Class Five First Stage Labor
Begin class by asking students about their nutrition and exercise habits this week and ask for any questions
that they may have.
I. Pre-Labor
A. Contractions begin but are irregular
1. labor may start and stop a number of times before The Day arrives
- If you think you are in labor do these things first before you begin timing contractions
a. get a drink of water or juice
b. eat something
c. take a walk
d. take a warm bath
e. take a nap
2. do not pay attention too soon-- many mothers become excited over these contractions
and wear themselves out before labor really begins. Ignore your labor signs until you
can't.
3. pelvis may become wobbly and loose
B. If they stop, don't become discouraged. All babies are born sooner or later!
II. Early First Stage
A. Labor begins- most women will do some of the following:
1. begin nesting and cleaning
2. become restless- walking, talking, smiling
3.become extremely hungry and/or thirsty
4. become excited
5. have bloody show
6. runny nose
7. urinate frequently
8. develop loose bowels
B. Contractions
1.ten minutes or less apart
2. 45-60 seconds in length
3. do not space out
NOTE: Some women do not develop a regular pattern at all or not until late in labor. The
mother's activities tell you better where a woman is in labor than contractions or dilation.
C. How to react:
1. try to keep busy
2. walk if possible
3. do not get overly excited-this can halt labor
WARNING: if at any time during pregnancy or labor the mother develops heavy bleeding, call the
birth attendant immediately.
III. Mid-First Stage
A. Labor becomes more pronounced and the mother and coach will have to work together-from
this point on, she should not be alone.
B. may need to try various labor positions now(have students practice these as they are discussed)
1. walking
2. sitting in rocking chair or birth ball
3.leaning
4.side lying (this position does not use gravity and should be reserved for fast labors or
for naps during long labors)
5. hands and knees
6. squatting- while this position opens the outlet of the pelvis, it does reduce the size of
the inlet
7. reclining at a greater than 45 degree angle against bed or coach
8. sitting in warm tub
9. kneeling
10. sitting on toilet
C. Characteristics
1. she is serious
2. appears to be concentrating
3. " to be working hard
4. may be hungry
5. may want to do something to pass the time--play a game, watch a movie, etc
6. may feel pressure in pelvis and back, sore pubic bone, crampy feelings
D. Contractions
1. now is a good time to begin timing them
2. usually five minutes (approx) apart
3. sixty seconds or so long
4. may be felt as a cramp or back ache or as a general squeezing sensation
E. How to react:
1. save your energy
2. continue to eat lightly and drink
3. remember to go to the bathroom about every thirty minutes
4. do not fight contractions--relax with them and loosen all muscles, especially pelvic
and abdominal muscles
5. breathe diaphamatically
IV. Late first Stage
A. Labor intensifies
1. she becomes very serious--she has a lot of work to do
2. she is no longer hungry, but she should continue to drink
3. probably sweating
4. she get upset if her concentration is disturbed
5. she will lose modesty at this stage
6. walking is beneficial, but she moves very slowly
B. Contractions
1. generally three minutes apart or less
2. last longer than 60 seconds
C. Characteristics
1. work becomes intense
2. concentration is required to stay relaxed
3. may lose track of time
4. prefers dark
5. requires space to move
6. requires peaceful environment
7.tension causes pain
8. labor may continue without noticeable progression--this is normal and can last many
hours. This is not a problem as long as mother and baby are fine. Labor does not need
to be augmented for lack of progression. Continue to relax and drink as normal. Take a
nap if possible. If it continues a long time, ask mother if something is bothering her.
She may need to settle some things before she can open up and receive her baby.
Above all, be patient.
D. How to react:
1. relax between contraction
2. during contractions mimic sleep--breathe deeply, completely relax, keep jaw loose and
open
3. change positions fairly frequently
4. listen to her body
5. if back pressure is a problem, upward pressure next to tailbone often helps, as does
pelvic rocking
6. give in to labor
V. Transition
A. Hardest stage of labor
1. this is the self-doubt phase- she will believe that she can't continue- when this happens,
it's almost over
2. She may say "I can't", "I quit", "I want to go home", "give me something"
3. this is the part of labor where many women believe they can't go on and accept drugs
--everyone reaches this point, and it is a sign that labor is almost over
--if she asks for something, give her attention, tell her you know it's hard, but
she can do it, help her into a more comfortable position, remind her of the
baby that is nearly here, guide her back into relaxation,
4. some women become confused and forget that there is going to be a baby, or forget
how to relax
B. Contractions
1. become very close and last very long
2. breaks between contractions may be very short
3. may become irregular or double peak
4. there may be no break between contractions
5. mothers often perceive contractions very differently now and may cause confusion,
panic, fear, nervousness.
6. may be heavy pressure in pelvis as baby aligns and adjusts.
C. Characteristics
1. shaky
2. sweaty
3. cold/hot flashes
4. may not want anything to touch her
5. may yell and snap at coach/staff
6. nausea/vomiting/burping
7.scared
8. may say "I don't want to have a baby after all"
9. this is the shortest part of labor-usually only a few minutes
D. How to react:
1. don't distract her during contractions
2. honor her wishes--if she says don't touch or don't talk, don't
3. stay in front of her so that she doesn't feel alone.
4. avoid drugs--at this point they tend to only make things worse since they may slow
labor or cause the mother to be unable to work with her contractions and express
herself
5. if she asks for drugs, wait until she is between contractions and tell her what a great job
she is doing and that it's nearly over and help her find a more comfortable position.
Remind her that she only has a few more minutes
6. know that she has to give up and give over to her labor now. She cannot progress with-
out doing this.
VI. What's going on
A. Physical changes--there are many physical changes during first stage labor
1. cervical dilates to approximately 10 cm
--cervical dilation is a poor indicator of labor progression. Cervix can dilate slowly,
quickly, moderately, or a combinations of these at different stages of labor
2. cervix thins--called effacement . cervix is usually 4-5 cm thick at "zero effacement"
and is completely flat at "100% effacement"
3. baby changes station
--measured from ischial spines(narrowest part of pelvis). When baby's head is even
with them, he is station. Every cm below that is expressed in terms of "plus"
(example- "plus two" equals two cm below ishial spines
4. baby's alignment in the pelvis--babies who are undrugged will work to find the path
of least resistance. He will naturally align himself so that the widest part of his head
goes into the widest part of mother's pelvis.
5. breasts are preparing to nourish the baby--they are busy making colostrum. The col-
ostrum of a mother after she has given birth has many more anti-bodies than the col-
ostrum of the mother before birth. Nature's vaccine for infants!
6. ligaments are loosening in pelvis to allow greater flexibility for birth
B. Contractions
1. time from the beginning of one to the beginning of the next, NOT the time between
them
2. length of the contraction is measure from the beginning of one contraction to the end
of the same contraction
3. they nearly always peak around 30 seconds, even if the contraction is longer than 60
seconds
C. Why?
1.why eat/drink? To stay hydrated and keep blood sugar stable and to prevent hunger
2. why go to the bathroom often? To keep bladder from becoming overly full, which
would cause discomfort and prevent mother from relaxing her pelvic floor muscles
3. why walk? Walking helps to open the pelvis and uses gravity to help move the baby
down
Open the floor for any questions.
Conclude with a short relaxation practice