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Childbirth Preparation: Stage 1

This is the second post in our 3-part Childbirth Preparation Series (written in collaboration with our Advisory Board member, Ashley Brichter of Birthsmarter). In our first post, 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 this is the stage where the uterus is contracting, and the cervix is softening to allow baby to pass through.  When baby’s head presses against the cervix, the pressure causes the cervix to thin, and in turn, causes the uterus to contract. These uterine contractions push the baby downward while also pulling the cervix up and out of the way. Typically, Stage 1 is broken down into 3 phases:

  • Early Labor: This is the time from onset to when the cervix is dilated to 6 cm (ACOG 2014). Contractions begin mild, almost imperceptibly, with a long rest in between. It can last approximately 8- 12 hours, and for much of the time you may not even be aware that you are in early labor.
  • Active Labor: This is the time when cervix dilates from 6 cm – 8 cm, and when many people are instructed to head to the hospital or birthing center.  Contractions typically last around 60 seconds, with a rest of 3-5 minutes. It can last 3-8 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 phase is the most intense – where the cervix fully dilates up to 10 cm. 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.

Factors That Influence Success

Now we will discuss three factors that can help you better manage through this stage.

1. Energy Management

When we described Stage 1 Labor (especially the Active and Transition phases), did it remind you a bit of High Intensity Interval Training (HIIT)? Childbirth is nature’s ultimate interval training. Therefore, energy system training is critical to ensure you have the endurance to make it through the many rounds of “stress-to-recovery” cycles. It is important to avoid expending unnecessary energy and to take full advantage of your rest periods so that you can be ready for the next round. It is also important to stay in the moment and keep your mind from focusing on “how much longer” you have to go. You can begin preparing your body physically and mentally for the energetic demands of Stage 1 Labor with a practice we refer to as LIIT™ (Labor Intensity Interval Training). Read this post to get the details on LIIT™ and how it works so you can begin practicing it on your own.

2. Position Variety

Movement is critical throughout the entire labor experience to ease discomfort and help baby perform its series of cardinal movements. Birthsmarter recommends setting up different position “stations” ahead of time with props in place, like circuit training. Spend about 30 minutes or so in each position, then change to a new position. This helps keep baby moving, while also helping you manage pain better.  Here are a few positions to consider:

  • 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 (quadruped): Any type of forward leaning position like this 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 the cat/cow stretch.  This will help loosen your low back for those moments you really need it.

  • Hinging: Similar to quadruped, this is another beneficial forward leaning position. You can do it standing by holding onto a tabletop or the back of a chair/couch with your torso parallel to the ground, or on your knees holding onto a chair or a large stability ball.

  • Side Lying: This is another position that could feel good. If possible, lie on your left side, because the large blood vessel carrying blood to your heart runs along the right side.

3. Mindset

Just as superior athletes learn to stay calm amidst the stress and chaos of competition, those who remain calm during labor minimize their energy expenditure and increase their production of oxytocin – the hormone that stimulates uterine contractions and moves labor along. Conversely, if you are scared or fearful, your body produces more cortisol and adrenaline. These hormones inhibit the production of oxytocin, which can slow, or even stall, labor. Therefore, the calmer you can remain during labor, the more efficient the entire process can be. This, of course, may seem easier said than done as “pain” increases.

However, consider this. Studies have shown that how we perceive pain plays a huge role in the degree to which we experience, and respond, to it. For example, one study on labor pain found that when respondents considered the pain to be “productive or purposeful,” they were much better able to cope with it than when they perceived it to be “threatening pain” that needed to be alleviated (Alder et al., 2007).  In other words, a focus on promoting labor “pain” as productive and purposeful may decrease your perception of “pain” and potentially the need for pain interventions.

That same study also found that the physical and social environment plays a powerful role in shaping the context within which pain is experienced. Oxytocin is the same hormone that triggers an orgasm. You don’t often have an orgasm while standing in line at the grocery store or riding on a crowded subway. Your environment and mindset play a BIG role in the release of this hormone.

There are several strategies you can use to create a safe and supportive environment, and improve your ability to focus and manage through discomfort. Quite possibly the most important strategy is 360˚ Breathing. This style of breathing activates your body’s parasympathetic nervous system, which calms your body and improves your ability to focus.  Watch this quick video to learn how to perform 360˚ Breathing

You can learn many more strategies in a Childbirth Education Class. We highly recommend the Birthsmarter classes for their refreshing, empowering, and evidence-based approach to all things birth.

What’s Next…

Now that you have a clearer sense of what happens during Stage 1 Labor, and some strategies you can use to help you more successfully navigate it, let’s move onto Stage 2: The Pushing Stage. Ready?  Let’s go…

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Sources:

Alder, J., Fink, N., Urech, C., Holzgreve, W., Hoesli, I., & Bitzer, J. (2007). Stress during pregnancy: The impact of maternal and fetal stress on pregnancy outcome. Journal of Psychosomatic Obstetrics and Gynecology, 28, 78.

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

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