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Mid first stage
What happens
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As the contractions get stronger, the cervix may dilate more rapidly. You may feel the need of positive support from those around you, and will not want to be distracted from the job in hand.
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Be prepared for a few more painful contractions than usual after the Midwife has examined your cervix or a change in the pattern of the contractions.
Helping yourself
Remember to empty your bladder every now and again, as you may not feel the normal sensations of a full bladder during labour. Pressure on the uterus from the bladder can make the uterus irritable and slow down the labour, it also prevents further decent of the baby.
If you are having a backache labour, do not lie on your back. Use hot water bottles / wheat packs and massage to lower back. Try to visualise the cervix opening, gently and purposefully in the response to the pressure from the baby’s head.
Relaxation / positions
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Give priority to full relaxation. Relax and breathe as seems comfortable. Don’t resist the good work that your uterus is doing. Remember to breathe out!
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For back ache labours, adopt upright and slightly forward positions or rock gently on all fours to encourage forward rotation of the baby.
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See attached sheets for other positions:
Partner’s help / needs
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Try to give her your total attention, despite any tiredness. Keep positive. Give her ice chips to suck & cool flannels about the face and neck to refresh.
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Support her in any decisions about pain relief that she may make - she ‘owns’ the pain.
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Help her to relax as upright as possible allowing gravity to aid descent and cervical dilatation. Now that the contractions are long and strong the baby can be more at risk of decreased blood supply should she lay flat during contractions.
Late first stage
What happens
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Dilation continues. The second half of the first stage is usually quicker than the first half. Contractions are now more frequent, last for longer and are stronger.
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The waters often break on their own during the second half of the first stage. When the waters go, the contractions seem to change in character, sometimes becoming more frequent and stronger.
Research clearly shows that it is usually better not to break them artificially unless there is a special reason to do so. More pain relief is required and the full force of the contractions is on the baby’s body once the waters have gone. Your Midwife will explain how an intact bag of waters aids the labour for both the Mum and baby.
Helping yourself
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Try not to think of anything but the present moment of time. Just respond to the contraction that you are having now. Focus on your ‘flop & relax time’ in between each one. Remember that you can only have one contraction at a time.
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Visualise the cervix half open now with the baby’s head pressing the remaining tissue away, smoothly and evenly.
Relaxation / positions
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Pelvic rocking can be very soothing during the contractions. It can also rock the baby’s head into a better position to negotiate it’s passage through the pelvis.
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Try finishing your contraction with a deeper breath and a smile - that is now one less to have to go through! Relax on this ‘resting’ breath.
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Do try a few different positions out, try kneeling , on knees and elbows, lying on one side supported on pillows, spa bath, standing - resting arms on the window sill etc...
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If you over breathe ( hyperventilate ) and feel dizzy, sick or get tingly hands, cup your hands over your mouth & nose and breathe more gently for a while.
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You may wish to use distraction techniques - a song, poem, prayer or meditation. Count in threes or just mouthing the word ‘out’ on each breath.
Partner’s help / needs
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Usually she will not want to talk very much. Help her to stay in the present. Do not discuss how much longer it may be - labour is unpredictable - it could be shorter!
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Help with changes of position.
Transition from first to second stage
What happens
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There may be strong irregular contractions, close together, making you feel muddled. There may be the urge to push down in the middle of the contraction before your cervix is fully dilated.
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The contractions may be overwhelming, as the cervix is now very stretched. This may produce panic and a loss of rhythm. You may feel irritable, angry, weepy, hot or cold. Often women shiver or vomit at this stage (midwives see these as positive signs that the second stage is close).
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After internal examination sometimes the woman is told that she has an ‘anterior lip’. This means that part of the cervix has not been fully pulled up over baby’s head. It may become bruised and very swollen should you push too soon.
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Ask to be checked that the cervix has completely gone before starting to push strongly, or ask the Midwife to tell you when she sees external signs of full dilatation.
Relaxation / positions
Upright positions may help with dilatation or try knees & elbows for extra comfort. Lying on your side can also be useful.
If you feel that you have to push before your Midwife wants you to, try huffing your breath out during the height of the contractions in short bursts to ‘waggle’ your ribs & diaphragm - it becomes harder to push then. Ask the Midwife for other hints to help.
Contractions can occasionally space out for a while during transition. Relax, enjoy the rest and wait for them to come back. Often a change of position - perhaps squatting, a drink, a walk to the W.C. or a shower will start them off again.
Partner’s help / needs
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Join in with distractions and keep eye contact if she wants you to. It may help if you also breathe in the same patterns as she is doing if she is trying not to push - it is so much easier to do with some one else helping you to keep rhythm.
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Remind her that she is almost there.
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Accept & understand moods and tears. Don’t argue. Comfort her.
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She may feel very vulnerable or out of control at this point. Don’t leave her alone.
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Remember that all the signs of transition are of progress.
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