Early Types of Labor*

Labor begins with the gradual softening and ripening of your cervix which is located at the base of your uterus. During the majority of your pregnancy your cervix looks as if it is a long tube, but as it softens it slowly draws up, thinning out, until it is nothing more than a slight dip at the base of your uterus.

If you think of your uterus as a bottle, then the cervix is the bottleneck, as it ripens and thins your cervix shrinks in until it is almost part of the bottle.

This work is done by the contractions commonly referred to as Braxton-Hicks, your OB/Midwife may refer to these sensations as practice contractions but the reality is that B-H contractions do a lot of the early work.

B-H type contractions feel like a tightening, your uterus hardens. The contractions last maybe 15-20 seconds and may occur every 10 minutes for awhile and then stop. They are common in the last 3 weeks of pregnancy.

This process can take many days or it can happen all at once, repeat moms usually thin faster.

Because of these early contractions you may already be partially dilated before you even realize you are in labor. It is common to perhaps be a couple centimeters dilated at your last pelvic exam.

It is certainly more valuable and reassuring to know that far from “practice” your body is already working on your behalf while you continue carrying on with your normal routine.

The medical world does not consider you to be in labor at this point. Thats fine, no need to be in hospital at this point anyway. Head to Prenatal Yoga class instead or take a long walk.

However, you must start to assess your contractions, learn what your body is doing, so that you can work to help birth. Truly listening to your body and your baby will help you come to the best decisions about handling each contraction.

Identify the sensation and immediately apply the appropriate positive response and several positive actions should be initiated at this point:

Carry on with your normal routine for as long as you are able and comfortable.
Practice a form of the Release Response cuing your body and your mind to relax around the sensations you are feeling in your body.
Add gravity where you can. Standing, upright sitting, propped up in bed.
Add some squats to your daily routine.

It is good to train your mind by priming it with these preferred responses, your mind will be more likely to use them as a “go-to” on your big day.

It is much easier to cement a practice while discomfort is relatively minor. I teach them as a part of every prenatal yoga class and today is a great day to get started.

Some moms will experience pre-labor contractions. This is called prodromal labor, real contractions that serve as a precursor to the onset of full active labor.

These contractions start then stop, they are inconsistent but are not the same as Braxton-Hicks.They feel like and are real contractions but they do not lead towards descent. Prodromal labor can last for days even weeks. It deserves its own post.

Most pre-labor feelings like restlessness, nesting and irritability may only be identifiable after you give birth.

There are, however, some reliable signs that your labor is about to begin:

1.  You lose your mucous plug. You see some bloody show or a gooey blob in the toilet bowl. This is an encouraging sign but no need to go to the hospital or call the doctor             simply go back to whatever you were doing.
2.  Your water breaks.This demands a more complicated answer and therefore has it’s own post.
3.  Regular contractions begin.

I am setting both “your water breaks first” and “prodromal labor” to different posts under the Special Circumstances category. And continuing on…

The stretching and thinning of your cervix triggers oxytocin production which will drive your contractions making them take on a rhythm. You will start to feel tightening pressure (hardening) both at the top and the bottom of your uterus.

If this is your first baby then you are probably unsure of what to expect during labor and may find yourself seeking admission to your hospital/birth center while you are still in one of the early phases of Labor.

Obstetrical maternity care and the majority of childbirth educators typically classify these early contractions as “false” or “pre-labor” and divide “actual” labor into three to four stages. I will mostly follow suit although I’m not sure Birth is such a stickler for man-made rules and I call early labor what it actually is: Early Labor.

Stage 1 spans the length of time from the beginning of “actual” labor until your cervix is fully dilated and has three phases. Latent, Active, and Transition.

Stage 2 spans the length of time it takes for pushing crowning and delivery of your baby

Stage 3 is the length of time it takes to deliver the placenta

Stage 4 arbitrarily lasts 1-2 hours after the delivery of the placenta. The immediate postpartum, where a women is closely observed while her body attempts to regain its equilibrium and recover.

It is essential to realize that both the early and latent stages of labor can last for a very long period of time. It is therefore vital to know the guidelines for assessing labor so that you can identify where you are in the process more accurately.

You need criteria that do not entail a medical exam. Criteria such as the decreasing intervals between contractions and the increasing intensity of abdominal pain are accurate indicators. Other tell tale symptoms are discussed at each of the various phases.

Early arrival at the hospital or birth center only to be sent home (or worse kept and "helped to progress") leaves women confused, embarrassed, insecure, and perhaps angry.

When women are able to accurately recognize the active phase of labor their confidence increases as does their feeling of being in control, which in turn greatly reduces anxiety levels.

Time to find a contraction app on your phone and use it to time your contractions. Once they get going well they will have a regular rhythm and will steadily get longer, stronger and closer together.

Periodically, time your contractions, keeping track for 30 minutes to an hour to check your rhythm, but don’t get glued to it. Come back to it every once in a while, there are more reliable ways to assess the progress of your labor.

The obsession with the clock and numbers will only serve to amp up your stress level. Assign a member of your birth team to do the timing. Keep your mind in the moment.

The goal is to get yourself into care in a timely manner. A key challenge is to balance the arrival to the labor ward at the “right” time, not too early, not too late, arriving at the right time leads to a positive path while arriving too soon might lead to a cascade of negative experiences.

There are six ways to progress in labor taking you all the way from early labor to birth.

