If you are in the last trimester of pregnancy and delivery is approaching, you will be interested to know how the birth of your baby will develop and what will happen at each moment to arrive as prepared as possible.
Its usually called labor when the baby is born, but the truth is that labor begins much earlier. It consists of five phases , four plus the last one – when you finally have your baby in your arms – which should be considered as part of the process. We tell you what happens in childbirth step by step .
Phase one: Early or latent dilation
The first phase of labor is that of dilation, in which we can differentiate a first moment of early, latent or passive dilation, which is when the opening of the cervix begins .
This stage is usually the longest and luckily the least intense; in fact, most women will not even be aware of their incipient dilation until the gynecologist explores them in their pre-delivery visits.
The effacement, softening and dilation of the cervix up to 3 centimeters that characterize this stage can be achieved in a period of days or weeks without producing annoying contractions.
The oxytocin passes smoothly into the blood and the woman begins to have little noticeable contractions. These contractions are common after the 35th week of gestation, but they are not regular, progressive or intense enough to think that the time has come for delivery and go to the clinic. However, they are a sign that the day is approaching.
The symptoms that can be perceived are back pain (either with each contraction or constantly), pelvic pain similar to that of menstruation, indigestion, diarrhea, a sensation of heat in the abdomen …
To a large extent, the quality of our delivery may depend on this stage, since it is not the same to reach true contractions with an “advantage” three centimeters and with the cervix erased, that is, already thinned and shortened.
Phase Two: Active Dilation
Early or latent dilation gives way to the active dilation phase. Here the cervix will go from 3 to 10 centimeters in dilation to open the birth canal and allow the baby to come out.
In this phase, the contractions are already rhythmic, strong and more followed , although in each woman their intensity and rhythm will vary, resulting in dilations of very different duration. It can dilate a centimeter per hour, but it can also move faster, especially if it has already given birth.
It will dilate until it reaches approximately 10 centimeters, which will be when the baby will be able to stick its head out and come out in the next phase, the expulsion. At this time it is convenient to put into practice all the techniques to relieve pain, such as breathing and other non-pharmacological techniques, or to decide if we want the epidural.
The mental attitude and relaxation is also important, since it can help to overcome a distressing dilation and make it more bearable. The father has a fundamental role in this regard and also the hospital staff who accompany us if it is the case.
The pain that accompanies this phase is due to the fact that the efforts of the uterus are very concentrated and when the uterus contracts strongly it tends to expel all the blood that is in its muscle fibers, which are squeezed. The absence of blood causes a lack of oxygen in the muscle and that is what determines the pain.
When the contraction ends, the muscle expands, relaxes and receives the blood supply again, becoming oxygenated again, when the pain ceases momentarily.
In this period of effacement and dilation, the amniotic bag usually ruptures and 2 stages can be differentiated: accelerated dilation up to 5-6 centimeters and advanced dilation up to 10 centimeters. Let’s look at each of these stages.
Dilation up to 5-6 cms.
We are in a period of acceleration is in which the contractions begin to become more painful. We go from the initial centimeters achieved in the latent dilation phase to true labor. During contractions the pain is considerable, and the mother may not be able to speak while undergoing them or may need to squeeze something with her hands. Many women find it helpful to focus on breathing work. Each mother will cope with these moments differently, and the perception of pain will also not be the same or located in the same places (it can be more intense in the abdomen, in the kidneys, spread through the legs …).
Between contraction and contraction, the pain usually disappears and the mother can take advantage of it to continue with her pain relief techniques and relax, because it is convenient to take strength for the next stage in which we will not have rest.
It is at these times when the epidural is usually administered if the mother wishes, since after 5 centimeters the process will go much faster.
Dilation from 5-6 to 10 cms
It is also called advanced active dilation or transition dilation, since it takes us to the next phase, expulsion. This is the stage of maximum speed, when it dilates in a short time at high speed and the sensation of pain increases due to the increase in the intensity of the contractions. It is probable that the mother already finds few moments of absence of pain, since the contractions practically appear chained to each other, although it is always necessary to try to remain calm.
At this time, hospital staff often consider that the administration of the epidural is no longer appropriate. Let’s think that it is usual for the last 3 centimeters of dilation to occur in 15 or 20 minutes. And the baby is about to be born.
The mother usually feels great pressure on the lower part of the back and / or on the perineum, which causes an intense desire to push, and although it is not yet the time to do so, it will only be necessary to wait a very short time. If we push when the cervix is not yet fully dilated, we could cause it to swell, which could lengthen labor.
