When regular uterine contractions become stronger, occur at shorter intervals, and last longer, it means that active labor is drawing near.

What happens during the first stage of labor?

At the beginning, signs appear that announce the onset of true labor: about 1–2 weeks before delivery, your abdomen may lower slightly as the baby descends toward the cervical opening. The mucus plug, which during pregnancy protected the uterine cavity from microorganisms, will also be expelled. Your body may begin a cleansing process – diarrhea, bloating, and increased vaginal discharge may occur. The amniotic fluid may leak slowly for several days or break suddenly with a gush (contact your midwife or doctor and note the time). Finally, the first contractions will appear – at first mild, then gradually becoming stronger.

The purpose of the contractions is to prepare the birth canal for the baby’s passage. The cervix shortens, becomes incorporated into the birth canal, and begins to dilate – first to about 4 cm (in the active phase of the first stage of labor) and eventually to about 10 cm (at the end of this stage). You may experience chills or hot flashes, trembling, nausea, and sometimes vomiting.

Admission to the hospital

When contractions become regular, contact your doctor or midwife. After an initial assessment of labor progress, you will be asked to come to the hospital. Take a warm bath or shower, dress comfortably, and remove nail polish (the color of your nails can be an important indicator of your well-being for the medical staff). Remember to bring your personal documents and all pregnancy test results.

The first place you will likely go in the hospital is the Labor Ward Admissions Unit. This is where your medical records will be created. You should undergo an examination (internal gynecological exam, external examination, basic measurements such as blood pressure and body temperature), and an assessment of the baby’s well-being.

This is also the moment when you will be asked to give consent for various medical procedures, such as the use of obstetric instruments or the administration of medications. It is worth thinking about these issues in advance, before labor begins.

If you have any doubts, needs, preferences, or expectations regarding perinatal care, remember that you have the right to express them. The medical staff should respect these rights (taking into account your and your baby’s current health) and discuss all procedures and examinations with you.

From the Admissions Unit, you will walk or be taken to the Delivery Room, where the next stages of labor will take place. The equipment in such a room depends on the facility you have chosen. It should include a special delivery bed, access to a toilet, a shower or bathtub, and possibly wall bars, exercise balls, or beanbags. Remember that inserting an intravenous line (for medications or fluids) or catheterization is not routine and should be done only when medically necessary.

How do contractions progress?

The beginning of labor is a phase of mild (for some women, a latent phase) to moderate contractions. Initially, contractions are short and infrequent – every 15-20 minutes. Gradually, however, they increase in intensity, duration, and frequency, occurring about every 6 minutes and lasting around 30 seconds. The pain may resemble menstrual cramps.

The active phase of the first stage of labor involves contractions every 4-5 minutes, lasting 35-45 seconds. The abdomen is no longer soft, but the pain is still manageable.

Toward the end of this stage, contractions become very intense, occurring every 2-3 minutes and lasting 45–60 seconds. The abdomen becomes very firm, and the cervix reaches its final centimeters of dilation. By the end of this phase you will certainly feel very tired, but with the onset of active pushing you will be able to summon the strength for one last effort.

Methods of relieving labor pain

The intensity of labor pain can vary greatly. It is often said that the perception of pain depends on the woman’s attitude, her knowledge and understanding of the physiology of labor, her confidence in her own abilities, and her trust in the midwife and doctor.

Among non-pharmacological methods of pain relief during labor, it is worth considering:

– massage, changes of position, physical exercises, water immersion, breathing and relaxation techniques, aromatherapy, acupuncture, prayer, music therapy, self-hypnosis, the “counter-pressure” technique, and similar methods.

Among pharmacological methods that may be used during labor, the following can be distinguished:

– epidural (lumbar) anesthesia, which blocks sensation from the waist down; it may prolong the second stage of labor and make effective pushing more difficult. It can usually be administered from about 4 cm of cervical dilation and is generally not given immediately before the pushing phase;

– spinal (lumbar) block, similar in procedure to an epidural but acting more deeply; often used for cesarean sections;

– saddle block, which numbs the vaginal and perineal area; used in assisted deliveries (with forceps or vacuum extractor);

– perineal block, a shallow local anesthetic of the vaginal or perineal area, used during suturing;

– general anesthesia, deep sleep induced for the time of delivering the baby, used for emergency cesarean sections and occasionally for some forceps deliveries. Because the anesthetic also affects the baby, it is usually administered in the final moments before delivery so that it does not have time to significantly reach the baby’s system.

