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Three Stages of Labor - for Birth Supporters

Rachel O'Reilly

By Aaryn Leineke

Labor can be one of the most rewarding experiences of a woman’s life. It can also be one of the scariest. Even if she’s read all the books and practiced all the breathing techniques, a new mother’s body will go through a change that no book or form of practice can prepare her for. As a birth supporter, your job is to offer comfort, reassurance and guidance throughout the process. Being a birth supporter can be very hard work, so it is important to take care of yourself in order to best take care of the laboring mother and her partner. You can find a few essential things to pack or have on hand if you know you'll be attending a birth here.

The below stages of labor refer to the ideal situations. At any moment of a pregnancy, need for medical intervention can arise. Before labor, be fully informed of the mother’s birth preference plan, and make sure you have all the information you need to contact the mother’s health care provider at any time during labor if things don’t feel right. I also find it helpful to find time to meet with the mother and others on her birth team to go over all questions, fears, excitements, must have's, do's and don'ts.

1. First Stages, 0 hrs - 2 weeks

       a. Early labor: 0 - 3 centimeters

            i. Anywhere from hours to a couple of weeks before birth, the mother’s cervix will dilate up to 3 centimeters. This stage of labor can happen over a lengthy period of time and can range from having relatively few bothersome or painful contractions, to being fairly uncomfortable. As a birth supporter, use this time to advise the mother to stay patient and find rest any time her body allows it.

            ii. During early labor, the mother should try to continue normal day/night activities as much as possible. It can take hours, and often the contractions are sporadic and anywhere between 5-10 minutes apart. Try to help her rest as much as possible at night, encourage her to take gentle walks during the day, and make sure you help with any last-minute preparations around the house.

            iii. As a birth supporter, the first stage of labor is when you should be a calm influence on the mother, offering comfort, reassurance and support. When you think labor has started, you can call the doula, who can help if the mother is feeling anxious.

            iv. If the mother and baby are healthy, it’s best to stay home during early labor or as long as possible. If your birth plan includes a hospital birth, keep in mind that nurses will most likely have mothers go back home who are not in active labor yet, if mother and baby are healthy. If you have a birth doula with you at home, she can help time contractions and provide insight on when the labor is becoming more active.

       b. Active labor: 3 - 6/7 centimeters

            i. Contractions will be stronger, longer, and closer together (lasting 45 - 60 seconds/3-5 minutes apart). At this time, you will usually take the mother to the hospital or call the midwife to support you at home.

            ii. Active labor is when all the labor prep gets put to work. Help the mother practice breathing techniques during each surge, and try to help her relax and let go of the tension between surges.

            iii. The best way to support a mother during active labor is to give her your undivided attention. Offer verbal encouragement and reassurance. Offer to massage areas of her body that you can see are uncomfortable, for example, her hips, lower back, shoulders, legs and feet. Keep track of the contractions and try to keep a log of their patterns or regularity. Go through the breathing techniques with her. Help her change positions and use props, like pillows, to support her when she’s found a position she likes. For example, use pillows between her legs to keep legs open, and under her belly for support of the baby when side laying. Suggest sitting on a yoga ball to inspire movement while working through surges as well as keep her hips open. Offer water, coconut water and other sources of hydration. Remind her to urinate frequently. Encourage use of music and remind her of any mantras she chose to use during challenging times. Tell her how proud of her you are.

       c. Transition: 7 - 10 centimeters

            i. Transition is generally considered the shortest stage of labor, but is typically the most intense. Contractions at this stage can be anywhere from 1-2 minutes apart, and lasting at least a minute, with little-to-no fluctuation on that pattern. As a doula, this stage is when I can see the light at the end of the tunnel for the mothers. But, that does not mean the mother always sees the same light. More than anything, this is when she needs the support of her birth team members.

            ii. During the transition stage, the baby can sometimes be low enough to activate the mother’s urge to push, yet in many cases, her cervix isn’t completely dilated, so she needs to resist. When the mother has urges to push, make sure the doctor or midwife are nearby and aware – and remind her not to push unless the doctor or midwife tell her to. Nausea, hot flashes, vomiting, gas and the need to defecate are all normal.

            iii. Remind the mother to take one surge at a time, and that each surge is what is bringing her baby closer to being in her arms. Don’t be alarmed if the mother is ready to “give up” or becomes very impatient. Avoid small talk, and use this time for encouraging words. If possible, try to use language that wasn’t a part of the many hours of early labor. After the 12th hour of hearing the same two encouraging words, the mother can get annoyed. :)

2. Second Stage, 0 - 4 hours (more or less)

       a. Pushing

            i. As a doula, this may be my favorite part of labor, as the mother will finally be able to find some relief with pushing. This doesn’t mean that pushing isn’t hard, or that labor is over. But, reaching this stage generally does bring some sense of accomplishment.

            ii. Many women need coaching while pushing. There are many techniques of pushing: spontaneous pushing, or bearing down for counts of 10 seconds, squatting or getting on all fours. Any pushing position that feels comfortable for the mother is a good one to let her try,. As a birth supporter it's good for you to then suggest for something new if she seems discouraged after some time.

            iii. Once the mother has found a preferred technique for pushing, she will need to push with everything she has. The feeling of frustration or embarrassment can arise during this stage, and as a birth supporter, you will need to continue to remind her that it is normal, it is HARD work, and the progress is there. Reiterate to the mother that she is doing all the right things to have her baby.

       b. Delivery

            i. Between surges, encourage the mother to rest and catch her breath.

            ii. If she wants it, use a mirror as guidance for the mother. When she can see the head of her baby emerge from her body, it will bring focus and encouragement back into her efforts.

            iii. An increase of bloody show is normal, and the crowning of the baby’s head can be very intense. The healthcare provider may ask the mother to slow down to avoid tearing of the perineum. Once the baby’s head is out, it often will take only one additional push to get the shoulders and remainder of his/her body out. As the floodgates open with tears, joy, laughter, relief and love for the new baby, again, tell the mother how proud of her you are.

3. Third Stage, 0 - 30 minutes

       a. Delivery of placenta

            i. By the final stage of labor, if all goes as planned, the baby will be in mother’s arms. She will be given time to connect with her baby through skin to skin contact. If and when the baby shows interest, the mother can allow her to begin nursing.

            ii. Mild contractions will eventually start up again. The placenta will release from the mother’s body and she will have the urge to push again, with guidance from her healthcare provider. Many moms can experience some discomfort during this final stage, due to tearing and stretching during the birthing process.

            iii. The mother’s body and hormones have gone through so much, so it is normal for her legs and body to shiver and shake during this time.

It is important to recognize that your role as a birth supporter continues after the three stages of labor. For the mother, although her new baby makes the process of labor all worth it, it won’t make the pain and exhaustion from the birthing process immediately go away. She will feel like she’s been hit by a truck. Parts of her body will not feel like her own. But with that new baby in her arms, the mother may be so overwhelmed with the new love she feels, that she forgets to address her own needs. In the hours and days following labor, continue to care for the mother’s basic needs like hydration and nourishment, and offer physical and mental support in whatever ways you can.

If you've ever experience supporting a Mother in labor, please share some of your best tips and props that you've found useful!