomfortable. She felt the pressure even more when she walked. Her family all commented that the baby had dropped. She wondered how much longer she would have to feel this uncomfortable before her baby was born.

Lorinda began to notice a pattern of contractions every evening about a week before her due date. Some of the contractions were painful enough that she thought labor was starting, but after a few hours they would subside. She called her midwife to ask if this was normal, as she had not experienced contractions like these before her first baby. Her midwife assured her that it was normal and suggested some coping techniques, including drinking plenty of liquids, adding a rest period in the afternoon, and taking a warm bath when the contractions started in the evening.
 
Like Ginny, Lorinda began to wonder how long she would have to put up with this before the baby was born. Ginny's doctor and Lorinda's midwife both assured these women that everything was normal, and that when things were normal, it was best to wait to go into labor and to use measures such as massage, hydrotherapy, warm packs, and Reiki [1] to make themselves as comfortable as possible while they waited.

What can I expect emotionally?

In addition to the natural physical preparation, you may also find yourself doing some emotional preparation. You may feel a strong need to be ready and want to tackle some last-minute projects. (Take it easy with these and pace yourself. Save your energy spurt for labor!) 

You might find yourself worrying more than usual, and these worries might change. You might be concerned about making it through labor, whether your water will break in public, whether your own midwife or doctor will be on call when you go into labor, whether your partner will really be able to help you, or even whether you will have a bowel movement during the birth and how your partner might react to that. You might be worried about the safety of you and your baby during birth. You might be worried about having a cesarean section. You might even worry about dying. These concerns are common.

If you find that you are unable to relax because of worries, try to find a time each day to reflect on and acknowledge them. Call it your "worry time." You might try an exercise like this:

• Choose a concern and state the concern out loud. For example, if you fear a cesarean section, you might say: "I am afraid that I won't be able to give birth vaginally."
• Mention some of your positive qualities or characteristics that might help with the concern. For example, "I am strong and healthy, and I am well-designed to give birth."  
• Now restate the concern in a positive way, including the likelihood that it may or may not occur, and how your positive qualities will help you with your concern. "My strength will help me if I need to have surgery, but almost all women can give birth vaginally. I am strong, and I can too."  
• Come up with a similar affirmation for each of your concerns. During your "worry time," repeat each affirmation several times and then tell yourself that worry time is over. 
• For the remainder of the day, if you find worries creeping in, repeat the positive endings to the affirmations. ("I am strong, and I can give birth.")  Give the majority of your energy to the positive statements.

In the Activities, you will find a link to a guided relaxation exercise, focusing on positive mental preparation for birth.

What are the stages of labor?

There are three stages of labor, excluding the preparatory changes discussed above.

• First stage: dilation. You have contractions that work to open your cervix. 
• Second stage: pushing. You have contractions that bring your baby down into the vagina and out into the world. You assist this process by pushing. 
• Third stage: placenta. You continue to have contractions that free the attachment of the placenta, and you push the placenta out.

What influences the progression of labor?

Childbirth professionals often refer to the following factors influencing labor progression as the "Four Ps" of labor:

• Passenger (your baby)
• Passage (the pelvic bones, your cervix and vagina, and the muscles in your pelvis)
• Power (your contractions) 
• Psyche (your emotions)

What happens in the dilation stage?

We don't fully understand what makes labor start, but changing levels of hormones influence the softening and preparation of the cervix and the onset of contractions. The contractions that you might have noticed before labor get stronger and more regular.

Your uterus is actually made up of layers of muscles-some that go around the uterus and some that go up and down. The contractions of these muscles pull on the cervix and help to open it and put pressure on the baby, helping the baby move downward.

Pressure from the baby's head against the cervix during contractions also helps to thin and open the cervix. To help you picture this, imagine putting on a turtleneck shirt. The neck is thick and smaller than the body of the shirt, but stretches as you pull it over your head, becoming thinner and more open.

The dilation stage can be further subdivided into phases of early labor and active labor.

During early labor, the contractions gradually get closer together and stronger. If your midwife or doctor checks your cervix, you might learn that it has changed from a previous office visit or previous exam, but it is normal to have slow dilation and effacement during this phase. Most women prefer to spend early labor at home, as they have freedom to move about, use their shower or tub, eat, and watch TV or movies. Most doctors and midwives also agree that the best place for a woman in early labor is at home. This early phase of labor is the most variable in length and most difficult to predict. For some women, it might pass so quickly that it is almost unnoticed, while for others, it could last for more than a day. 

