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The stages of labor
Q: What are the stages of labor? I'm terrified I won't be able to stand the pain!
A: Dear Angela,

It can be very helpful to learn about labor and your options for pain management before the big event, so I'm happy to see you are asking questions.

Labor commonly is divided into three stages. The first stage is the longest, and includes the time it takes for your uterine contractions to engage your baby's head against your cervix and allow your cervix to shorten and stretch open completely. Second stage of labor is when you will be able to push, allowing your baby's head to rotate in your pelvis and descend through the birth canal and be born. The third stage of labor encompasses the delivery of the placenta, or afterbirth. Although all of your labor involves uterine contractions, each stage of labor feels different.

In the first stage of labor, which last many hours, contractions (or uterine muscle tightenings) usually begin mildly with large pauses between each one. Changing positions, moving around, walking, taking a shower, and having a massage can ease the discomfort at this time. Gradually, contractions increase in duration and intensity and may eventually feel overwhelming.

While many women prefer to use deep breathing, movement and massage to cope with their pain, others prefer narcotic medications or an epidural. You should find out what options are available in your birth center or hospital. Narcotics are generally given as an injection or through an intravenous line and will decrease your perception of pain. You may feel calmer and somewhat drugged, but you will still be aware of each contraction.

An epidural, on the other hand, may completely minimize your pain and allow you to remain quite alert, or take a nap if you prefer. This is a medication administered by an anesthesiologist near your spinal cord which numbs the nerves in the lower half of your body. A properly administered epidural will allow you to be aware of touch and pressure, but not pain. You will comfortably be able to push during the second stage of labor! For many women, it is a miraculous option.

In the second stage of labor, if you choose to have natural labor, you may find some relief during when you begin to push your baby out. The urge to push may be intense, and your contractions will be strong and powerful. The pushing stage generally lasts from a few minutes to a few hours. As your baby descends, you will feel increased pelvic pressure. During the actual birth, you will feel an intense burning as your perineum (the skin around your vagina) stretches. This is normal and will diminish after the baby's head and shoulders are delivered.

In the third stage of labor, which lasts up to 30 minutes, the uterus has longer, infrequent contractions that help the placenta to separate from the uterine wall. Your provider may help to ease out the placenta, or ask you to gently push during this phase. If you are already breastfeeding, your baby's suckling will help your uterus to contract, expelling the placenta, and stay firm, minimizing postpartum bleeding.

It would be very helpful for you to take a birth class or lecture. Learning about the process of labor and knowing about your options for pain relief can lessen your anxiety. Being fearful usually increases your sensation of pain, so finding ways to calm yourself are helpful.

Hypnotherapy and relaxation tapes are helpful for some women; having a caring partner or attendant is also essential. You and your labor coach should learn about deep breathing, massage, laboring in water (such as a bath or shower) and relaxation techniques before you go into labor.

If you are very anxious, and concerned about your own capacity to tolerate pain, be sure to choose a hospital that can provide an epidural if you desire one. It is best to choose a hospital that has anesthesiologists readily available, to minimize the time it would take to obtain an epidural if you choose one. Speak to your health care provider about childbirth classes in your area, and the options for pain relief in your own hospital.
Laura E. Stachel M.D. Obstetrician & Gynecologist