1. What are the stages of labor?
  2. What can be done to alleviate pain?

What are the stages of labor?

Labor begins spontaneously between weeks 37 and 41 of pregnancy and usually lasts 12-18 hours. It is important that the mother-to-be is aware of the timing, mechanisms and sensations of labor in order to live all phases of childbirth with peace of mind and confidence.

Blood loss mixed with mucus may occur and, in most cases, this indicates the beginning of labor. The way contractions are perceived is subjective: it is different from one woman to another and may also be different in the same woman during different labors. The first contractions may either be very strong or very weak, actually allowing to continue with the normal daily activities.

Labor begins with irregular contractions of increasing intensity. As labor progresses, contractions become longer, more intense and more frequent, and are needed to prepare the cervix for the baby’s passage. 

Labor is divided into three stages: the prodromal stage or prodromal labor, the dilation stage and the afterbirth stage.

The prodromal stage marks the beginning of labor and can have a variable duration. At the beginning, contractions are still short and irregular, occurring every 20 minutes; as labor progresses, contractions start occurring more frequently, at closer intervals, reaching 5-minute intervals. Contractions prepare the cervix to the expulsion of the fetus; the cervix thins (effacement) and opens (dilation). If during this phase the amniotic sac breaks, then a liquid containing prostaglandins will be the released. This liquid is produced both by the mother and by the baby and stimulates contractions. Pain will be perceived especially at abdominal and lumbosacral level, and if in this phase the amniotic sac is still integer, it is not necessary to rush to the hospital.

During the dilation stage, contractions become more and more intense, prolonged, frequent and regular. The cervix is now thin and completely dilated. 

At this point the expulsion stage begins. Initially the baby’s head will descend through the birth canal and, slightly rotating, it will position itself in the best way to come out. The mother-to-be will feel the need to push; she will contract abdominal muscles and pelvic floor muscles will dilate. By pushing, the head of the baby continues to descend, while the vulva, which is the last obstacle before the baby’s birth, dilates.

What can be done to alleviate pain?

Women will be supported by the midwife who will guide them to coordinate breath and manage contractions. When contractions arrive, it is necessary to relax the whole body and focus on breathing, trying to keep the muscles of the perineum relaxed. Changing position or walking may be useful. 

The midwife will understand if and when to recommend the epidural during labor-delivery.