During active labor, the contractions are strong and regular, usually occurring every three to five minutes. You will find that you need to concentrate on each contraction. Your cervix begins to change more quickly, and it is easier to predict the length of time that this phase will last. Various researchers have estimated lengths of between five and ten hours for first-time mothers and between two and eight hours for women who have already had children.

What can I do during the dilation stage?

During this time of labor, consider the time of day. If you would normally be sleeping, try to rest. If possible, try to sleep between contractions. You don't know how much time will pass before birth, and it is best to start labor well rested. However, the onset of labor is often accompanied by a burst of adrenaline, and you might find that you are too excited to sleep. See some of the relaxation tips below. If it is daytime, alternate periods of activity with periods of rest, conserving your energy as much as possible for the active labor to come.

Review the sections What About Pain? [2] and What Factors Influence the Natural Progression of Childbirth? [3] for suggestions on coping with pain and encouraging the progression of labor. Here are some additional suggestions:

• Try to promote a feeling of wellbeing and rest at the start of labor. A warm bath or shower, warm beverage, and a progressive relaxation exercise can help with this. 
• Stay well hydrated. A general rule of thumb is to have at least 8 oz. of liquid each hour. Liquids with calories such as juice, sweetened tea, or sports beverages may help provide energy for the work that you are doing.
• Eat lightly during early labor. When you have contractions, your digestive system naturally moves more slowly and you may find that you become nauseated. Choose foods with this in mind. Some easily digested foods include fruits, yogurt, or toast. You might want to avoid foods with a higher fat content, such as meat, because they digest slowly.
• Choose positions of comfort. You might find that your body almost instinctively moves to certain positions during contractions, almost as if it knows what will help encourage the movement of the baby through the pelvis. Slow swaying movements could also help during contractions. Standing also helps your body and your baby work with gravity, and encourages the downward movement of your baby through the pelvis.
• Consider using massage [4], bodywork, music [5], and hot or cold packs.
• Try out any breathing techniques with your contractions during early labor to get an idea of how to work with the ebb and flow of a contraction. But don't use them for every contraction until you need to.
• Consider using visualization techniques. You might choose a very literal visualization, where you picture your cervix opening around the baby's head, or a representative visualization, where you picture something else that opens, such as a flower unfolding.
• Try using vocalization to relax the muscles of your pelvis and your abdomen. Try this exercise ahead of time: Make a high-pitched noise, like "Eeekk!"  Pay attention to what happens to your muscles around the vagina and in your abdomen. Do you feel them tighten? Now make a slow, long, low-pitched deep noise like "Oooohhhhh."  Do you feel your muscles relax and loosen? The same thing happens during labor. Low, slow, deep moaning helps to relax the muscles of the pelvic floor and abdomen, and screaming has the opposite effect. Your labor companion or companions can help remind you of this as you vocalize during labor. 
• As your contractions become closer and stronger, begin to gather your support people so that they can help you.

Your emotional wellbeing is as important during active labor as your physical wellbeing. Fear, anxiety [6], and excitement can all trigger the release of adrenalin, which can slow your labor progress. Talk about your feelings with your partner and other support persons. Progressive relaxation, imagery [7], positive affirmations, and good emotional support can all help relieve anxieties and encourage the progression of labor.

When should I go to the hospital?

Most women wonder when to notify their midwife or doctor and when to go to the hospital.

In general, most providers and most laboring women agree that early labor is best spent at home. You have freedom of movement at home, may use the bathtub, rest in your own bed, watch movies, and eat and drink.

If you have had an uncomplicated pregnancy, your provider will probably tell you something like, "Call me or the hospital when the contractions are three to five minutes apart and have been that way for more than an hour."  You should also call your midwife or doctor if your bag of waters breaks, or if you notice any heavy bleeding. If this is your first baby, you might consider waiting until the contractions are three minutes apart before calling, but if you have had children in the past or live far from the hospital, then use the five-minute guideline.

However, the frequency of your contractions and the length of time you have been having them are not the only factors that may help you decide when it is time to go to the hospital. The strength of the contractions and your emotional state are also a consideration. As labor progresses, you may find that you pass from excitement to a serious phase of work. 

