Ep 242: The Stages of Labor – A Sneak Peek Inside the Birth Preparation Course!

Dr. Nicole (00:00): When do you know you're in labor? When is active labor? What exactly is labor? You'll get all these questions answered and more in the sneak peek episode of the birth preparation course on the stages of labor.

(00:23): Welcome to the all about pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now, let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 242. Whether this is your first time tuning in or you've been here before, I'm so grateful you're spending some time with me today.

(01:17): In this episode, I'm giving you a sneak peek inside my online childbirth education class, the birth preparation course. I'm sharing with you the lesson from the course on the stages of labor. So in this lesson, you are going to learn what labor is. It's not exactly what everyone thinks. You're going to learn the stages of labor and you're going to learn how you will know whether or not you're actually in labor. Now, I will say that this lesson is great in audio, but it's even better in video because I do offer visuals inside the birth preparation course. And if you want to check out the birth preparation course after listening to this episode or you just want to check it out, period, grab all the details at drnicolerankins.com/enroll. All right, so let's get into this episode on the stages of labor. The first thing I want to share with you is that every labor is different.

(02:22): Labor can be different between different women. Labor can different for the same person between different pregnancies. So what you are going to learn in this episode are some common generalities about labor that are true for most women. And I'll talk about some of the outliers too, but be prepared that your labor may not go exactly as I describe. You must keep an open mind about that possibility. What's going to be most important, the most important thing that you take away this episode is that you must listen to your body. So learn these guidelines, keep 'em in your head, but start with listening to your body and what your body is telling you that is so, so important. Okay, so what exactly is labor? A lot of people think that labor is just contractions. That's a really common belief, but contractions are just half of the story.

(03:26): Labor is contractions and your cervix has to be opening or dilating. You have to have both contractions in your cervix opening in order to be in labor. Otherwise, it's just contractions. Now, it's not always easy to tell when contractions are full-blown labor contractions, especially when it's your first baby. So do not be surprised or feel bad if you think it's labor. You go to the hospital, your doctor or your midwife says, no, it's not time yet, not labor yet. Or you think it's labor and you're like getting ready to go to the hospital. You picked up your bags, you got everything ready, and then the contractions all of a sudden stop. This happens all the time. It is very, very common because the truth is no one knows exactly what causes active labor, what causes true labor to start. We know that hormone like substances called prostaglandins as well as the hormone oxytocin play a big role in labor, but we don't know what exactly triggers that labor button.

(04:42): Now, there are some things that are associated with labor like your baby dropping where it feels like your baby is lower in your pelvis or starting to lose your mucus plug. But these things can happen days or even weeks before actual labor starts. So these are things that you need to go to the hospital for or even call your doctor for when your baby drops or you start losing your mucus plug. You don't need to go to the hospital or call your doctor or be alarmed because it could be days or weeks before labor actually starts and you may continue to have mucus discharge after a noticeable mucus plug coming out. It's not a static one-time thing. You definitely may see more mucus over the next days or even weeks. Some people also may have bloody show, which is like a pink tinged, brown mucusy discharge.

(05:36): That is a more reliable sign that labor may be starting because you don't have that bloody show until the cervix is starting to open. So that again, may be something that's more indicative of labor, but not necessarily. So it's really going to be contractions, regular contractions, and we'll get into that how you will know that you should be concerned that labor is actually starting. So let's talk about the stages of labor. You don't need to remember these specifics. I don't want you to think. You have to understand the first stage of labor is this. The second stage of labor is that I want you to understand the stages in broad terms and then particularly know what that active labor means. And I'm going to explain why that's important, knowing why active labor is important. So don't feel like you need to memorize every single thing that I'm saying, or oh, am I in the first stage?

(06:30): Am I in the latent? Am I in the active? Don't get hung up on the terms. Just understand labor in broad terms so that you can know what to expect for your own labor. So we basically define the stages of labor based on how dilated your cervix is. So we kind of broadly define the stages of labor based on that. So let me first explain what cervical dilation is, and actually let me even back up before that and say what the cervix is. So the cervix is the opening to the uterus and during pregnancy it is what stays closed. It stays what's called long. It helps to protect the baby from any bacteria that are in the vagina. It helps keep the baby in that protected environment inside the uterus. And I said it's closed. And when I say long, I mean it's about three to four centimeters in length, okay?