Instead of thinking about what we have left, we can look back and see all that we have already been through, the great path that we have already traveled. Draw strength from weakness and keep your spirits up. In a few minutes you will see your baby for the first time.
Phase Three: Expulsion
If in the early stages of labor the contractions had the function of opening and lengthening the cervix, during the expulsion period they are a kind of propulsive force that helps the baby to be born. They are associated with pushing and are accompanied by a sensation of pressure due to the baby’s head pressing on the rectum.
The contractions of this stage are more regular than the previous ones, they last between 60 and 90 seconds and may be more distant. The perception of pain in these moments is very different according to the woman, sometimes they feel like more painful contractions than the previous ones, sometimes the fact of pushing makes the pain less felt.
Mothers’ feelings at this time are very diverse, they can range from the recovery of energy knowing that they can push and begin their more active participation in childbirth, to the feeling of dejection due to fatigue and pain. But what matters is not to decay and think that there are only a few minutes left to see our baby.
There are several postures to carry out this expulsion stage, and it is becoming more and more evident that the traditional hospital posture, lying on the delivery table with legs apart and feet on stirrups placed at the end of the table, is one more option, not always the most suitable as we have seen. Vertical delivery, sitting or squatting, is another option.
To push, in each contraction the mother must take a deep breath, hold her breath, and push two or three times, resting until the next contraction.
If necessary during this stage, an episiotomy would be performed, an incision in the perineum to facilitate the passage of the baby, and although this technique is applied routinely on many occasions, this application is not accepted by the World Health Organization ( WHO) .
Throughout this phase the baby progresses in stages. In deliveries in which the baby is positioned upside down, the head begins to emerge from the uterus, passes through the pelvis and, once the muscles that separate the vagina from the rectum (perineum) are distended, the vagina dilates and the head appears by the vulva. When the head is released, the shoulders come out and finally the rest of the body. The birth has occurred, we can already see our baby for the first time.
This expulsion phase can be of very variable duration, approximately between 30 and 60 minutes when it comes to the first birth and between 15 and 30 minutes when there have been other deliveries. If the expulsive phase is prolonged, and if the mother is suffering intensely, she may feel frustration, or the need for the suffering to end, in a kind of “despair”, a normal and transitory reaction that professionals and companions can help to mitigate with your understanding and advice.
Phase Four: Delivery
After the baby is delivered, and while it is being given the first care and it is placed on the mother’s breast, the uterine contractions return to achieve the expulsion of the placenta, membranes and the rest of the cord .
In this phase of delivery, it is not necessary to specifically resort to an external help factor, we will only have to keep the body at rest, which will not be difficult after the effort and when we are finally with our baby.
The contractions, which at this stage are hardly painful, will do the rest, and between 5 minutes and 1 hour after the baby is born, the placenta will be delivered. This passes to the lower segment of the uterus and into the vagina, with which it can be extracted. Once the placenta is delivered, the doctor will take care of suturing any tears or the episiotomy, if it has been done.
If the mother has delivered under epidural anesthesia, she will hardly notice any discomfort. If not, you will experience pain similar to the dilation period, but less intense and lasting.
At this stage, the mother’s sensations can be very varied, but in general, fatigue and pain give way to happiness for having the baby already with us. Hunger, thirst, chills, tremors, impatience, relaxation, anxiety … each mother will describe these moments in a different way, but probably where they coincide is that all the previous suffering is forgotten.
After verifying that the uterus has contracted well and that it does not bleed excessively, the hospital staff clean and disinfect the mother’s genital area. Afterward, you are transferred to your room, or to an observation room if you have received anesthesia.
Phase Five: Immediate Postpartum
Ideally, the mother should be allowed to establish the first bonds with the baby thanks to direct contact and an atmosphere that is as intimate and relaxed as possible.
After the expulsion and while the placenta is being delivered, the baby is placed on the mother’s breast to establish a first bond . It is a very emotional moment, the first time you have your baby in skin-to-skin contact with your body, feeling its heat, its smell, seeing its face for the first time.
The power of instinct is so strong that if the baby is placed on the mother’s abdomen, it is able to crawl up to the breast without any help.
In some hospitals, after the first contact, the baby is taken to clean, weigh and carry out the first tests, including the Apgar test, but it is recommended that this protocol be carried out close to the mother, to avoid separating them.
The first hour after childbirth, even the first two hours are spoken of as sacred to the mother and the baby. It is a particularly sensitive period in which early contact between mother and baby has both immediate and long-term positive effects. In those moments, what is known as an affective imprint is established that favors the bond between the two and the establishment of breastfeeding.
