Women’s experiences with labor and birth vary widely from woman to woman, from one phase of labor to another, and from one labor to the next. Your labor will be unique, influenced by many factors: the size, position, and health of your baby; your health and medical history; your expectations and feelings; the people who support and attend to you; and the place in which you labor and give birth.
But despite the variations, there is a common theme: the natural flow of labor. This process involves interplay between you and your baby. During your pregnancy, your body has held and protected your baby. Now, under the influence of hormones that you and your baby release, your body will soften, open, and yield to allow the baby to pass through.
Labor contractions, your body movements, and your pushing efforts will guide the baby down while the baby flexes, stretches, and rotates to navigate the birth canal. The birth process progresses from the softening (ripening) and opening (dilation) of your cervix to your baby’s descent and birth to the delivery of the placenta.
Giving birth was life-changing for me and for many of the women I have attended as a midwife. In a world in which we may often feel ineffective and pessimistic, working through labor under our own power can transform our sense of self. We experience ourselves as strong, sturdy, resilient, and able. We tap on inner strengths we may never have tapped before and are amazed by what we are able to accomplish. Once we become aware of how powerful we can be in giving birth, we can call on this throughout our lives, in all sorts of situations.
A woman who gave birth in a hospital birthing center says:
The day before she was born, I’d done everything: cooked, mopped, even put up a new mailbox in the bitter cold weather outside. At three a.m. my waters broke. We didn’t sleep much after that. We had an already scheduled appointment with Lucy at ten. Since I was only one centimeter dilated, she said, “Go on home.” . . . Off we went, and all of a sudden, there I was in hard labor, doubled over. Back we drove to the hospital birth center. No one was expecting us; the place was empty.
We got a room. I took a shower and curled into the yoga “child’s position,” letting hot water run down my back, relatively comfortable. Lucy finally arrived, saw I was completely dilated, and said, “Impressive! Good show!”
Signs of Approaching Labor (Prelabor)
Labor continues the process begun at conception. The finely tuned biological system that nurtures developing babies guides labor as well.
Just before labor begins, your body and your baby get ready for birth. The joints in your hips and pelvis further relax and open, ligaments increasingly soften, and the baby may drop deeper in your pelvis.
Toward the end of pregnancy—for some women, even earlier—you may occasionally feel a painless tightening of your uterus, the Braxton-Hicks contractions. You may also feel increased pressure in your pelvis and on your bladder as the baby settles deeper into your pelvis.
One woman was surprised by how little warning she had before labor began in earnest:
It was July 4, and while eating breakfast I said to my husband, “I guess we’re not going to have a Fourth of July baby.” I just felt so normal. I’d had Braxton-Hicks contractions for a few weeks and some mild indigestion the night before, but everything seemed to be status quo, and I figured that even if I began having the early signs of labor, I’d still have a long road ahead. Little did I know that my “independence baby” would be in my arms by four o’clock that afternoon!
Another woman describes the beginning of her labor:
I went into spontaneous labor in the wee morning hours during a rainstorm. My contractions started waking me up at two a.m., so I got out of bed and started cleaning… I did some organization around the apartment for a bit and then took a wonderful bath in our Jacuzzi tub. I deep conditioned my hair and carefully shaved my legs, knowing that I might not have the luxury to do these things in the busy weeks to come.
I told my partner, Brian, at around four a.m. that I was starting labor. We snuggled in bed, and he put on one of my favorite movies. I held on to him tightly through my contractions, which were not that close together yet. I called Melissa, my nearest and dearest friend, who lives three hours away. She was one of my labor support team. She would head down right away to help me through this.
Labor Begins and Early (Latent) Labor
The latent phase of labor may feel much the same to you as pre-labor, but during this time your cervix will open up (dilate) to four to five centimeters and will usually completely thin out (efface). Labor contractions will be short and spaced relatively far apart (from five to twenty minutes apart).
During the latent phase, your contractions will become longer, more painful, and more regular. This is not yet the time to go to a hospital or birthing center. However, most women at this stage want some kind of care, such as the reassuring presence of a partner or close friend or a care provider or other guide familiar with birth. Some women say that this phase of labor is the hardest psychologically. One midwife explains:
It’s like starting a hike and no one is telling you how long it is. The trail has lots of meandering switchbacks and hills, and you don’t know where you’re headed or how long it will take to get there, but you just keep going. Later, it may get physically more difficult, but at least then you can see the end in sight, the peak of the mountain, and you can push on.
Sometimes contractions build up gradually, starting with any of the signs mentioned above, with menstrual-like cramps evolving into stronger contractions that grow closer together over a long period of time, sometimes even over a period of days. At the other extreme, labor can begin abruptly, with strong regular contractions no more than five minutes apart, causing you to stop everything you are doing and concentrate.
Everyone responds differently to early labor. Walking, showering, taking long baths, or cuddling with loved ones can relax you and help labor progress. These early hours may be sweet as you lie with your partner or sit alone, the baby still within you in the quiet of your home.