• If you are still feeling excitement and are able to talk or smile through contractions, it might be too soon to go. 
• If you have settled into the work of labor, cannot talk during contractions, find it difficult to walk or change positions during a contraction, and must focus on every contraction, this is a better indication that it might be time to go to the hospital.

Many women worry about going to the hospital "too soon" and being sent home, and this is especially hard when you are having a baby for the first time. It is okay to go to the hospital, be evaluated, and then return home. Remember that home is the best place for early labor. The longer you are in the hospital, the more likely your midwife or doctor is to suggest interventions, however well-meaning, as it is simply human nature for everyone to want to welcome your baby.

If you are planning a home birth, your midwife probably has told you something like, "Call me when the contractions start."  She may not come at that time, but needs to begin to plan.

Carrie woke in the middle of the night with contractions five days after her due date. They were painful, but irregular. She tried to rest in between the contractions and sometimes drifted off, but always awoke when her next contraction started. She tried changing positions, and found that she was more comfortable in the rocking chair, so she dozed off and on there, sipping water after each contraction. Her contractions got even stronger. She decided to call Tina about three hours after she began having contractions, and by the time Tina got to her apartment, her contractions were regular and strong, and Carrie began to notice a little blood when she went to the bathroom. Tina helped Carrie with vocalization and relaxation during the contractions, and both sisters realized that Carrie was unable to do anything but concentrate on each contraction. They decided to go to the hospital, where a nurse checked Carrie and found her to be 4 centimeters. Carrie felt that the vocalization and relaxation was working well to help her cope at this stage in her labor. Her nurse brought a large pitcher of water for Carrie, and brought in a rocking chair, since that had worked well at home, as well as a birthing ball for Carrie to try.

What happens in the pushing stage?

After your cervix has opened fully and the baby has descended low enough into the pelvis to push on the muscles and nerves of the pelvic floor, you may begin to feel an urge to push. Although the second stage technically begins when the cervix is fully dilated, this might not happen at the same time as the descent of the baby. So, some women might feel like pushing before the cervix is fully open, while others might not feel like pushing until sometime afterwards.

During the pushing stage, the contractions change to become expulsive. 

• If you begin to feel like pushing before the cervix is fully open, you might notice that your uterus does this pushing, and that you cannot stop it. Your midwife or doctor may encourage you to push gently at this time, or may ask you to try to keep from pushing. If this happens, just recognize that while you cannot stop your uterus, what you can do is avoid holding your breath or bearing down with your abdominal muscles. 
• If your cervix is fully open, but you do not yet feel like pushing, it is usually best to wait until the baby is lower and triggers this urge.

You might be able to feel the downward movement of your baby, but some women do not notice this very much. Your baby is making a series of turns as he or she travels through the pelvis, turning his or her head to make the best fit. Click here [8] for a good animation that shows this. (Click on the picture, then click the arrow control on the bottom left to start the animation.)

If you have had an epidural or intrathecal anesthesia, you might feel strong pressure during the second stage, which helps you know when to push. If you have very little feeling, your nurse, midwife, physician, or partner may give you more guidance with pushing. It is normal for the pushing stage to last longer for women with epidurals than it does for women without.

What should I do in the pushing stage?

Once pushing begins, follow your body's urges. Try different positions to see which feels best to you. (See What About Pain? [2]for suggestions, as well as tips for coping with pain during the birth itself.) Your midwife, doctor, or labor nurse might offer suggestions as well.

Two common styles of pushing have caused some debate among childbirth providers and researchers.

• In the first style, women are encouraged to hold their breath and push as hard as they can for about ten seconds, repeating this three or four times with each contraction, taking one quick breath between pushes.
• In the second style, women are encouraged to exhale or grunt as they push and to push for briefer periods than ten seconds. In this style, a woman might push six to eight times during the contraction and take more breaths between pushes. The second style of pushing has been associated with better fetal heart rate patterns, as more oxygen is available to the baby. It takes a little longer than the first style, but not by much. If you push using this style and make good progress, it conserves your energy as well. On the other hand, many childbirth providers continue to use the first style, especially if a woman does not appear to push well.

Your emotional wellbeing is as important in the second stage of labor as it is in the first stage. If pushing goes quickly, you might feel overwhelmed to suddenly have your new baby in your arms with little time to adjust to the idea.

If pushing progresses slowly, you might become frustrated and tired, and begin to doubt whether you can continue. You might feel like you are pushing as hard as you can, yet are asked for even more by your doctor or midwife. If this happens, sometimes it is useful to take a rest or a break from pushing, rest on your side, push gently with contractions, and have something to drink. This can help you recover both physically and emotionally. Encouragement and support from those around you are most crucial now.