(07:25): Three to four centimeters in length. Now, we always talk centimeters in pregnancy, we don't talk inches. We always talk centimeters and millimeters. So when it's three to four centimeters long, an inch is about two and a half centimeters. So your cervix is between an inch and a half, two centimeters long. Okay? You can feel that link. We can measure that link with ultrasound, and then as you go into labor, the cervix dilates or opens, and then it ef faces meaning that it shortens in length. Alright? So as you go into labor, it opens and it goes from three, three to four centimeters and shortens in length. That's called effacement. Okay? So that's what happens with the cervix. Now, inside of the birth preparation course, I have visuals that show you what the cervix looks like when it's closed, what the cervix looks like when it's a faced at different stages of effacement, what the cervix looks like when it's dilated, okay?

(08:30): You have some images inside the birth preparation course, in the video version that show the progression of the cervix during labor. Obviously we don't have that here, but I am going to give you an idea of what cervical dilation looks like at various stages in labor by comparing it to some common things that we all know and can relate to. When the cervix is about five centimeters dilated, it's about as open as a kiwi slice, okay? Kiwi slice, lemon slice, that's about five centimeters dilated. All right? And when the cervix is 10 centimeters dilated or completely open, that's about as wide as a bagel about the size of a baby's head, right? So it's going to be about as wide as a bagel. Now, something to know about cervical dilation. This is an estimate. Nobody has a ruler in your vagina measuring the exact opening of the cervix.

(09:22): We all have our own rough estimates in terms of how cervical dilation is measured, so know that it's always an estimate, but that's just a general rough guess to give you an idea of how open your cervix is during those different time points. So now that you know about cervical dilation, let's go into the stages of labor. And there are three stages of labor. The first stage is actually divided into two parts. That is the latent phase of labor and the active phase of labor. Now, the latent phase of labor is from closed or zero centimeters to about five centimeters. So that first half of labor or half of cervical dilation, I should say, from zero to five centimeters, that is the latent phase of labor. Now, the latent phase generally begins with mild irregular contractions, and they over time will soften and shorten the cervix, and the contractions can start out quite far apart.

(10:30): They may be every 30 minutes, and then they'll slowly or even rapidly get closer together every 30 minutes and it's every 15 minutes and it's every 10 minutes, and it can go up and down. Oh, sometimes they're 5, oh, sometimes they're 12, but they're going to over time get closer together and they get stronger. So they progressively get more rhythmic and stronger over time. Now, how much time that takes can vary. It can be hours, it can be days, it can even be weeks to get through that latent phase of labor. So when people say they have a long labor, it is generally this early part, getting from zero to five centimeters, that is the part that takes the longest, okay? Now, ideally, you want to spend as much of your time at home during this early part of labor. You're going to be more comfortable at home in your own environment typically.

(11:33): And again, it can take a while. It can take some time for this early part of labor to progress. And if you're in the hospital, I'm going to be honest, it's more likely that interventions will be suggested. It may be like, oh, maybe you want a little bit of Pitocin in order to get things going, or maybe we can break your water in order to get things going. The reality is that in hospital birth, we are pretty terrible at just watching and waiting in the hospital and letting labor unfold, okay? We just do not do a great job of that. Now, please know that it's okay if you can't stay home if that early part is difficult because it can be challenging, it can still be painful, or you don't want to stay home because you feel uncomfortable. You want to be in the hospital.

(12:26): That may be a better environment for you because mentally it helps you feel better. That's totally fine, but know that you're more likely to be susceptible to interventions, okay? And when you stay at home, it's easier to let nature and your body dictate your labor as opposed to the hospital staff. But again, if you feel more comfortable going to the hospital, then certainly go to the hospital. My best advice that I can tell you about this latent phase of labor is to try and ignore it as much as possible until it really demeans your attention. So try and take a nap. Try and lay down and rest, cook something. If you want to, try to take a little walk, watch a movie. All of those things can help distract you from what's going on. And I say the reason to try and ignore it is because again, it can last a while.

(13:25): I've seen women get really excited when those contractions start and they're like, okay, it's go time, and they're using all this energy, they're breathing hard, they're rocking on the birthing balls, they've caught everybody, and then they end up getting really tired because they've expended all of this energy in that early part of labor. And then by the time active labor comes around and that hard work really begins, they don't have that much energy and then their support people are tired. So especially if you plan an unmedicated birth, just ignore those early contractions. Try to distract yourself. Like I said, go for a walk, take a nap. It may be hard to take a nap, granted having some contractions, but take a walk, cook something, watch a movie, try to ignore it until they really make you not ignore them. By that I mean your contractions are so strong and so intense, you can't ignore them.

