Amy Price PT, MSc PT, BSc Kin

For new parents-to-be, as baby’s expected due date approaches there can be a lot of feelings, including excitement, nerves, and uncertainty about what is to come with labour and delivery.  Labour, or childbirth, is the process of a baby leaving the womb and entering the world.  Although every pregnancy and birth is different, labour and delivery can be divided up into three main stages.  The first is when the uterus starts to contract and relax, and can be further divided into 3 phases (early labour, active labour, and transition). The second stage is the delivery of the baby, and the third stage is the delivery of the placenta.  The following blog will explore each stage in more detail, and discuss how pelvic physiotherapy can help you prepare for the process of labour and delivery. 

First Stage

The first stage of labour is characterized by the onset of contractions, as the body prepares for birth. This stage can be divided into three phases: early labour, active labour, and the transition phase. This phase is generally the longest and can last anywhere from 12-24 hours for a first baby

o    Early labour: contractions begin as the cervix gradually thins and dilates (opens). At this point may be irregular and mild at first, they can last 30-60 seconds and come every 5-20 minutes. This phase of early labour can last for hours or even days. 

o    Active labour:  contractions become stronger, longer, and more regular as the cervix continues to dilate. During this time, the birthing parent may feel pressure in the lower back and abdomen. In the course of this phase the baby is progressing towards birth. 

o    Transition: during this phase, rapid cervical dilation occurs, usually from 8-10 cm. Contractions reach their peak intensity and occur close together (only 1-2 minutes apart). Transition is when the body is preparing to enter the next stage, which involves pushing. 

Second Stage

Stage two of labour begins once the cervix is fully dilated (10cm). It involves the act of pushing the baby into and through the birth canal. The duration of this phase can vary from only a few minutes to several hours. The baby’s head will gradually descend with each push.  As the baby moves into the vagina, the birthing parent may feel pressure in the rectum and an urge to push.  When the babies head begins to show in the vagina, this is called “crowning” and the birth provider will start to assist and guide the baby out. 

Third Stage

After the baby is born, the third stage occurs which involves the delivery of the placenta. Mild contractions occurs at around 5-10 minutes after baby has been delivered to expel the the placenta from the uterus.  The birthing parent may or may not need to push, and the birth provider can assist with this process by gently pulling on the umbilical cord.  This generally takes 30 minutes or less.  Finally, after the 3 main stages of labour, the last phase of recovery can begin. 

Seeing a pelvic physiotherapist during pregnancy can help you prepare for labour and delivery. This can include learning about different positions to assume during the process to optimize progression of labour.  During early labour, the goal is to use positions to open the pelvic inlet so that baby’s head can descend into the pelvis.  This can be achieved by getting into postures that increase lower back flexion, like laying on your side, being on all fours, kneeling, or squatting with the pelvis tucked under.  During late labour, the goal is to get into positions to open the pelvic outlet, to allow baby’s head to reach the perineum and to create space for tailbone movement. This can be achieved by positioning into postures that involve low back and sacral extension, like laying on your side, all fours, kneeling, or sitting on a labour chair with the back arched. A pelvic physiotherapist can also help you prepare for labour by teaching you breathing and pushing strategies to assist with making phase 2 as easy as possible. Additionally, a pelvic physiotherapist instruct in performing massage and stretching of the pelvic muscles to help ease the process of pushing and reduce the risk of vaginal tearing.  Book an appointment to see a pelvic physiotherapists at Proactive Pelvic Health Centre today if you feel you would benefit from learning strategies to help you best prepare for your labour and delivery during pregnancy. 

Resources:

https://www.osfhealthcare.org/blog/what-to-expect-the-stages-of-labor-and-delivery/

https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/stages

https://www.healthyparentshealthychildren.ca/im-pregnant/labour-and-birth/stages-of-labour

https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/stages