As you get closer to the time of birth, your support persons and midwife or doctor may tell you about what they are seeing, and you might feel more of the head as it expands your vagina and the muscles and skin around it. If you look in a mirror, you can get your first look at your new baby. You might feel tremendous stretching and burning, and your midwife or doctor may ask you to push gently to ease the baby's head out to minimize any tears. With a final push or two for the shoulders, you will be able to welcome your child.

(A few words about episiotomy: In some circumstances, such as a baby with a low heart rate, your doctor or midwife may cut an episiotomy before the baby's head is born to speed up the birth. An episiotomy is a cut in the skin and muscles of the perineum. Your doctor or midwife might also cut an episiotomy if they feel it might avoid a large tear. A few providers may do an episiotomy routinely. This is a question worth asking as you choose your healthcare provider.)

Lucia and Roberto had a much longer labor with their third baby than they had experienced before, and she pushed a little longer this time, too. Although her midwife kept assuring her that she was making progress, Lucia was frustrated and confused, as she had expected things to be easier. With help from Rob and her midwife, Lucia tried to relax completely after each contraction, and she pushed in several positions, including on her hands and knees and in a squatting position. Shortly after switching to her hands and knees for the third time, Lucia felt a great deal more pressure, and knew that the baby was coming. Her midwife confirmed that the baby had shifted position. Within several contractions, her baby was born, and Lucia could see even before her new daughter was weighed that she was her biggest baby so far.

What do I need to know about the third stage?

Your baby is out. You might be holding the baby, or you might have asked someone else to hold the baby briefly while you regroup. Many babies cry vigorously shortly after birth, some breathe readily but are quieter, and a few need a little encouragement in their transition and might be moved briefly to an infant warmer.

While you are getting to know your baby, your doctor or midwife is watching for signs that your placenta is ready to come out. They will remind you of your final physical task of labor, and ask you to push out your placenta. While you admire the baby, your uterus continues in its work, contracting and reducing in size, so that the placenta detaches from its site. Once this has happened, a few pushes are usually all that is required to birth the placenta.

Generally, the placenta is delivered within a few minutes, but delays of up to thirty minutes are considered normal. If the separation is delayed, breastfeeding the baby or stimulating your nipples may help trigger contractions to encourage separation. Some midwives and doctors give medication, such as oxytocin to help encourage separation, or they may give the medication after the placenta is out to help minimize bleeding.

Now what?

One of the limitations of this website is similar to that of many childbirth classes or preparation books. In the focus on childbearing, little attention is paid to the aspect that will ultimately take up much more of your time and lead to more personal growth than pregnancy and birth ever did: your new role as a parent.

We hope that many of the things you have learned during your pregnancy and birth will also prepare you for your growth as a parent. A holistic approach to parenting and taking care of yourself while parenting offers countless benefits, including a thoughtful awareness of how you are feeling physically, emotionally, and spiritually.

Complementary therapies and practices you might have learned during pregnancy, such as massage [4], Reiki [9], and aromatherapy [10], can continue to offer healing comfort and relief from physical symptoms. Additionally, the methods of relaxation that you adopted during pregnancy can help relieve stress [11], both during your child's infancy and throughout the growth of your child. Indeed, many parents have stated that they draw on the strength they found in childbirth during challenging times of parenting.

Finally, skills you learned in advocating for yourself [12] in the healthcare system remain important, both for yourself and for your child.

The author of one of the most famous books on childcare, Dr. Spock, starts each edition with the words, "Trust yourself." You can. No one else will ever know your child or have his or her best interests at heart as much as you do.

Additional Readings

Everyday Blessings: The Inner Work of Mindful Parenting. 1998. Myla and John Kabat-Zinn. Hyperion.

Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby. 2005. By Tracy Hogg and Melinda Blau.

The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby. 2001. By Martha Sears.

The Baby Book: Everything You Need to Know about Your Baby from Birth to Age Two. 2003. By William M. Sears, Martha Sears, Robert Sears, James Sears.

The Womanly Art of Breastfeeding, 7th ed. 2004. By La Leche League International.

Touchpoints: 0 to 3. 2006. By T. Berry Brazelton, Joshua D. Sparrow, Joshua D. Sparrow.