The First Stage of Labor

pregnant bellyOnce you are having regular contractions, you are considered to be in true (or active) labor. The duration and distance between contractions will differ from labor to labor, but they may be around 5 minutes apart or less. You cervix will, at this point, probably be dilated to about 3 or 4 centimeters. You are entering the first stage of labor. The first stage of labor continues until it is time to push the baby out, which is the second stage of labor.

Throughout history, women have given birth in upright postures: sitting, standing, and mostly squatting. We know this is true because we see it over and over again in artwork from every civilization and every era. Margaret Mead said that whenever we see the same custom being used by many different peoples, it probably is based on some “very stubborn species-characteristic element that is worth following up.”

In the Renaissance, however, with the rise of science, the flat-on-your-back, or supine, position began to be used by doctors for difficult births. The reason for this was simple: it was more convenient for the physician.

Today the flat-on-your-back position is standard procedure in most American hospitals. Fortunately, the growing movement to return birth to a more natural process is slowly changing this. More and more hospitals now have birthing chairs or birthing beds in their labor rooms, and women are being taught alternative labor positions in childbirth education classes.

Why Upright is Best:

  • The force of gravity assists the baby in coming straight down and out of the birth canal. There is less need for forceps and the chances of cesarean delivery are decreased.
  • The mother is better able to use her abdominal muscles to assist her uterus in pushing the baby out. Imagine trying to have a bowel movement while lying flat on your back!
  • Labor is, on average, 36 percent shorter when a woman works in an upright position.
  • In an upright position, labor is less painful, with less need for painkilling drugs.
  • There is less chance a woman will need an episiotomy, or that a perineal tear will happen.
  • Women who are not confined to their backs on a table will naturally change positions and try new ones.
  • Being upright encourages better drainage of fluids and tissues from the uterus.
  • Pregnant women are advised not to lie on their backs for extended amounts of time in later pregnancy. That is because this position can reduce blood flow and oxygen to the uterus and to the baby. Why wouldn’t this be true during the labor process as well?

And finally, human beings tend to feel more vulnerable and less in control when they lie on their backs. This is a time when women need to feel powerful.

A Potpourri of Birth Positions
Here is a sample of the birth positions most commonly used around the world:

  • Squatting. This is the classic, time-honored position for women all over the world and is a favorite of first-time mothers. Try a supported squat with your back against a wall, or with your partner or a doula sitting in a chair behind you. If a full squat is just too hard to manage even with support, try placing pillows between your thighs and calves to take some of the pressure off your legs.
  • Kneeling. You can kneel on a pillow or soft rug and support yourself by leaning over onto a chair onto someone’s lap.
  • Standing and walking. You can use your partner for support.
  • Pelvic rocking. You may find it very helpful in labor to slowly rock your pelvis, like a belly dancer, during contractions.
  • Bending forward. Stand and lean over onto a tall table or counter.
  • Sitting. You can sit in a comfortable chair, in a birthing chair, or upright in bed. Try sitting backward on a straight-backed chair, with your legs open to either side, and support your upper body on the chair’s back.
  • On the toilet. Many women report that laboring on the toilet was good for them. This is probably because the toilet is a place where women are used to relaxing their pelvic floors.
  • Semi-reclining. This position involves sitting up at a 45-degree angle by propping yourself up with pillows or adjusting the angle of your hospital bed.
  • Hands and knees. Second-time mothers especially favor this position. This is a good one for back labor because it takes the weight off your spinal area. You can also rest on your elbows, rather than your hands.
  • Lying on the left side. Contractions will be stronger in this position than laying flat on the back, but still not as strong as an upright position. This takes the weight off the main blood supply to the baby and reduces tension on the perineum.

Back Labor
While most women experience at least a bit of back discomfort during labor, for some it can be acute. This is especially true if the baby is in a posterior presentation, with the back of his head pressing against your spine. You will probably also experience back labor if the baby is in a breech position.

Try these tips:

  • Change positions frequently. Lying on your back will be the most uncomfortable position because gravity will cause the baby’s head to press even more against your spine.
  • Ask that your membranes not be artificially ruptured. Once the waters are broken the baby may sink into the pelvis in that same posterior position, and there will be cushion between you and the baby’s head.
  • Use massage as a pain aid. Counter pressure against the back using the heel of the hand or a tennis ball can be very helpful.
  • Acupressure may offer relief. Try applying pressure just below the center of the ball of your foot. Also try the fleshy pads under the big toe and the one next to it.
  • Apply heat to the area.
  • Take a hot shower and let the water cascade onto your back area.
  • Ask a homeopathic practitioner ahead of time about remedies for back labor, which may include Kali carbonicum, Pulsatilla, Causticum, Nux vomica, Chamomilla, or Coffea cruda.

Signs of an Emergency in Early Labor
It isn’t likely that you will experience an emergency situation at this point in your labor, but it’s good to know the signs, just in case:

  • More than a tablespoon of bright red blood. If you are bleeding, do not allow anyone, under any circumstance, to give you a vaginal or rectal examination unless you are in a hospital. Bleeding can indicate a serious condition, which could be aggravated by an examination.
  • A greenish or discolored discharge.
  • An abdomen that remains hard and tense between contractions.
  • Any sign of the umbilical cord coming out of your vagina. If this happens, get into a hands-and-knees position with you head down and your bottom in the air immediately. Call 911 and try to stay in this position on the way to the hospital in order to avoid putting any pressure on the cord and cutting off the baby’s oxygen supply.

If you experience any of these symptoms, call your practitioner immediately.