First stage of labour
The first stage of labour is usually the longest and the hardest to get through. Once you are in established labour, your contractions get longer, stronger and your labour progresses more quickly.
What are contractions?
Contractions are the regular tightening of the uterus, working to dilate the cervix and push your baby down the birth canal. They may feel like a tightening sensation across your tummy, which can extend into your back. Contractions have a rhythm and wave-like pattern to them. They start small and build up as the contraction progresses peaking in the middle and then dropping off until the tightening is all gone.
Mild contractions may feel similar to strong period pain. However, each woman perceives them differently. Several factors influence this perception, including their pain management strategy, their environment, support, culture and pain threshold. Some women seem not to notice until their baby is nearly here, and others struggle to cope before they established labour.
Your labour is considered established when you are having three to four regular contractions in ten minutes. However, this is also an individual situation. Women in established labour often have difficulty maintaining their sense of humour and need to stop and breathe through their contractions. However, contractions could last over a minute with just a minute to rest in between (keep the individual thing in mind though) when approaching the end.
During this first stage, contractions are working to open your cervix. To date, your cervix has been kept tightly closed, so opening it will take some hard work. This work is necessary to make room for your baby to move down the birth canal and be born, a process called dilation.
Labour Progress
Sometimes during your labour, your midwife may seek your consent to perform a vaginal examination (you may hear them call this a VE). We perform a VE to assess several things about the progress of your labour, including;
- how many centimetres dilated your cervix is
- if your cervix is thinning (it starts about 3-4 cm long and then thins out completely and retracts up into the wall of your uterus)
- baby’s head position
- how low (or high) your baby’s head is
This examination may happen more than once. Your midwife may need to assess how your labour is progressing. At the start of labour, especially if it’s your first baby, you don’t seem to dilate very fast. However, when you get to five or six centimetres dilated, your contractions should get longer and stronger, with labour progressing more quickly.
Try to keep the end goal in your mind. Contractions are steps on the way to achieving that goal and bringing you closer to meeting your baby. While your contractions may be painful, in between each contraction, you may get a chance to rest and not feel much pain at all.
Tips for coping with labour
Listen to your body; listen to your instincts.
- Experiment with different movements and positions and find what works for you.
- Relax when you feel a contraction coming on; your shoulder, your hands and your face
- Try not to fight the contraction or be afraid of it; if you relax and accept it, it hurts less
- Concentrate on your breathing, keeping it slow and relaxed.
- Focus on breathing out. If you breathe out the breathing-in comes automatically.
- Sway and rock your pelvis
- As it goes, blow it away. You never have to do that one again.
If you aren’t coping, speak to your midwife about your pain relief options.
Coping with the first stage of labour
- Listen to your body; listen to your instincts.
- Experiment with different movements and positions and find what works for you.
- Relax when you feel a contraction coming on; your shoulder, your hands and your face.
- Try not to fight the contraction or be afraid of it; if you relax and accept it, it hurts less.
- Concentrate on your breathing, keeping it slow and relaxed.
- Focus on breathing out. If you breathe out the breathing in comes automatically.
- Sway and rock your pelvis
- As it goes, blow it away. You never have to do that one again.
- If you aren’t coping, speak to your midwife about your pain relief options.
Positions in the first stage
Most women cope better with labour if they can move freely. You never know until you are labouring what positions will work for you, but it’s a good idea to have a practice before you get there, so it’s not new when you need it.
- Kneeling or all fours: you can rest by leaning forward between contractions, and it can take the pressure off your back.
- Sitting: you can sit astride chairs and lean forward, rest on a cushion, pillow or beanbag.
- Birthing balls: you may find a birthing ball comfortable – this is a large inflatable ball which may have seen in the gym. They are more comfortable when not fully inflated, and can keep you mobile while still sitting down…
- Supported standing or squatting allows your pelvis to stay open, and lets gravity help your baby move down. You will need to hang on to something to support your upper body to keep your balance – this can be your birth partner, a frame or rope. You can be supported by being held under your arms from behind.
- Use a birthing pool where appropriate and available – you can assume almost any position and get great pain-relieving benefits too.
There’s no right or wrong way to approach the first stage of your labour. However, not many women are comfortable laying on their back, and it may make it more challenging to help baby navigate his way around the curve of Carus. It is rare for a woman to lay on her back when encouraged to do what feels best for them.
Birthing partners
Birthing partners can be great if they are relaxed and the two of you are on the same page. However, if your birthing partner is nervous or tense or scared, you will pick up on these feelings. When you are in labour, your instincts are at their sharpest – it’s an inbuilt survival mechanism. If you pick this up in your birthing environment, your adrenaline will rise and block the effects of oxytocin. The same applies to anyone else who may be in the room. Before you decide that you want your whole family there, please make sure they are supportive of the birthing process and aware of your choices.
Checks and monitoring during labour
You and your baby are going through a physically intense experience. It is part of our duty of care as midwives to keep tabs on how you and your baby are coping. We will ask your permission to perform regular observations on you both throughout your process. If you consent, we will take blood pressure, pulse and temperature readings at regular intervals. We will also ask to feel your tummy to assess how strong and consistent your contractions are and listen to baby’s heartbeat.
For the options on how we can monitor baby click here.
Transition from first stage
Transition is the period between the first and second stage. This transition is an intense stage of the labour, and the time women demand that they don’t want to do this anymore. They often want to go home and want to know whose idea this was anyway. If any of that is going to happen, it’s going to be during this period.
Transition is a psychological as well as a physical state. You may feel impatient, tired, sick, irritable, angry and frustrated with the people around you. These feelings are a normal reaction and means that the birth of your baby is not far away.
It’s ok to let everyone know how you are feeling. If you don’t want to be touched, let people know. Depending on your circumstances, you may feel the need to push. You may also get a break from your contractions before your second stage begins. Both are common when you get to full dilation, but what happens next will depend on your circumstances.
Click here to read more about the first stage of labour.
Dr Janelle McAlpine (PhD), Clinical Midwife
Photo by Natalia Deriabina used under license from Shutterstock.com