During the first stage of labor, the contractions of the uterine muscles will cause the cervix to efface and dilate. Effacement is basically the shortening or thinning of the cervix. Dilation, in contrast, refers to the opening of the cervix, which is usually expressed in centimeters--from zero to 10 centimeters, or the point at which dilation is completed.
Another term used to indicate progress in labor is station or the location of the baby's "presenting part" -- usually the head -- in relation to certain bones in the pelvis. This indicates how much the baby has advanced or moved through the pelvis and is usually expressed in centimeters above (minus) and below (plus) the level of a certain point on the pelvis.

The healer should do a physical examination to determine effacement, dilatation of the cervix, and the baby's station. While this exam might be a little uncomfortable, it will help the patient and her labor partner understand how far she's progressed.

The first stage of labor is divided into three categories: early, active, and transition.

Early Labor
Early labor is the easiest but longest part of the labor, lasting from two to nine hours. Along with effacement, the cervix is dilating from zero to four centimeters. The contractions are from 30 to 60 seconds long, starting 20 to 30 minute apart and gradually getting closer until they're just five minutes apart. Starting out slow and slightly uncomfortable, the contractions will get stronger as labor progresses.
During the rest period between contractions, the patient should feel good, be talkative, and be able to walk around and continue normal activity. At this stage, most women feel confident that they can handle the labor. Others feel fearful that once labor has started, it won't stop.

When her labor starts, it's probably helpful for the patient to get some rest, so that she can do a better job of handling the later phases. The patient should know that as her contractions grow stronger, she'll wake up. That's when she should walk and move around to encourage labor.

During early labor, the patient may want to take in some clear liquids such as tea, juice, or broth. She should also try eating some light, nutritious snacks such as crackers, fruit and toast. During active labor her digestion will slow as much as her desire for food. Moreover, eating during active labor might result in vomiting and aspirating the contents of her stomach into her lungs.

For her labor partner, this is a time to get acquainted with her contractions. If he places his hands on her abdomen, he'll feel that her uterus has become very hard. Sometimes he'll feel a contraction beginning even before she is aware of it and can help the patient prepare for it. He can help the patient time the contractions and make sure she's relaxing with them. If he notices the patient tensing or expressing discomfort during the contractions, he can encourage the patient to relax, change position or urinate. (It's possible that a full bladder could be causing at least some of the discomfort.) If these ideas don't work, the patient might begin some slow-paced breathing.

Active Labor
During active labor, the patient's cervix dilates from four to eight centimeters. After five centimeters, her labor may move forward very quickly. Contractions get stronger (from 45 to 60 seconds), peak sooner, and are typically two to four minutes apart.. If her membranes rupture, it's usually with a gush. She may notice that her contractions become more intense as soon as her water breaks.
During this phase she'll probably notice that her mood becomes more and more serious and birth oriented. The patient may want to focus and may begin to doubt her ability to handle the contractions. She'll probably no longer want to chat or play games and may need help staying relaxed.

For her labor partner, this is a time to give reassurance and encouragement. Her partner should keep the healer informed of the patient's progress, help the patient maintain control during the contractions, and help the patient with breathing. The patient will want to hear short commands and suggestions since she probably won't be interested in long conversations.

If the patient's mouth is dry, her partner can get the patient ice chips, or a wet cloth for her to suck on. Or, the patient may want to have a cool cloth applied to her face. If the patient decides to walk around, the patient may want to depend on her partner to stop and support the patient during a contraction. If she's in bed, she'll want to change positions often -- every 20-30 minutes -- and adjust the bed to a comfortable position.

Transition
The transition from the first stage of labor to the second stage is the shortest phase, but it's also the most intense. The cervix is dilating from eight to 10 centimeters with contractions usually 60 to 90 seconds long. These contractions, which peak suddenly and peak more than once, can be as close as one and one-half to two minutes apart. Even though this stage of labor involves short rest periods, the patient may feel as if the contractions are right on top of each other. This can last from 10 minutes to one and one half hours. Transition is a sign that her labor is almost over and the baby is about to enter the world.
Ask her labor partner to be prepared to look for the following signs of transitions. However, be aware that the patient may not experience all of these signs:

An urge to push or bear down that could be mistaken for a bowel movement
Belching and hiccups
Nausea and vomiting
Shaking or trembling of the legs and body
Chills or extreme warmth and throwing off the covers
Cramps in the legs
Extreme sensitivity to touch
Spontaneous rupture of membranes, usually with a rush
Disorientated feelings
Forgetfulness between contractions
Sleeping between contractions
Body mucus discharge
Confusion or inability to understand directions
Lack of confidence in her ability to handle labor
Hopeless feelings
Panic
Irritability and restlessness
Flushed face


During the transition, it's important for her partner to offer encouragement. During this phase, he should take care not to leave the patient alone for any reason. The patient may panic even if she's left alone for a short period of time. Because of her heavy involvement in labor, the patient may want her labor partner to do most of the communicating with the healers. Make sure he knows her needs.

Make sure her labor partner catches each contraction. If she's sleeping or forgets between contractions, the partner should make sure that the patient starts breathing on time. He should help the patient relax between contractions. Remind the labor partner to be patient. Even if the patient yells at him, tell him not to argue or reprimand the patient and to use short and precise commands. If the patient gets confused, ask him to help the patient sit up in bed. If the patient seems to want to give up, have him remind the patient that this is the shortest phase and that labor is almost over.

Her partner needs to be especially careful about responding to the patient if the patient panics. For example, the patient may rock her head from side to side, grip the sheet, his hand or the bed. Or the patient may stop her breathing patterns and instead moan, cry out or even thrash around the bed. In cases like these, the labor partner needs to stand up, grasp her face in his hands, and bring her face close to his. The patient needs to hear that the transition is almost over and the patient only has a few contractions left.

If her back is uncomfortable, she should let her partner know. He can then use pressure, massage the area, or apply a warm and cool cloth. Or, he can put warm socks on her cold feet. To help with trembling legs, he can lightly massage her inner thighs or firmly grasp her legs. And, of course, he can keep a cool cloth on her forehead.

Here's a list of tips for her labor coach.

Give as much attention as you can without being overbearing. The patient will need a shoulder she can lean on for support.

Stay calm and have confidence. Take a few moments out to relax. If a difficult situation arises, take a few moments out, take a deep breath, make the best decision possible and then move on.

Provide physical and verbal support. Ask if you can hold your partner's hand to help ease pain and tension. If your partner is beginning to panic, but not breathing or coping effectively, turn her face towards yours. Tell her to open her eyes and look directly at you. Hold her firmly and let her know that you're there to help. Remind her what a great job she's doing. If she gets discouraged, remind her of how far she's come and to try to take one contraction at a time.

Breathe with your partner. If your partner's breathing pattern isn't working, encourage her to try a different one. If the patient forgets the patterns, don't worry. Just remember to start and finish a contraction with a cleansing breath. Breathe at a comfortable rate.

Make helpful suggestions, as opposed to giving orders. Talk to your partner in between contractions and be sure to ask her if your ideas have been helpful and if there's anything else you can do for her. She may not be able to concentrate so you may need to repeat yourself to make sure she understands you.



See Also: No articles yet

Referenced By: No articles yet