(14:24): You have to stop. You have to focus. You have to get through that contraction, okay? The other thing that you should do in early labor is eat. Eat. So you have some energy. Labor requires energy also, again, when you get to the hospital, we are not great at supporting people in eating during pregnancy, even though it's a very energetically demanding event labor. So eat, go ahead and eat something. Now, I'm not saying you got to eat a five course meal, but eat something. So you have some energy during the active part of labor, which I'm going to get into just in a minute. You won't have much of an appetite. Actually, most people don't have a tremendous appetite in the active part of labor. All of your energy is just focused on getting through the labor, so you're not really hungry. So make sure you eat something in the early part of labor so you have some energy when you get to the active part.

(15:18): So let's talk about that active part of labor. Active labor, and again, this is still the first stage. Active labor is from five centimeters to completely dilated, which is 10 centimeters, five centimeters to 10 centimeters. Now, the good news about active labor is that it is generally a lot, lot faster than latent labor. In fact, it should be faster than latent labor because this is the part where things are really ramping up. So where zero to five centimeters can take, like I said, hours or days from five to 10 centimeters, you're going to dilate roughly one centimeter an hour, okay? Roughly one centimeter an hour, and that can be faster. It can be slower, but roughly one centimeter an hour. Also, your baby is moving down in your pelvis during this phase, so your cervix is opening, it's becoming completely efface, and your baby is moving down in your pelvis. This is the rip roaring part of labor. Most often people are in the hospital at this point when they get into the active phase of labor, you're not really doing the active phase of labor at home.

(16:31): So how do you know when it's time to go to the hospital? When is it really labor? Let me give you some guidelines. So when it's labor, so labor is typically going to be when contractions are strong, they are five minutes apart or less. They are lasting about 60 seconds. So one minute, and they have been that way for at least an hour. Actually it can really be two hours, but that five minutes apart lasting for a minute for at least an hour. That's the 5 1 1 rule, and I am talking about when you are full term, that is at least 37 weeks or more. If you're less than 37 weeks, you have more than five contractions in an hour. That's not normal. You should call your doctor. But if you're 37 weeks or more full term, five minutes apart or less lasting for a minute, they've been that way for an hour.

(17:27): Can be longer, can be two hours. Now, one of the keys about this is that they need to be consistently five minutes apart or less. If they're five minutes apart for three contractions and then they go up to 10 minutes apart and then they go down to seven and then they go back up to 10, that's not labor. They need to be consistently five minutes apart or less and getting closer together stronger before they're in labor. So all of that where there's five minutes and it's 10 minutes, that doesn't count as part of the five minute rule or the 5 1 1 rule or for an hour of contractions, they really need to be consistently for an hour or two strong and regular, strong and regular, where they're not up and down going back and forth in intensity. They need to be getting more intense or staying at that high level of intensity during that entire hour.

(18:22): If it goes back and forth, then it's not quite time. Now, one question folks have, and it's certainly a question that I had, is when do I know that I'm having a contraction? I thought the same thing with my first daughter. I'm like, I'm an obstetrician. I don't know what a contraction feels like, but trust me, you'll know contractions when they happen, trust yourself that you'll know. And even if you can't immediately identify that what you are feeling is a contraction, you will know that something different is happening in your body and it will grab your attention. Contractions are often described as very strong menstrual cramps or they may be felt in your back as back labor, but contractions are always going to be rhythmic so that back pain will come and go or the squeezing or tightening of your belly will come and go.

(19:18): And when their really intense at that labor level, their labor level, they are going to grab your attention. These contractions are really going to grab your attention. And when I say grab your attention and strong, I mean you can't talk through the contraction, you can't do anything but focus on how to get through the contractions. The contractions should literally be stopping you in your tracks. If you are walking and the contraction comes, you stop walking. If you are talking and the contraction comes, you stop talking. They really demand all of your attention. That is what I mean by strong contractions. If you can still talk through it, you can still keep moving. It is probably not quite at the level of labor. Now, again, I know this is not always easy to tell. We don't get a lot of examples of what labor really looks like.

(20:23): What we see is fictionalized diversions on TV and movies, and they are all extremely inaccurate. They depict labor as this. You have three contractions and it's a commercial break, and you go to the hospital, right? This is ridiculous, or it is 30 seconds of contractions and everybody starts panicking. It is not like that in reality at all, okay? At all. You may end up going to the hospital and thinking you're in labor and being told that it's not yet active labor. That is okay, do not be embarrassed if this happens. It can be frustrating, but it is so, so common. It can also be scary because people are like, wait, you're telling me it's going to get even more intense than what I'm feeling now? But this is really, really common that folks think they're in labor and they aren't quite yet. This is especially for your first baby, for your first baby.