What does the midwife do during Stage I?

• Assesses the progress of labor – performs an internal examination (to assess cervical dilation and condition) and an external examination (to check the position of the fetus).
• Assesses the mother’s condition – measures blood pressure, temperature, and heart rate.
• Assesses the baby’s condition in the womb – monitors the fetal heart rate.
• Evaluates the frequency and effectiveness of contractions and any discharge from the birth canal (the color of leaking amniotic fluid, the presence of blood).
• Reminds about hydration (and, if necessary, offers intravenous fluids) and regular emptying of the bladder (catheterization is considered an unnecessary routine intervention).
• Assesses how the woman is coping with pain – helps her use non-pharmacological pain-relief techniques, which is important for the effectiveness of contractions and proper progress of labor.
• Assesses the emotional state of both the woman in labor and her companion – provides emotional support and a sense of safety.
• Suggests positions for the active pushing stage that take into account both the woman’s needs and the obstetric situation (the baby’s position and the angle at which the head enters the birth canal).

This is the stage between full cervical dilation and the birth of the baby.

In the second stage of labor, the baby descends into the pelvis, adapting to the shape of the birth canal. Contractions may temporarily weaken, then give way to new ones accompanied by an urge to push. This stage can be divided into a passive phase, when the baby’s head moves spontaneously toward the outlet of the birth canal, and an active phase, in which pushing techniques during each contraction play the main role.

The baby’s head exerts constant pressure on the perineum. At a certain point the perineal tissues reach their maximum tension and no longer feel pain. It is at this moment that an episiotomy may be performed, if necessary. Such a decision should be guided by the well-being of the mother (risk of extensive tearing or a suspected large baby) and the well-being of the baby (e.g., breech presentation or the need for an assisted delivery with forceps or vacuum).

Labor is hard work, so you have the right to make sounds, groan, or even cry out. From a physiological point of view, however, lower-pitched sounds are more beneficial than high-pitched ones, which can interfere with breathing.

What actions can you expect from the midwife?

• Identifies Stage II of labor – confirms full cervical dilation, assesses the condition of the amniotic sac, and evaluates uterine contractions.
• May decide to perform an amniotomy (rupture of the membranes) to speed up labor or to better assess the baby’s condition. From the moment the membranes are ruptured, internal examinations should be limited to reduce the risk of infection.
• Assesses fetal well-being – listens to the fetal heart rate every 5 minutes and after each contraction.
• Monitors the progress of labor – performs external examination and, if necessary, internal examination; identifies the onset of the urge to push.
• Helps the woman assume appropriate positions (vertical positions and water immersion are recommended), taking into account her preferences and the current obstetric situation.
• Decides on perineal protection or episiotomy – evaluates the anatomical structure of the perineal tissues (current guidelines for midwives recommend avoiding routine episiotomy).
• Chooses appropriate pushing techniques (limiting directed pushing is recommended, allowing the baby’s head to descend spontaneously through the birth canal mainly due to uterine contractions and the natural urge to push), also respecting the woman’s preferences.
• Reminds about regular emptying of the bladder and adequate hydration (small sips of still water).
• Assesses the emotional state of the woman in labor, as this can significantly influence the progress of labor.

You have just given birth! All discomfort suddenly becomes less important, and you will soon forget the pain. If everything has gone well, the baby stays with the mother, and she can already attempt the first breastfeeding. Further surges of oxytocin are released. Almost immediately after birth, the uterus begins to contract and shrink, returning over time to its pre-pregnancy size.

What does the midwife do immediately after the baby is born?

• Ensures skin-to-skin contact between mother and baby right after birth, regardless of the final birthing position (it is recommended that this last at least 2 hours), and even after a cesarean section, at least for a short time.
• Assessing the newborn using the Apgar score at 1, 3, 5, and 10 minutes after birth.
• Clamps and cuts the umbilical cord (by prior agreement, the baby’s father may do this) after the cord has stopped pulsating, and secures the stump with a special clip.
• Closely monitors the mother’s general condition – measures blood pressure, temperature, and heart rate.
• Observes postpartum bleeding and signs of placental separation (pulling on the cord, uterine fundal pressure, and routine administration of oxytocin during the third and fourth stages of labor are not recommended).
• Helps the mother initiate breastfeeding when both she and the newborn are ready – assists with proper latch and, if necessary, corrects the baby’s sucking technique.

