The birth is divided into three stages mainly: dilation, expulsion, and delivery. Each of them has certain characteristics and duration that you should know to be well prepared for when the time comes.
This stage begins with the first labor contractions that cause the onset of cervical dilation and ends when it reaches 10 cm, a measure necessary for the baby to leave the birth canal. This stage is divided into two others:
- Latent phase. It includes from the beginning of the expansion until it reaches 4 cm. In this period the contractions begin to be more irregular and less intense, but, as labor progresses, they become increasingly intense, strong, frequent and painful. This causes the cervix to begin to erase and dilate to reach 4 cm. Generally, unless you have broken the bag of amniotic fluid, it is advised to be at home, at least until you have two contractions every 10 minutes for two hours, since the latent phase can last even days, and in the hospital you do not They will enter until the contractions are not very regular and frequent.
Therefore, you should monitor your contractions, be calm, prepare everything and even take a shower. When you see that the time has come, you can go to the hospital, while at home you will be calmer.
- The active phase begins when the cervix reaches 4 cm dilation and ends when it reaches 10 cm. In this phase, the contractions become much more frequent, regular and painful, and it is usually the phase in which the epidural anesthesia is put on if the mother so wishes. If you are not monitored or have put on your epidural, you can relieve pain and promote dilation by walking or exercising with the pilates ball.
This phase can last between 3 and 18 hours, depending on whether the woman is primiparous or not, the size of the baby, the posture she adopts at this time, etc.
During the dilation phase, as we said, it is normal to be at home during the latent phase and already in the hospital or motherhood once the active phase begins. During this time you will be in a room with your partner, which is usually individual, where you can lie, sit, walk or exercise, as you find yourself. If you have put on the epidural, unless it is the epidural walking, you will not be able to walk, so you will remain lying down. In this case, to promote dilation, it is recommended to change the posture of the legs.
The midwives or the doctor will see you from time to time to see if the baby is well using the fetal monitors, which may be permanently placed or not, and how the dilation is going through the vaginal touches. In addition, they will place an intravenous line and put the epidural if it is what you want, preferably when the cervix is more than 3 cm.
Try to be as calm as possible to favor the process and reduce pain and tension. Being relaxed also shortens the duration of labor. Remember what you learned in childbirth preparation classes about breaths. You can also play background music if it helps you to be calmer.
This phase includes the complete dilation of the cervix until the baby leaves the birth canal, that is, is born, and is carried out in the delivery room.
During this stage the contractions become increasingly intense, long and frequent and, in addition, the child’s pressure on the perineum makes the mother feel like pushing. However, not all women feel the urge to push as soon as they dilate, so you should not force the bids, but wait until the baby has descended completely and you feel like it.
In women who have the epidural, it is possible that these desires are not noticed, although it is true that the doses of epidural are increasingly controlled better and it is normal to also notice the urge to push, even if you have put the anesthesia.
Therefore, there are different types of bids according to the woman, more or less wanting to push:
- Spontaneous bids: they are those that the woman performs freely whenever she feels like pushing. You must push as hard as you can and you can help by emitting some noise or throwing air while pushing. Remember that it is more beneficial than pushing out the air (with the glottis open), than withholding it (with the glottis closed).
- Targeted bids: those that are indicated by the medical staff, midwife or gynecologist, according to the contractions detected on the monitor’s screen. With each new contraction, they will tell you to push with all your strength. Although in this case the Valsalva Maneuver is usually used, which means that, with the arrival of the contraction, the woman must take a lot of air and push retaining it, this technique can damage the pelvic floor or limit the oxygen supply to the Mom and the baby, so it is better to push with the open glottis too, that is, by expelling the air.
Each bid helps the baby descend through each of the planes that make up the pelvis until, finally, it’s crown head, that is, is visible through the vagina. At that time, you have to push harder to get the head out and, once it is out, the rest of the body comes out more easily. If the baby does not go out alone, he can be helped by episiotomy (a small cut in the perineum) or with medical instruments such as forceps or suckers.
The best positions for the expulsive are those that take advantage of the force of gravity, such as squatting or standing, but if you have put the epidural you will not be able to adopt them, in addition to that, in most centers, they prefer that you lie. If you can’t squat, try to stand on all fours, semi-sitting or in lateral recumbency. Lying on your back is the least recommended posture, even if the medical staff prefers.
The duration of this phase also depends on each woman and whether it is the first birth or not, but usually lasts between 30 minutes and 2 hours.
Although many women think that childbirth ends when the baby is born, the truth is that the birth phase is still missing, in which the woman expels the placenta. At that time you will begin to notice smoother contractions than the previous ones that will help expel the placenta and all placental tissues. You must keep pushing to help the placenta take off and leave. Once outside, the doctor checks that it has come out completely and there are no remains left inside the uterus that can cause bleeding and infections.
Also, if an episiotomy has been performed, at this stage it is time to suture the incision. Once this process is finished, which usually lasts a total of 45 minutes, you can return to your room with your little one.