(21:17): So you would not be alone in that regard. Now, with all that being said, with everything I just said, I want you to remember what I said in the beginning that every labor is different. I once had a student of the birth preparation course and she took the 5 1 1 rule to heart, bless her heart, she was really listening and pay attention. She was like that 5 1 1, but things were actually ramping up pretty intensely for her in a short period of time. It was actually shorter than an hour. And so she thought that she could not possibly be in labor despite the fact that things felt very intense to her. And by the time she got to the hospital, she was actually close to delivering. She was actually close to giving birth, and it was pretty overwhelming for her that things went that fast. So although for most women, labor is going to be a gradual process, you're not likely to give birth on the side of the road or anything like that.

(22:24): It may be different for you. So you really need to listen to your body if things feel intense, if you have questions about things, then go in to be seen. You can always go back home If it's not quite labor, that's pretty easy and straightforward. These are not hard and fast rules. These are guidelines. So take them and put them in your back pocket, put them in your toolbox. Obviously know these guidelines, but listen to your body as well. Okay? So let's move on and talk about what happens if your water breaks. So just know that actually about 80 to 90% of the time you are going to have contractions first before your water breaks. It's not common that your water breaks first. It does happen for some people, obviously 10 to 20% of the time. But it's not common that your water breaks first.

(23:12): You almost always going to have contractions first. Now, if your water does break first, then labor is usually going to follow within a few hours. After that, within about 12 hours after your water breaking, at least half of people will be in labor. So my personal philosophy, the way I approach this, I can't tell you give you specific medical advice, but let me tell you how I approach what happens if your water breaks. First, you don't have to rush to the hospital, okay? You don't have to necessarily rush to the hospital when your water breaks. Now, two things to consider when making that decision though. Two important things to consider. Number one is the fluid clear. If the fluid is clear, then you definitely don't have to rush to the hospital, and by clear, I mean it's not bloody. If you see bloody fluid, then you need to go.

(23:59): If it's green or brown, that may be a sign that the baby has pooped inside. That's meconium. And babies do that when they're under stress. So in that case, you need to go to the hospital if you see green or brown in the fluid. But if the fluid is clear, then you don't need to rush to the hospital. The second one is if you carry the GBS bacteria group, beta strep, GBS is a bacteria that we check off pregnant women for. If you have it, then you need antibiotics while you are in labor. You can learn all about GBS in episode 31 of the podcast. I did that way back in the beginning. So that's dr nicole rankins.com/episode 31. But if you have gbs, then we recommend you get antibiotics during your labor, and roughly 30 to 40% of women will carry GBS. Some people say you can wait, and that's really dependent on the provider.

(24:50): Whether or not they're comfortable with you waiting, I definitely think you can wait a few hours even with GBS. But in general, we prefer that you come to the hospital to get antibiotics started when you have the GBS bacteria. Now when your water breaks, that protective barrier around the baby is no longer there. So your water protects the baby from bacteria that are in our vaginas that are normally in our vaginas. And when that barrier is gone, then those bacteria have an opportunity to get around the baby and potentially cause infection, so it can increase the risk of infection. So for that reason, some doctors are not comfortable with having women wait at home once their water breaks. So definitely check with your own doctor about how they like to approach things. I personally am comfortable with women staying at home for six hours, eight hours or until labor starts.

(25:41): Some people even say 24 hours. There is no 24 hour rule that you have to have a baby within 24 hours after your water breaks. That's just not true. As long as the baby is healthy and looks okay, you can continue to go on with labor. But in general, if your water breaks first, I say wait for a period of six to eight hours and then come to the hospital for a check, make sure the baby looks okay. Now, even though it's not likely that your water will break first, lemme just share with you what it feels like when your water does break. Similar to contractions, it's different for every woman. Some will have a big gush of fluid, and it's obvious like, okay, my water broke. This is obviously what this is, but some, it can be a slow leak, so it's not necessarily the big gush that you think of.

(26:24): It can be a little bit more. The key typically is that fluid is coming out of your body. You have no control over it, and it continues to leak. Okay? So fluid is coming out, you have no control over the fluid coming out, and it continues to leak. Even with those things, it can still be not so straightforward to tell that your water is broken. There are some tests we can do in the hospital in order to determine whether or not your water is broken. So again, if you have concerns, you can always go in to get checked out. And speaking of going in to get checked out, do know the hospital's procedures for going into labor and delivery? You may need to call first. At our hospital, we much prefer the people call first because it helps us to grab your records. It helps us to prepare for staffing.