The final step is the delivery of the placenta, which usually requires little effort from the mother. A natural way to speed up this process is to begin breastfeeding, as the release of oxytocin causes uterine contractions and promotes placental separation from the uterine wall. It is important to check that the placenta is complete and that no fragments remain in the uterus, as retained tissue could lead to hemorrhage.

Sometimes additional procedures are necessary, such as suturing the perineal tissues or curettage of the uterine cavity if placental remnants are suspected. In such cases, you will receive appropriate anesthesia – local, epidural, spinal, or, in more serious situations, general anesthesia.

The midwife’s tasks include:

• Checking the completeness of the afterbirth (membranes, placental tissue, and umbilical cord).
• Assessing the birth canal – examining the vaginal vault, cervix, and perineum; if injuries are present, performing suturing and wound care (or, if not authorized, assisting the physician who does).
• Monitoring vaginal bleeding and the contraction of the uterine muscle.
• Assessing the mother’s general condition – measuring blood pressure, temperature, and heart rate 1 and 2 hours after birth, and evaluating her overall well-being.
• Assessing the newborn’s general condition – skin color, respiratory function, neurological reflexes, heart rate, possible birth injuries, and measuring basic parameters such as weight, length, BMI, and head and shoulder circumference.
• Ensuring continued physical and visual contact between mother and baby and protecting them from heat loss.

If the health of both mother and baby allows, you will be transferred together to the postnatal ward.

• The midwife informs the mother about the need for self-observation: signs of uterine contraction, bleeding, the healing process of any perineal injuries, overall well-being, and the need to report any abnormalities.
• The midwife instructs the mother on how to observe the baby’s condition: skin color, breathing, muscle tone, passing of meconium and urine, effective sucking, and the condition of the umbilical stump.
• The midwife informs the parents about the newborn’s examination by a pediatrician or neonatologist within the first 24 hours after birth and about the mandatory vaccinations.
• The midwife prepares the delivery documentation – the labor observation chart, partogram, newborn records, discharge and observation forms, and immunization cards.
• She documents the birth – prepares certificates for the civil registry office, for the employer/social insurance institution, and the child’s health booklet.
• She informs the parents about the need to register the child with a primary care clinic and to enroll the baby in health insurance.

Fear of childbirth is usually connected with uncertainty about the place of birth (Where? Will I get there on time? How will I be treated?), concerns about the physiology of labor (Will I manage to give birth? What about my privacy? How will my body react?), and fear of labor pain (How strong will it be? Will I cope?). You will manage, and everything will be fine 👍. Do you remember the birth scene from the movie "Apocalypto"? A well-being flooded by rain, and in it a woman standing on a single stone, hiding from enemies, giving birth… with her small son sitting on her shoulders… The baby is born just before the well is filled with water. At the right moment the husband appears and they escape together 😀. You will certainly not experience such an extreme birth, but every mother truly has enormous reserves of strength within her 👍.

The most important things in natural childbirth are:

• a sense of self-worth, self-confidence, and trust in yourself as a mother;
• awareness and understanding of what is happening and why;
• the presence and support of a close person (husband, friend, doula, midwife).

Labor pains and contractions have an important function – they inform you about the current stage of labor. Remember that this is periodic pain that ends with the birth of your child. Labor pain may feel stronger and more distressing when the woman in labor feels anxious, fearful, uncertain, helpless, is in an uncomfortable position, or senses a negative attitude from the medical staff. It is worth remembering that childbirth is a cooperation between mother and child. Excessive medicalization and interference with the natural process may cause the woman to hand over her role as the Giver of Life to doctors or midwives, losing motivation and control over her own birth. Very good results in overcoming fear of childbirth are achieved through visualization – positive images of birth – and by approaching labor as the most important task of your life, in which you, the Mother and Giver of Life, help your child from the outside to pass through the successive stages of birth. Good luck!

Sources used:

“Standards of care and medical procedures in perinatal care for women during physiological pregnancy, physiological labor, the postpartum period, and care of the newborn”, Ministry of Health, 2010.

“Model of care for women and children in the physiological perinatal period in out-of-hospital practice”, Midwife. Science and Practice, 4 (12)/2010, PZWL.

“Child: health and development”, Steven A. Dowshen, Neil Izenberg, Elizabeth Bass. Świat Książki, Warsaw, 2003.