STAGES OF LABOR Childbirth, also called parturition, is the culmination of pregnancy.

It usually occurs within 15 days of the calculated due date. The series of events that expel the infant from the uterus are referred to collectively as labor. The four stages of the childbirth process are based on changes in the uterus and cervix as labor progresses. Stage 1. Dilatation and Effacement First stage of labor which is the longest begins with the onset of regular contractions which progress to cervical dilatation and effacement. There are three phases on the first stage: the early or latent phase, the active phase and the transition phase. At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours and shorter on subsequent pregnancies. Early or Latent Phase.During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. Active labor is marked by regular contractions that become longer, stronger and closer together over time. The cervix is 4-7 centimeters dilated. It is recommend that you go to the hospital when the contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measuring the contractions from the start of one contraction to the beginning of the next must be done. A tightening feeling in the pubic area and increasing pressure in the back is felt. Breathing techniques may already begin. Pain medication is often given at this stage. Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 8 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. Stage 2. ExpulsionStage this begins with delivery of the newborn and ends with delivery of the placenta. Average length for first time mother ranges from one to two hours and shorter on subsequent births. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has successfully passed through the pelvic brim. Ideally it has successfully also passed below the interspinous diameter. This is the narrowest part of the pelvis. If these have been accomplished, all that will remain is for the fetal head to pass below the pubic arch and out through the introitus. This is assisted by the additional maternal efforts of bearing down . The fetal head is seen to crown as the labia part. At this point the woman may feel a burning or stinging sensation. This is also known as the ring of fire. Stage 3. Placental StageThis begins with the birth of the baby and ends with the delivery of the placenta. Average length for all vaginal deliveries ranges from five-to-fifteen minutes. Maternal blood loss is limited by contraction of the uterus following delivery of the placenta. Normal blood loss is less than 600 ml. The third stage can be managed either expectantly or actively. Expectant management (also known as physiological management) allows the placenta to be expelled without medical assistance. Breastfeeding soon after birth and massaging of the top of the uterus (the fundus) causes uterine contractions that encourage delivery of the placenta. Active management utilizes oxytocic agents and controlled cord traction. The oxytocic agents augment uterine muscular contraction and the cord traction assists with rapid delivery of the placenta. Stage 4. Recovery StageThis begins with the delivery of the placenta and ends from one to four hours after birth. In this stabilization phase, the uterus makes its initial readjustment to the nonpregnant state. The primary goal is to prevent hemorrhage from the uterine atony and the cervical or vaginal lacerations.