(27:19): So then we're really at our best when you are there. Not that you can't just show up to the hospital, but if you call first, it helps us to know and plan more appropriately. You may have a specific place that you need to go. Some people need to go to through the emergency room or their hospital. Some people go straight to labor and delivery. Everyone is different. So definitely know those procedures, what your practice does before you go to the hospital. Okay, that was it for the first stage of labor. And again, first stage is latent and active, and that's from zero to 10 centimeters. The second stage of labor begins with complete cervical dilation at 10 centimeters, and that ends with the birth of your baby. This is the stage where you are pushing. So the second stage of labor is when you are pushing.

(28:07): This stage can last for several hours potentially. Some people push for a few minutes, some people push for four hours, occasionally even more. It really just depends. I have another lesson inside the birth preparation course, specifically on pushing and strategies to help you with pushing. So you can check that out, dr nicole rankins.com/enroll. Now, the third stage of labor is between the birth of your baby and the delivery of your placenta. Delivery of the placenta usually takes less than 10 minutes. It typically is not very long, but that third stage between the birth of your baby and delivery of the placenta can last as long as 30 minutes. After 30 minutes, it's considered prolonged. And at that point, the placenta may have to be removed manually. And what I mean by manually is that we have to reach our hand inside your uterus and remove your placenta.

(29:07): That does not happen very often, but it is a possibility. Now, regarding the third stage of labor, most OB doctors and midwives in the hospital too do active management of the third stage of labor. So what active management involves is giving oxytocin through your IV or through a shot in your arm if you don't have an IV to help prevent bleeding. It involves doing delayed cord clamping, but then clamping and cutting the cord after that. And then what's called controlled traction of the umbilical core, where we apply a little bit of gentle pressure and tugging to the umbilical core. And the reason that we do active management of the third stage is that studies show that active management reduces bleeding. Now, the quality of the data is not great, but from what we have, active management is preferred bleeding or postpartum hemorrhage is actually a leading cause of maternal morbidity and mortality.

(30:09): So we actively work to prevent that, and that is what active management of the third stage can help do. Okay, so just to recap the stages of labor, the early part of labor can take some time. Try to ignore this early part. Also eat, take a nap, take a walk, cook. Just try to not focus on that early part until it grabs your attention. The active part of labor begins at five centimeters. The number five centimeters is important for assessing how labor is progressing. It's actually an important number that we use to say whether or not labor is slow. I discuss more about that five centimeter number and labor slowing down what that means in a separate lesson of the birth preparation course. That second stage of labor is from when you are completely dilated to when the baby is born, and that can take some time.

(31:11): That's when you're pushing. That can take anywhere from a few minutes to several hours. It really depends. And then the third stage of labor is from the birth of your baby to when the placenta is out, and that takes at most about 30 minutes. Now, the final things I want to say about the stages of labor and labor in general is that labor isn't something to fear. It's normal. It's natural, yeah, it's going to be intense. Yeah, most people interpret it as painful, but you don't need to fear it. You don't need to be scared about it. Fear can actually slow labor down or even stop labor in really extreme circumstances. It tenses your body up. It's like trying to use the bathroom if you're scared, right? You cannot relax and release and use the bathroom if you're scared. Labor is the same way. You can't relax and release and work with your labor if you fear labor.

(32:02): So if you are fearing labor, tell yourself right now you ain't got to. You can handle it. You can do this. Educate yourself and you will be ready, not scared. Also, remember to listen to your body. Listen to your body. The things that I told you are guidelines. Everyone is different, and your experience very well may fall into these guidelines, and actually, it's most likely to fall into these guidelines, but it's going to be uniquely yours. And I want you to get into the habit of listening to your body and really listening to your whole self. That means listening to any gut feelings that you have, listening to any little whispers, any little voices that you hear, get in the habit of trusting yourself. Now, this episode was an overview of the stages of labor, but there's so much more inside the birth preparation course.

(32:55): I have lessons on how to manage pain and labor unmedicated labor, what happens with monitoring your baby during labor, what happens with IV fluids during labor eating and drinking, and labor, how to push your baby out, how to prevent vaginal tears. So there is a ton more information inside the birth preparation cords. You can check that out at drnicolerankins.com/enroll. All right, so there you have it. That's it for this episode. Be sure to subscribe to the podcast so you never miss an episode. And if you feel so inclined, leave me a five star review an Apple podcast. If you enjoy the show, I love to hear what you think about the show. Also, come follow me on Instagram. I'm on Instagram at Dr. Nicole Rankins. You can follow me there to get great bite-sized tidbits of information about pregnancy and birth as well. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.