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What stages will I go through during labor and childbirth? (Part 2)

What stages will I go through during labor and childbirth? (Part 2)

First stage: Transition

The last part of the active phase — when your cervix dilates from 8 to a full 10 centimeters — is called the transition period because it marks the transition to the second stage of labor. This is the most intense part of labor. Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more, and you may find yourself shaking and shivering.

By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously — to "push" — and may even start making deep grunting sounds at this point. There's often a lot of bloody discharge. You may also feel nauseated or even vomit now.

On the other hand, some babies descend earlier and the mom feels the urge to push before she's fully dilated. And some babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and every birth.

If you've had an epidural, you'll feel varying amounts of pressure, depending on the type and amount of medication you're getting, and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.

How long it takes

Transition can last anywhere from a few minutes to a few hours. It is much more likely to be fast if you've already had a vaginal delivery.

Coping tips

If you're laboring without an epidural, this is when you may begin to lose faith in your ability to cope, so you'll need lots of extra encouragement and support from those around you. The good news is that if you've made it this far without medication, you can usually be coached through transition — one contraction at a time — with constant reminders that you're doing a great job and that the end is near.

Second stage: Pushing

Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them. Many women find their contractions in the second stage easier to handle than during active labor because bearing down offers some relief. Other women don't like the sensation of pushing.

If your baby's very low in your pelvis, you may feel an involuntary urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you won't have this sensation right away. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push.

Waiting a while may make you less exhausted and frustrated in the end. However, in many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent — so let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. If you have an epidural, the loss of sensation makes it hard to feel what you're doing, so you'll need explicit coaching to help you to push effectively.

Your baby's descent may be rapid or, especially if this is your first, gradual. With each contraction, the force of your uterus — combined with the force of your abdominal muscles if you're actively pushing — exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression. Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of different positions during the second stage.

After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible, a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.

Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vagina and perineum. A slow, controlled birth can help prevent you from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.

Your baby's head continues to advance with each push until it "crowns" — the time when the widest part of his head is finally visible. The excitement in the room will grow as your baby's face begins to appear: his forehead, his nose, his mouth, and, finally, his chin.

After his head emerges, your doctor or midwife will suction his mouth and nose and feel around his neck for the umbilical cord. (No need to worry. If the cord is around his neck, your caregiver will either slip it over his head or, if need be, clamp and cut it.) His head then turns to the side as his shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as his shoulders emerge, one at a time, followed by his body.

Once he hits the atmosphere, your baby needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby's mouth and nasal passages again if he seems to have a lot of mucus. If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket — and perhaps given his first hat — to prevent any heat loss. Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps or your partner can do the honors.

You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.

How long it lasts

The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.

Third stage: Delivering the placenta

Within minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall. When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.

How long it lasts

On average, the third stage of labor takes about five to ten minutes, though it can last up to 30 minutes or more.

And then what?

After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that it remains firm, and massage your uterus if it isn't. This is important because, as it contracts, the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.

If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but hold your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse within the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers your body to release oxytocin, the same hormone that causes contractions, and helps your uterus stay well contracted.

If you're not nursing or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll probably be given other medications as well.

Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. (If you've had a baby before, you may continue to feel occasional contractions for the next day or two.)

These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also find that you get a case of the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.

Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to see if you have any tears that need to be stitched. If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches — it can be a great distraction. Or, if you feel too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.

If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. (This takes just a second and doesn't hurt.) Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his birth.

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