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What Happens during this Stage

• The cervix softens (ripens), thins, and moves forward. Contractions are usually irregular and may be changed with Mother’s change of activity
• Mother may become anxious, discouraged, or tired if contractions go on for long. (should not be perceived as unproductive)
• Mother may experience: burst of energy or nesting urge, vague nagging backache causing restlessness, several soft bowel movements often accompanied by flu-like symptoms, cramping, blood-tinged mucous discharge, bag of waters leaks, continuing, nonprogressing contractions that do not become longer, stronger, and closer together over a period of time.

What Partner/Dad can do to Help

• Encourage mother to continue normal activities during the daytime (as long as not strenuous) or rest if at night, drink and eat as usual, time contractions occasionally, suggest water (bath or shower) for relaxation, do a deep relaxation exercise, drink a glass or two of herb tea or wine, and/or ignore these contractions using distraction activities.

Early or Latent Labor
What Happens during this Stage

• Cervix continues thinning and dilates to approx. 4 cm.
• Progress usually begins slowly
• Mother may experience one or both of the following:

  Spontaneous rupture of membranes (membranes rupture before other signs of labor only about 10% of the time—usually ruptures after 7 cm)

  Contractions become longer, stronger and closer together over time (it is a clear sign that the cervix is dilating if the mother has had 10-12 contractions that (1) average one minute in length, (2) occur five or fewer minutes apart, and (3) feel intense or “very strong”)

• Mother may feel these contractions in her abdomen or back, or both. Bloody/mucus show

What Partner/Dad can do to Help

• Remain with the mother, continuing as in pre-labor for as long as possible
• Encourage mother to begin using slow breathing and relaxation techniques when she can no longer walk and talk through contractions.
• Do not ask questions or speak during contractions
• Offer light, nourishing refreshments frequently; between contractions
• If membranes rupture use precautions to prevent infection (limited vaginal exams, good hygiene, no intercourse, increase fluid intake)

Active Labor
What Happens during this Stage

• Cervix dilates to about 8 cm and effacement is usually complete or almost complete.
• Contractions become intense, last 60 seconds or more, come closer – every 5 or fewer minutes
• Progress speeds up; the mother cannot be distracted from these contractions
• Bloody/mucus show
• Mother may become quiet, serious, focused on her labor

What Partner/Dad can do to Help

• Discuss with mother when to call birth attendants, if any are desired to be present.
• Give mother your total, undivided attention for every contraction from this point on
• Match her mood
• Time a few contractions for frequency and duration
• Offer encouraging words pointing out more rapid progress of this phase
• Use comfort measures (for backache use cold or heat, counterpressure, and leaning forward positions)
• Between contractions, get feedback from mom on comfort measures and adjust as requested
• Offer a sip of liquid after contractions, alternate juice and water
• Remind mother to urinate every hour or two
• Maintain a calm and quiet laboring environment

Transition
What Happens during this Stage

• Cervix becomes completely effaced (100%) and dilated (10 cm)
• Baby may begin descent, and mother may feel rectal pressure and the urge to push
• Contractions every 2-10 minutes lasting 60- 90 seconds and are intense
• Mother becomes completely inward-focused and may become restless, tense, overwhelmed, irritable, tired, despairing, weepy, cry out, want to give up or fight contractions.
• She may doze the few seconds between contractions.
• Mother may tremble, vomit, may not want to be touched, may want complete silence.

• Encourage mother to focus on one contraction at a time
• For some mothers, continuous encouragement/reassurance are necessary
• Remind her that this phase is the shortest and she will be pushing her baby out soon
• Keep external stimulation to a minimum! (talking, procedures, unnecessary touching, smells)
• Firm touch/massage is usually more favorable than light stroking
• Respect the birthing woman's wishes regarding noise, lights, and touch.

Second Stage of Labor – Birthing

Resting Phase or Natural Alignment Plateau
What Happens during this Stage

• Cervix is fully dilated
• The baby may be repositioning or molding
• Contractions may space out, subside, or seem to stop
• The uterus is “collecting itself” for upcoming effort
• Resting phase may not occur if baby is very low
• Mother becomes clear-headed, optimistic, and determined; she may wonder where the contractions went

What Partner/Dad can do to Help

• Be patient, your baby may need a little while longer.
• Be patient; remind mother of the resting phase, encourage her to relax and take advantage of rest.
• If mom feels discouraged, suggest she change positions (hands and knees, squat, supported squat, any upright positions.) If there is no hurry, encourage her to continue to rest as long as she and baby are without distress.

Decent Phase
What Happens during this Stage

• Spontaneous, uncontrollable urge to push
• Strong contractions resume, contractions 3-10 minutes apart
• Baby moves down the birth canal
• Mother may be alarmed at feeling the baby’s head in vagina. She may resist its passage by tensing her pelvic floor
• Baby moves down during contractions, slips back between pushes (“two steps forward, one step back”)

What Partner/Dad can do to Help

• Encourage rest between contractions
• Encourage mother to listen to her body as baby is descending
• Encourage her to release and relax her pelvic floor (“open up”, “let the baby come”, “you are stretching wonderfully”)
• Encourage mother to relax all muscles especially in her jaw, upper back/shoulder, legs, arms
• If pushing goes on for a length, offer moist rag or sips of water/juice for dry mouth and lips
• Encourage mother to touch baby's head once she is able
• Help mother to change positions if she needs to

Crowning and Birth Phase
What Happens during this Stage

• Baby’s head no longer slips back between pushes
• Birth of head is imminent
• Mother feels intense burning, stinging in vagina (“ring of fire”); she may feel as if she is going to split open
• Baby’s head emerges, rotates; then the shoulders and the rest of the body are born

What Partner/Dad can do to Help

• Remind mother that the burning (ring of fire) is the baby’s head stretching the perineum and coming out and her body’s signal to slow her pushing and “breathe the baby out” or pant
• Don’t rush mother
• Encourage mother that her perineum is stretching well, that her body was made to open up for her baby
• Receive baby or help mom to receive baby
• Help mother hold baby, preferably skin to skin

What Happens during this Stage

• Mother may experience extreme shakiness
• Mother may have contractions immediately after the birth or there may be a rest period
• Cord is clamped and cut (after the cord stops pulsating/pumping)

What Partner/Dad can do to Help

• Encourage mother to breastfeed baby
• If mother isn’t breastfeeding; nipple stimulation will help bring on contractions to expel placenta and control bleeding
• Hold baby while mother is repositioning or birthing placenta (if mom desires)