1. The cervix moves from a posterior to an anterior position.
2. The cervix ripens and softens.
3. The cervix effaces.
4. The cervix dilates.
5. The fetal head prepares for descent by rotating, flexing, and molding.
6. The fetus descends, rotates further, and is born.

You must know the difference between non-progressing and progressing contractions.

Non-progressing contractions remain the same over time, they do not vary in intensity, duration, or time. They start, stay for awhile, then stop.

They do not effect descent but they are necessary for the successful completion of the first three steps. Significant dilation (Step four) can only occur when the cervix has already undergone the necessary preparatory changes of these first steps.

Caregivers minimize the importance of these three steps, when in fact progress in those areas is a very good sign, as they are a necessary precursor to significant dilation.

The first three steps take place gradually, simultaneously, and almost unnoticed over a period of weeks before labor begins. For a minority of women this process can take days of non progressing labor to fully complete the necessary changes to the cervix.

Having this knowledge makes the waiting to be “diagnosed with actual labor” easier to bear.

This should not concern you, although these periods can be quite lengthy, clinical trials have reliably proven that good outcomes are still the normal—healthy mom and healthy baby.

Early labor can indeed be frustrating, take positive appropriate action and do what you can to prevent exhaustion, keeping yourself nutritionally sound, and comfortable.

What should be of concern is the need to equip yourself with the knowledge of coping techniques to carry you through the many hours of early labor, enabling yourself to successfully stay out of the hospital for as long as possible.

Progressing contractions get progressively longer, progressively stronger, and progressively closer together. They are persistent, they keep on coming, they form a regular pattern.

Steps 5 and 6, the rotation, flexion, molding, and descent, all take place near the end of stage one and are the primary focus of second stage labor.

If your body is ramping up into Stage One Labor then your contractions will persist, and activities such as walking will make them intensify.

An easy way to identify this distinction is to drink a large glass of water, move around and change your position—if it is still early on then your contractions will generally diminish and taper away.

If they continue right along— rest in the assurance that hydration and movement are two appropriate positive responses that will continue to encourage the progression of your labor.

Childbirth labors can vary by time, some are lightening fast, some are average, some plateau, and some are long. Labor also varies by intensity, some women feel no pain (1%), some mild pain (2-7%), some feel labor is intense and effortful (85-96%), and some feel labor as excruciating unbearable pain (1-5%). That last number jumps considerably if labor is induced. (Natural Hospital Birth, Cynthia Gabriel, 103)

The onset of early labor generally comes with a rush of pre-marathon jitters, a rush of anxious excitement. This nervous energy makes it difficult for you to rest, but do your best. You will probably feel mild contractions low in your abdomen near your pubic bone, you may have some low back pain that can range in intensity from a mild crampy feeling to mild menstrual cramps.

You are still fully capable of going about your daily routine without much interference from your contractions and that indeed that is the best advice and is a positive appropriate action.

Acknowledge the sensation, take a deep relaxing breath, and go about your business.

The mild contractions of early labor help dilate your cervix going from 0 to 3cm. You will definitely feel them in your abdomen, not only in your back. They may feel like low surges near your pubic bone and will most likely build to a peak. Your contractions will build in intensity as your cervix dilates, they will perhaps feel like an average to strong menstrual cramp.

The duration and spacing of your contractions is still variable at this point. The majority lasting less than a minute and spacing out between 5 to 15 minutes.

You are still capable of walking during contractions perhaps using a wider gait, you may even feel the urge for swaying and rocking. These are all positive appropriate actions.

Most mammals are restless at this point as this is the time that the baby is jostled, wriggled, and turned into the most advantageous position to pass through the maternal passageway. If your baby is not already in a optimal position this period of labor needs the time and patience that will allow it to do its work.

While you can still move easily from one place to another, stronger contractions may require you to stop and lean in. It is helpful to think of this as a form of counter pressure, as if you are stepping on a stubbed toe to temporarily numb the pain.

You will find during active labor that you become more “attached”, you find moving more difficult and want to remain in one spot, one place, and in one position. Gravity will greatly and positively effect your experience.

You are still capable of rational thought but as you are also starting to feel more pain you may feel your mind spinning out, hoping that this is it, you are already at 8cm. How long? How much pain? This is the Catch-22 that I was referencing in the Feedback Loops post.

The appropriate positive action is to counteract this mindset as quickly as possible by using a combination of distraction and staying in the moment.

You stay in the moment by just dealing with the contraction you are in and nothing else, not the next one, or the one after that—neither do you want to dwell on the ones in the past.

You distract yourself by giving your mind something else to focus on at this point.

Positive appropriate actions here include, sit on a birthing ball and watch a movie, bake cookies, make lasagne, or organize an album of pregnancy photos on your phone or computer. Find something, some bit of work that demands your attention, something that flows your attention to the task and away from your labor. For me it would be adding transactions into Quickbooks and balancing out my accounts, for some of my other clients it has been making lesson plans, and finishing up last minute work related tasks.

The system goes like this: You focus on your task—you deal with a contraction—you go back to your task.

Gradually you will notice that the labor process will require you to give your contractions more and more focused attention. This is a very good sign that your labor is progressing. It is a far better predictor of progress-- more so than the numbers game presented on your contraction app.

At some point you will be unable to focus on anything other than your labor, you put away your project, let someone else finish the lasagna, and turn off the movie, the positive appropriate action here is to welcome in the fog of active labor.

You have made it to Stage 1, the early period of labor is done. So we move on.

*The material for this post primarily comes from these Childbirth Physiology Sources.

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