The first stage of labour

The first stage has three phases:

• Latent or early phase.
• Active labour.
• Transition.

Latent phase
This is usually the longest and easiest phase of labour.

• The cervix dilates from 0–3 cm.
• Contractions last for 30–60 seconds and may be 20–10 minutes apart, progressing to about 5 minutes apart.

You will probably be at home, feeling talkative and fine. Walking around should stimulate contractions.

Active labour

• 80% cervical effacement and 5 cm dilation at active stage.
• The cervix dilates from 3–8 cm.
• Contractions become stronger and peak faster, usually lasting about 60 seconds and occurring 2–4 minutes apart.

During this phase you will need to concentrate on pain management skills, and use your comfort aids.

Note to support person:
Latent phase and active labour

• Help her to relax.
• Allow her to concentrate deeply during a contraction.
• Help her to maintain slow breathing techniques.
• Massage her if she needs it.
• Encourage her to change her position frequently and to keep her bladder empty. Suggest that she tries different comfort measures that feel appropriate.
• Time contractions and count off 15 second intervals to help her know where she is in a contraction and how much longer it will last.
• As labour becomes more intense, help to identify the beginning and end of a contraction and highlight the break between contractions.
• Remind her to keep breathing “low and slow”.
• If she loses her way, guide and encourage her to resume the skills she learned.
• Expect and allow her moments of irritability, accept it as part of labour.
• Talk to her about things that mean a lot to you both.
•  Praise her.
• Never let her doubt your love for a moment.
• Be sure to tell her it’s nearly over!

Transition

100% cervical effacement and 8 cm dilation at transitional stage of labour.

This is the shortest and most intense stage of labour.

• The cervix dilates from 8–10 cm.
• The contractions usually last 60–90 seconds and peak quickly.
• The contractions may peak more than once and can be as close as 90 seconds to 2 minutes apart, which makes them feel like one long, continuous contraction.
• Transition may last from 10–90 minutes.

Signs of transition

• Premature urge to push.
• Nausea and/or vomiting.
• Shaking or uncontrollable trembling.
• Chills and/or extremely warm/flushed face.
• Loss of modesty.
• Sensitivity to touch.
• Increased bloody discharge.
• Tendency to want to give up, “I can’t go on!”.
• Despondency.
• Panic, if left alone.
• Irritability and restlessness.
• Feelings of being out of control.

Note to support person: Transition

•  Don’t leave her alone.
• Give plenty of support.
• Inform staff if she feels the need to push.
• Help her to breathe or ‘pant’ if she is not fully dilated.
• Help her change position to reduce the effects of gravity.
• Remain calm.
• Don’t be offended by her behaviour.
• Keep reminding her that it is nearly over.

Panic or loss of control routine

If she loses her focal point, starts tensing instead of relaxing, stops her breathing pattern, moans or cries out or thrashes around, help her gain control.

• Hold her face or wrists with your hands.
• Call her name and establish eye contact.
• Do the breathing with her.
• Be firm but encouraging.
• Continue with other comfort measures, as needed.
• Be sure to tell her it’s nearly over!

A positive thought:
My baby is almost here!