It is important that you continue to eat nourishing foods to prepare you for the work ahead. And sleep is critical for much the same reason, particularly with a first baby, for which labor may be longer. Some women feel too excited or apprehensive to sleep. Try to save your energy for active labor. Don’t worry if contractions slow down when you lie down to rest; it’s still early. If you truly don’t feel up for rest, spending time with friends and family can be a nice distraction, but check in with yourself frequently and consider whether you would rather be resting.
If you begin to feel like a “watched pot,” ask for some time alone.
When we went for a walk, we ran into friends. “What are you doing up? I thought you were in labor.” It was fun changing people’s image of a woman in labor.
Labor Progresses (Active First Stage)
For many first-time mothers, it can take a day or more to get to about four centimeters dilation, which signals entry into the active phase of labor. When you feel painful, wavelike, regular, rhythmic contractions that last 45 to 60 seconds and that are so intense you can’t talk or walk while you are having one, you are likely in active labor.
The contractions may begin in your back, you may feel them only in the front, or you may feel them in both the back and front. Your uterus feels hard to the touch.
Though you may have heard that labor will get more and more painful as it progresses, this is not necessarily true. Some women say the active phase of labor was the most painful, some say the transition phase, and others say pushing was the most painful. In general, women feel the most pain during periods when the cervix is dilating fast or when the baby is descending quickly. These events can happen at different phases of labor for different women.
I spent most of the night laboring alone in the dark, like a cat. It was marvelous. Not easy—it’s hard work; that’s why it’s called LABOR. It was intense. Not painful—I can’t call it painful. But it’s . . . inevitable. Inescapable. Uncontrollable. You can’t get away. I kept thinking of that kids’ game “Going on a bear hunt”: “Can’t go over it, can’t go around it, have to go through it!”
This is the time to gather your support people, to call your provider if you are having a home birth, or to prepare to go to the birth center or hospital. If you are not sure if you are in active labor yet, your care provider can help you know for sure. A careful phone consultation, a home visit, or a visit at the office can help determine your progression.
Staying home or in another familiar, comfortable setting until active labor is well established is an important strategy for reducing your chance of interventions. Studies show that being admitted to a hospital in early labor increases the chances of having medications to speed up your labor or a cesarean section. Travel can be an uncomfortable challenge during active labor, but you can regain your rhythm once you are settled in your chosen birth setting.
Progress in the active phase of labor, both for first-time mothers and for women who have given birth before, is widely variable. In many hospital birth settings, expectations for labor progress are based on outdated studies that showed average dilation rates in women with medically managed labors (known as the “Friedman curve”) or driven by financial incentives to get labor done more quickly and make room for the next patient to be admitted.
The traditions of natural or expectant management and current evidence show that normal labor can be significantly longer than previous studies suggested, and “plateaus”—when the woman’s cervix doesn’t actively dilate for several hours— are common. As long as the mother and baby are doing well, labor should be allowed to progress on its own.
One woman describes her experience of getting “stuck” temporarily at a certain point in active labor:
I got stuck at about 8 to 9 centimeters for a really long time. I wasn’t aware how long, except that it was hours. [The doctor] who was on call suggested Pitocin to speed things up, but I refused. Part of my concern was that the contractions were already so intense that I felt if they were stronger and closer together I wouldn’t be able to cope, and I did not want to do anything that put me at risk for a C‑section… In the end, I realized that though it was hard, it was never more than I could take, and I had been prepared to keep pushing for even longer if necessary. I had not reached the end of my strength. We never would have been able to do it without our doula’s help—she was worth her weight in gold.
The last few centimeters, from eight centimeters to complete dilation (about 10 centimeters), can be the hardest, most intense phase of labor, but it is also usually the shortest. In first pregnancies, this period generally lasts no more than a couple of hours.
The transition is when many women get discouraged and feel that they have hit a wall and can’t go on. Excellent labor support from a loved one or doula can help you discover deep wells of strength to finish birthing. If you experience challenges at this time, keep in mind that this is the home stretch.
Your body has already accomplished most of the difficult work. Do whatever makes you feel more comfortable and helps you handle the intensity of labor. When transition is over, you will be pushing your baby out. One woman recalls how she shed her usual inhibitions during transition:
The hospital’s birthing pavilion was like a good hotel. But I didn’t get to kick back with a book and some room service. All through the night, I heaved around on the floor in a variety of positions—on my side Jane Fonda aerobics style, on all fours with ass and yoni to the wind, on the floor, and then up on the bed. I was desperate for comfort, relief and a baby in my arms.
Shift changes were going on, and people were coming and going. It was like Grand Central Station. . . They asked me if I minded having a nursing student watch the birth. By this time, I didn’t care if the security guard from the parking lot brought in popcorn and Raisinettes to watch the event.
Another woman says:
The peak of each contraction was such that I needed to close my eyes and really concentrate on the number of deep breaths I was taking, knowing that at the count of five or eight, depending on the length of the sensation, it would start to ease up. There’s a sureness in numbers— the logic overwhelmed the raw wildness of the sensation. I knew time was my only ally in dealing with the pain. With time each contraction would be over, with time the baby would be born.