Labor!

On any pregnancy website you can find a list of the signs of impending labor: spotting, nesting, crampy regular contractions, bag of waters breaking, etc. First-time moms anticipate labor beginning hourly during their last weeks of pregnancy, thinking it could happen at any moment. This is an exciting time, especially since it is nearly a universal sentiment by this stage of pregnancy that the woman is ready to be done with being pregnant and move on to the next phase. And it could happen at any time, whenever the baby is done developing, that mysterious and unknowable timetable.

Most first-timers go beyond the 40 week mark. Some, like me, go way beyond it. Tests and ultrasounds can monitor the placenta and make sure it's still functioning, since one of the risks of being overdue is that the placenta will fail - it is, after all, only a temporary organ (amazing! the body grows this wondrous organ, only to dispose of it a few months later when it is no longer needed!). I haven't seen statistics on this occurrence, but with my first baby I was 18 days overdue. Everything was fine, and I chose not to be induced. When my baby was born, she was just fine, not huge, not peely and leathery like babies who have overstayed their time in the womb - just perfect. I think a lot of women, who are tired and feel huge and just want to meet their babies, go in for inductions before their babies are ready to be born... but more on inductions later.

The truth is that unless you are one of those very rare women who has a completely painless, unfeeling labor, you will know when labor starts. You will likely have been feeling contractions all through the third trimester, but there will probably be a distinct change in sensation when the real work begins. Labor carries an intensity with it, and a regularity, that is obvious to those who experience it. From that point, the issue becomes, how much longer will it last, and how much worse will it get?

I don't believe that most people can, even through relaxation techniques, experience a painless labor. I think that relaxation is important in helping the work to progress, and in making the pain manageable, but I believe the majority of women will still have pain during labor. So long as I was relaxed, every one of my labor contractions hurt less than, say, a stubbed toe. People endure stubbed toes without getting analgesics injected into their spines; so too can people endure labor, with the proper support and understanding of what's going on, without needing medical help.

The first phase, early labor, begins with the onset of regular contractions. This is usually the easiest part, as the contractions are far apart (a few minutes) and the woman can talk and interact even while experiencing contractions. She will probably be very excited, knowing that "this is it" - but that excitement can lead to one of the most common major missteps that first-time moms are especially vulnerable to: using too much energy during this phase, when labor is easiest! The mother-to-be might decide that this is the time to clean the baby's space or cook a big dinner or even focus too deeply on the contractions when she doesn't really need to - any one of these things can lead to exhaustion. Labor probably won't feel very difficult at this point, but it is crucial that the mother get plenty of rest and not burn herself out.

The contractions will continue to get stronger and closer together. The uterus is working hard, and the sensation of cramping might turn into something that feels more painful and harder to handle. This is because the uterus, the strongest (and at this point largest) muscle in the body is being exercised, contracting and releasing, for several hours. Any muscle that is worked this much will begin to feel sore, and the same pain one gets from using an arm or leg muscle to its limits is the same as what the woman experiences - only to a larger degree. She will experience the unusual and uncomfortable sensation of moving beyond that. The uterus has a long way to go. What is happening physically is that the uterine contractions are pulling the cervix open. The cervix needs to be dilated to about 10 centimeters, or approximately the width of a human hand (this of course varies, as does the actual measurement of full dilation for each woman). When the cervix has reached 4 centimeters, the woman has entered the next phase of labor, the second stage. Contractions are typically demanding all her attention now, and usually are about 3 minutes apart and last about one minute. What this means to the woman is that she is going between contractions and rest at a rather fast pace! One minute of contractions, two minutes of rest, one minute, two minutes...it will be more challenging to stay atop the contractions. Most women cannot help but remain focused on their labor at this point, and do not want to be distracted, which is essential to getting through it.The last phase of this part of labor is transition. If women are going to panic, this is often where it happens. Here labor tends to be the most dramatic and requires the most from the woman. The good news is that it is also the shortest phase, lasting less than an hour and often only about 15 or 20 minutes, maybe 10 to 20 contractions long. The uterus is finishing its work of dilating the cervix, and contractions are hardest and closest together. Women often become overwhelmed during transition - they may decide they can no longer handle labor, or they might insult their partners or caretakers, or become nauseous and shaky. (During my first labor, transition was quite easy - it was getting from 4 centimeters dilated to 7 cm that was the tough part!)Fortunately this phase typically ends peacefully, with a period of quiet, where contractions stop completely. Sheila Kitzinger calls this the "rest and be thankful phase". With the cervix completely dilated and effaced, the body is resting in preparation for pushing the baby out. The kinds of contractions the woman endured before have ended, and the work the uterus does now to birth the baby are of a different sort and usually not painful. This restful period can last several minutes before the second stage of labor begins.

Pushing

Now the hard work begins! Up to this point, labor was characterized by endurance alone, by just getting through it, and allowing the body to do its work by not interfering. But with the second stage of labor, the woman can finally actively participate in the birth of her baby. This is the pushing stage, where the cervix is dilated and the body is ready for the passage and delivery of the baby. Even though labor may have been exhausting up to this point, a welcome surge of energy comes, and women again get excited to meet their babies.How this stage is experienced depends greatly on the woman's caretakers and environment. Some hospitals coach women through pushing, telling them how and when to push. But it is becoming more acceptable to let women push spontaneously, when they feel the urge. Most women will experience a deep primal and irresistable need to bear down as the baby descends. The uterus is still contracting, and the baby will be born whether she actively pushes it out or not, but she will probably not be able to control her desire to push. The baby makes a two-steps-forward-one-step-back progression. This is a natural way of reducing damage, to stretch out the tissues of the birth canal. Left to descend on their own, the movement of the baby down and out often prevents much damage and results in a gentler birthing than constant pushing from the moment of dilation.The head of the baby is the largest part of its body. Once it has stretched the perineal tissues to their maximum (often called the "ring of fire" because of the burning sensation this produces - to get a small idea of what this is like, place a finger at each corner of your mouth and pull hard), and is born, it will no longer retract and the baby will be born within moments. The head turns - the body is maneuvering itself down the birth canal, down the path of least resistance - and the shoulders emerge, often followed very quickly by the rest of the body. For first-time mothers, the second stage can last several hours, but for subsequent births it may be only minutes.All the hard work of labor has accomplished the most amazing thing, the birth of a baby. This time is crucial for bonding with the baby, for beginning breastfeeding, and welcoming the little one into the world.

A Second Birth

However, the woman's body isn't yet finished with its work. The third stage of labor is the expulsion of the placenta and the continuing contracting of the uterus to its prepregnancy size. The detachment and birth of the placenta is painless, and some women often do not even realize it has happened.With the detachment and delivery of the placenta and the uterus returning to its original state, labor is finally at an end, and motherhood is just beginning.