Holistic Pregnancy & Childbirth

What happens in the dilation stage?

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 pregnant people 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 birthing person in early labor is at home. This early phase of labor is the most variable in length and most difficult to predict. For some people, 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 people who have already had children.

What can I do during the dilation stage?

Try to relax. 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? and What Factors Influence the Natural Progression of Childbirth? 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, bodywork, music, 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, 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, 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's Story

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 birthing people 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 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 birthing parents do not notice this very much. Your baby is making a series of turns as they travel through the pelvis, turning their head to make the best fit. Click here 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 individuals with epidurals than it does for individuals without.

What should I do in the pushing stage?

Once pushing begins, try different positions to see which feels best to you. 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.

1. In the first style, birthing people 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.
    
2. In the second style, birthing people are encouraged to exhale or grunt as they push and to push for briefer periods than ten seconds. In this style, a birthing person 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.