During the active phase of stage one labor, your contractions will become more frequent, longer, and stronger, and your cervix will begin dilating faster. As a general rule, once you have had regular, painful contractions (each lasting approximately 60 seconds) every 5 minutes for an hour, it is time to call your midwife or obstetrician. (The doctor may prefer to receive an early warning call; discuss this in advance.) In most cases, the frequency of contractions eventually increases to once every 2 to 3 minutes, although some women have contractions only once every 4 to 5 minutes.
The active phase of stage one labor can last up to 6 hours, or more, although it can be shorter, especially if you have previously had a vaginal delivery. Now the real work of labor begins, and you will no longer be able to talk during contractions. Breathing exercises, relaxation techniques, and a good labor coach can be helpful during this phase. Massage and gentle encouragement can also be helpful.
By now, you have probably arrived at the hospital or birth center. If you have no medical or obstetric complications, you should be able to move around. You may find that it feels good to walk, but you will probably want to stop and lean against someone or something during contractions. If you feel exhausted, sit in a rocking chair or lie in bed on your left side. This might be a good time to take a warm shower or bath if you have access to these facilities. Warm water can help ease the pain of labor, and women sometimes progress quite rapidly with the relaxation that water provides.
You may want to ask for general or regional analgesia if you are having difficulty coping with pain during the second phase of stage-one labor. You will still feel contractions with systemic pain relief (usually delivered by IV or injection), but to a lesser extent. The medication might make you feel drowsy or dizzy, and you will not be allowed to walk around after receiving it. Generally, regional anesthesia (such as an epidural or spinal, or both) will provide more complete pain relief, although you might continue to feel some pressure if the baby is low in your pelvis.
The last part of the active phase of stage one is called transition, because it marks the transition to the second stage of labor. Contractions are usually very strong during transition, coming approximately every 21/2 to 3 minutes, and lasting a minute or longer. The cervix continues to dilate until it reaches the full 10 centimeters.
Transition can last anywhere from a few minutes to a few hours. It is much more likely to be rapid if you have previously had a vaginal delivery. This is the most intense phase of labor, with contractions coming hard and fast, and symptoms that may include shaking, shivering, and nausea. Some women who have been coping well up to this point may begin to lose control during transition. They might reject those around them, but clearly have trouble being left alone. Some women who have previously expressed the desire for a drug-free birth may begin to lose faith in their ability to deliver the baby without medication. This is the time when you will need plenty of encouragement. If you have made it this far without medication, you can usually be coached through transition—one contraction at a time—with reminders that you are doing a great job and the baby will arrive soon.
By the end of the first stage of labor, when the cervix reaches full dilation, the baby has usually descended somewhat into the pelvic area. You might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously, and may even start making some deep grunting sounds. There is often a lot more bloody discharge. You may also feel nauseated, or even vomit, as you make the transition to the second stage of labor.
If you have an epidural, you will feel varying amounts of pressure, depending on the type and amount of medication. If you want to be a more active participant in the second stage of labor, ask to have the dose reduced at the end of the first stage of labor.
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