Fig. 22.—Diagrams showing how the cervix is dilated as the bag of waters is forced downward by the uterine contractions.
The entire duration of labor may vary from a few moments to several days, but the average length of the first labor is about eighteen hours and of subsequent births about twelve hours. The process is usually described as being divided into the first, second and third stages of labor, approximately as follows:
| First stage | Second stage | Third stage | Total | |
|---|---|---|---|---|
| First labor | 16 hours | 1¾ hours | 15 minutes | 18 hours |
| Later labors | 11 hours | 45 minutes | 15 minutes | 12 hours |
The first stage begins with the onset of labor and lasts until the cervical canal is completely dilated; the second stage begins when the cervix is dilated and lasts until the baby is born; the third stage begins with the birth of the baby and lasts until the afterbirth is expelled.
First Stage. The pains are mild at first and occur at intervals of from fifteen to thirty minutes, but they gradually increase in frequency and intensity until by the end of fourteen to sixteen hours, they are very severe, and recur every three or four minutes, each pain lasting about one minute. The pains begin in the back, then pass slowly forward to the abdomen and down into the thighs.
The average woman is entirely comfortable between pains and until they become very frequent she will usually prefer to be up and about, but if she is on her feet when a contraction begins she will usually seek relief by leaning forward on something secure, as the foot of the bed or a table, or by sitting down until the pain subsides. As time passes, there is an increasing, sometimes persistent desire to empty the bowels and bladder because of pressure upon these two organs by the baby’s head as it is forced slowly downward. There may be vomiting, also when the cervix becomes nearly, or quite dilated.
In the course of the stretching process, the cervix sustains many tiny tears from which blood oozes and tinges the vaginal discharge. This bloodstained discharge is often called the “show” and usually appears toward the end of the first stage.
When the cervix is fully dilated, the membranes, or bag of waters, usually rupture, and there is a sudden gush of fluid, but the rupture of the membranes does not necessarily mark the end of the first stage. Sometimes, though not often, they break before labor begins, thus producing what is known as a “dry” labor. They may rupture before the cervix is fully dilated or they may not rupture at all until the doctor punctures them to facilitate the baby’s birth.
If the nurse is delayed in reaching you, there is a good deal that you can do and have done, during this first stage of labor, in the way of preparing for the baby’s arrival, this preparation relating in general to yourself and to the room including placement of the sterile dressings.
As to yourself, try first to picture what takes place during the fifteen or sixteen hours of the first stage. The baby’s head has usually passed through the pelvic inlet and not much happens, now, beyond the widening of the cervical canal, as the bag of waters is forced down by the squeezing of the uterus each time that it contracts. (See Fig. [23].) As the contractions grow stronger and more frequent you may have a desire to help matters by “bearing down,” or straining, but this is very unwise for nothing that you can do will hasten the dilation of the cervix. The bearing down will tire you and then you will not be able to make as much helpful effort during the second stage as you would in a fresh and rested condition. For this reason, if your pains begin at night, don’t get up, but stay in bed and try to get as much sleep as possible. If they begin during the day, keep up and about during most of the time, but lie down often enough and long enough to prevent your getting tired. But above all don’t bear down during the first stage.