By Katherine Schreiber
If all goes according to schedule, you’ll start experiencing labor contractions—the dilation, shortening, and softening of your cervix—around week 40 of your pregnancy. Congratulations, you’ve entered the first phase of first stage of childbirth: Early labor. It can last from a few hours to a day more (yep). During this time your cervix is dilating to 6 centimeters, says Gupta.
[ READ AGAIN: WHAT ACTUALLY HAPPENS TO YOUR VAGINA BEFORE YOU GIVE BIRTH? ]
Early labor: More of a slip 'n' slide than Splash Mountain
Early labor may or may not be followed by your water breaking — the rupture of the amniotic fluid-filled sac your baby’s been suspended in for approximately nine months, which most women experience as a heavy but gradual trickle of fluid, rather than that dramatic splash often portrayed in movies and on television. Light bleeding (think: gooey blood stains in your underwear) during this stage is normal, says Gupta.
“However, any bleeding that is bright red or more than half a cup could indicate complications, like a placenta previa (when the placenta covers the cervix) or preterm labor.” Get yourself to a hospital stat if you haven’t already and this is the case, she advises.
Active labor: Push It Real Good
Next up is the active labor phase, or stage two of childbirth, where contractions increase in intensity (each lasting up to 90 seconds at a pace of every three to five minutes) as your cervix expands to ten centimeters. Expect nausea, possible leg cramping, and pressure in your back as your cervix dilates by one centimeter per hour.
An epidural, the introduction of local anesthesia to the lower spine, can be given at any time during active labor. Active labor lasts, on average, from four to eight hours — though sometimes more, as in California-based mom of two Raven Noyes’s case, who was in labor for over 30 hours during her first pregnancy and around 20 hours during her second.
Active labor is often when a cesarean-section — delivery via an incision in mom’s abdomen, a.k.a. C-section — is ruled in or out. C-sections are necessary if mom or baby are determined to be endangered by a vaginal birth — if, say, mom risks transmitting HIV or genital herpes to her baby through a vaginal birth, if baby is unable to be moved from a breech position, in distress, or the umbilical cord is pinched, or simply if labor is excessively prolonged.
C-sections are necessary if mom or baby are determined to be endangered by a vaginal birth — if, say, mom risks transmitting HIV or genital herpes to her baby through a vaginal birth, if baby is unable to be moved from a breech position, in distress, or the umbilical cord is pinched, or simply if labor is excessively prolonged.
For Noyes, 3 hours of trying to push her first baby out led her and her doctors to decide on a C-section. “It was either that or an episiotomy and vacuum attempted deliver with no guarantee of success,” she recalls.
Myers, who had to be induced at 39 weeks due to gestational diabetes, a condition in which blood sugar is dysregulated during pregnancy, recalls her own arduous active labor process after receiving a low dose of Pitocin, a drug that induces contractions, and receiving a catheter that mechanically assisted the dilation of her cervix.
“My water broke around 8-9 hours later, and the contractions came on hard and fast —we are talking from nothing at all to two intense contractions within five minutes, a few minutes in between, then starting again. I had done all the natural birth classes and had an amazing doula, but nothing prepared me for the intensity without a ramp up. I am a calm person, but at times I was screaming in pain. Then, because I felt like doing so was somehow failing those around me, I kept apologizing. I decided to get an epidural, and I am so glad I did, because when I looked at the monitors while they were putting the epidural in, my blood pressure was 180/120. I was terrified. I remember thinking, I am glad I am doing this, because I don't want to die." After a nap and 3 hours of pushing, doctors elected for a C-section, which brought Myers’ healthy baby into the world via incision within minutes.
"I had done all the natural birth classes and had an amazing doula, but nothing prepared me for the intensity without a ramp up."
Other women recall this painful period as an almost out-of-body or spiritual experience. “The hormone release that occurs during labor put me in an altered state of consciousness. The best way that I can explain is that it felt like I had a few glasses of red, without the slurring,” says pregnancy coach, doula, and childbirth educator Nichole Joy, who had her first baby via C-section, and her second and third vaginally.
Here comes baby
The second stage of childbirth concludes when baby comes out into the world. Once your cervix has reached ten centimeters, your baby’s head should being to emerge from your vagina (an event called “crowning”), and you’ll feel an overwhelming urge to push, which enables baby to make it out through your pelvis and birth canal. During this process you may feel a burning and stretching sensation called “the ring of fire” that results from baby’s head expanding your vaginal tissue even further, says Gupta. (Don’t worry, this part is only expected to last a few minutes, and when it’s over, the worst of labor is done.)
You may feel a burning and stretching sensation called “the ring of fire” that results from baby’s head expanding your vaginal tissue even further
Let’s be clear: You might (read: probably will) poop during this process and this is absolutely nothing to be embarrassed about. “In fact, if you’re pooping, you’re pushing well,” says one labor nurse.
“In fact, if you’re pooping, you’re pushing well.”
During baby’s descent through the birth canal and into the world, the vagina stretches to the width of a large bowl. That is, depending on your baby’s weight and size…. The average size of a baby’s head is 11.4cm. But pushing out shoulders and torso often stretches the vaginal walls even further, says Gupta. Once baby is out into the world your vagina will stretch back to a size that approximates it’s pre-birth width — though it may take around 6 weeks or more for the vaginal walls, uterus, cervix, and perineum to resume their pre-birth size and feel, says Gupta. As for your uterus? Give that about four weeks to assume its pre-birth size and weight.
And here comes ... everything else
Stage three comes after baby is out and the placenta follows suite within thirty minutes to an hour, requiring one final push. At this point, your physician will determine whether or not you’ll need stitches to resolve any tears in your vaginal, perineal, or anal region. For some women, stitches can be painful. But for others, like Joy, who received stitches after her second birth, they’re barely noticeable. “I didn’t even feel the stitches when I peed,” Joy recalls.
Be prepared. A couple tips to facilitate the birthing process and minimize your risks of tearing? Unless your baby is in a breech position or you have been medically advised to avoid physical activity, do squats every day during your pregnancy’s final weeks. Squatting consistently has been found to ease baby into the correct birthing position and facilitate water breaking.
As you head into your final month of pregnancy, consider (also) mastering the art of massaging your perineum — again, provided you get the green light from your OBGYN. Here’s a how-to from American Pregnancy Association. Research suggests perineal massage reduces first time moms’ likelihood of requiring stitches due to vaginal or perineal tears during the birthing process or requiring an episiotomy — a procedure involving a surgical incision between the vagina and perineum (space between your vagina and anus) with the goal of enlarging the opening through which baby comes out. (Side note: two comprehensive academic reviews have found no benefit of routine episiotomy to baby or mom.)
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Katherine Schreiber is a contributor to the Public Goods Blog, a publication about health, sustainability and people making an impact. Check it out for a wide range of topics: everything from product reviews and pesticides to watch out for to interior design and non-gmo foods.