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Childbirth Preparation: Stage 1

In our first post of this 3-part Childbirth Preparation Series (written in collaboration with our Advisory Board member, Ashley Brichter of Birth Smarter), we provided an overview of what happens during labor, including a breakdown of the 3 stages.  Now that you have that foundation, this post will focus specifically on helping you prepare for Stage 1 Labor.

Recap: What Happens During Stage 1?

Recall that Stage 1 is the period where the uterus is “contracting” and the cervix is getting thinner (effaced) and opening (dilating) to allow baby to pass through. Contractions typically start quite short and mild, and gradually grow longer and (much) stronger.  Typically, it’s broken down into 3 phases:

  • Early Labor: This is the time from the onset of labor to when the cervix is dilated to 6 cm (ACOG 2014). Contractions begin mild, almost imperceptibly, with a long rest in between.  For example, you may feel a sensation in your lower back or lower abdomen (akin to menstrual cramps) for 30 seconds, followed by a period of no contractions for anywhere from 6-20 minutes. This cycle of stress-to-recovery can last approximately 8- 12 hours, and for much of the time you may not be aware that you are actually in early labor.  During early labor, you should balance rest and activity depending on the time of day, with the understanding that you may want to conserve energy for later. You should also prioritize proper breathing (more on this below) and staying hydrated.
  • Active Labor: This is the time when the cervix dilates from 6 cm – 8 cm, and the time when many people choose to head to the hospital or birthing center.  In active labor, contractions typically last around 60 seconds, with a rest of 3-5 minutes. This phase can last anywhere from 3 to 8 hours. Due to the intensity of contractions, you’ll need to rely on your mental strength, as well as several of the strategies we outline below.
  • Transition Labor: This is the shortest – and most intense – phase where the cervix fully dilates up to 10 cm. The intensity of this stage often brings women to “the wall.” You may express self-doubt and question your ability to continue. You may feel contractions radiating throughout your whole body, lasting for up to 90 seconds, followed by perhaps only 2 minutes of recovery before the next cycle begins.  Thankfully, this stage is also the shortest – lasting between 30 minutes to 2 hours.  You will need strong support from your birthing coach and/or partner during this time.

1. Pain Management

In our overview, We discussed the most fundamental technique to master first: 360° Breathing. Breathing in this manner is especially important during labor, as it releases endorphins (chemicals that have a natural calming effect), which reduce tension in your body and calm your nervous system.  Once you’ve mastered this, see other strategies below:

  • Patterned Breathing: This is a “distraction technique,” or something we do when pain is intense to shift our focus externally so we are less focused internally on the pain we’re feeling.  To figure out your own personal “pattern,” just start doing your 360° Breathing, but count in your head how long it takes you to inhale, and how long it takes you to exhale.  Let’s pretend it took you 4 counts to inhale, and 6 to exhale.  Then 4:6 becomes your pattern.  During labor, when pain is intense, get into your desired position (category 2 below) and focus on directing your breathing according to your 4:6 pattern — making your inhale 4 counts long, and exhale 6 counts long.  By concentrating on breathing according to your pattern, you are (at least somewhat) less focused on the pain.
  • Squeezing something: Another form of distraction is to have something in your hands that you can squeeze during contractions. Brichter recommends an old-fashioned comb so you can squeeze the pokey parts.
  • Heat + Ice: Brichter recommends disposable heat pads that can travel with you for your low back and shoulders.  Cold can also feel good — like ice packs on your low back, or cool compresses on your forehead.
  • Massage/Compression: Have a partner or doula massage your low back, hips, thighs, shoulders, head, hands, or feet. They can learn these strategies in a comprehensive childbirth education class.

2. Position Practice

Getting into various positions is another important component of pain management (and also helpful in facilitating proper position of your baby).  Review the various positions below, then we’ll cover strategies for how to use these during labor:

  • Deep Squats: This hip-to-heels squat is one of the most common labor positions.  In some cultures, it’s a position people spend a lot of time in. You can perform it on your own, holding onto the back of a chair or tabletop, holding onto your partner’s hands, or having your partner hold you from behind, as in the images below.  Can’t quite get into a deep squat yet?  Watch this video to learn how to practice the deep squat.

  • All 4s Hands and Knees:Any type of forward leaning position like this (or hinging below), not only feels good, but is also typically most friendly for getting baby into a good position. Once in this position, you can alternate tipping your pelvis forward and backward like in this video on a better way to perform cat/cow.  This will help loosen your low back for those moments you really need it.

  • Hinging: Similar to all 4s hands and knees, this is another beneficial forward leaning position.  You can do it standing by holding onto a tabletop or counter top with your torso parallel to the ground, or on a stability ball like the image below.

Brichter explains that once active labor hits, you cannot stand and have a contraction alone.  You need to throw your weight somewhere. She actually suggests setting up different position “stations” ahead of time with props in place, similar to circuit training. Spend 30 minutes or so in each position, then rotate through to keep your baby moving and you more comfortable.  Be sure the position is something that feels good for you and allows you to relax.  Any position where you are holding or straining is counterproductive to the work you need to accomplish. So throwing your weight onto a ball, your partner, or your bed, might be beneficial in allowing your inner body to work the way it needs to.  For more information on labor positions, read this post on Questioning Childbirth Positions.

3. Stamina Training

When we explained Stage 1 Labor above, did it kind of remind you of interval training? Childbirth is nature’s “ultimate interval training.” If you’ve ever taken a HIIT class (High Intensity Interval Training), the active and transition phases of Stage 1 labor are similar — just a LOT more intense.  You can begin to train your body now for these cycles of stress-to-recovery with this interval practice below, which we at PROnatal refer to as LIIT™ (Labor Intensive Interval Training).  

  • Work Guidance:Pick one movement to do for your “work” intervals that taxes your cardiorespiratory system (like football runs, reach down & up, high knee marchesetc…).  It can also be a strength move like a squat to overhead press, lunge pattern, or squat to row.  There are tons of options.  Just make sure it gets your heart pumping.
  • Recovery Guidance: For the recovery periods, choose a labor position to get into and immediately begin your 360° Breathing (or patterned breathing). This deep, diaphragmatic breathing pulls more oxygen into your body so your uterus can recover, and helps to calm your body so you can be ready for that next bout.
  • Interval Guidance: To determine how long to work and how long to rest, start with longer/more moderate intensity work periods and longer rest (like 60 sec of work, followed by 60 sec of rest).  As you get more comfortable, gradually make the work periods shorter and more intense, and the rest shorter.  Perhaps at the most intense, you are doing 30 sec of work (at what feels like an intensity of an 8 on a 1-10 scale for you), and only 20 sec of rest.  Do this for 3-5 rounds.  Of course, this is all completely customizable to what feels safe and right for your body.  You should also feel empowered to stop whenever you want.  The point is to gradually begin building your stamina and training your body to immediately transition into recovery so you can be better prepared when the “ultimate HIIT” comes.  

Conclusion and What’s Next…

While there is often a great deal of fear and anxiety surrounding childbirth, having a clearer picture of what to expect, and beginning to prepare yourself physically and mentally, can go a long way in easing anxiety and building your confidence. One thing we highly recommend every expecting mama (and her partner) do is take a Childbirth Education Class. This is one of the best ways to ensure you feel as prepared as possible going into your big day.

Now that you have a better sense of Stage 1 Labor, we will move onto Stage 2.  Ready?  Let’s go…



American College of Obstetricians and Gynecologists (2014). Nation’s OB/GYNs take aim at preventing Caesarians. February 19.