The First Stage of Labor - Including Effacement and Dilation - What To Expect
Being knowledgeable about your pregnancy is essential because it can help you understand what to expect. In addition, that knowledge may calm some of the anxiety you may be facing, particularly regarding labor and delivery.
The stages of labor and birth are part of an amazing and seemingly miraculous process. Therefore, it is helpful to understand the typical process of how the body progresses through the stages of labor to ready itself for birth.
Every pregnancy and labor and delivery is unique, including the length of time, it takes to move from one stage to another. To help you on your personal journey, we’ve created a guide to the first stage of labor that will help you to understand the stages of labor and what is happening to the body during both early labor and active labor:
The Stages of Labor
There are three stages of labor. Stage one of labor involves early labor and active labor. The second stage of labor is the delivery of your baby. The third stage of labor is the delivery of the placenta.
How long each stage of labor lasts varies from pregnancy to pregnancy. Early labor could last hours or days. As labor progresses to active labor and your uterine contractions become more intense, regular, and close together, your doctor will send you to the hospital or birthing center.
Active labor usually lasts between four and eight hours. However, the birth of your baby can take a matter of minutes or hours. The baby’s head is the most significant and challenging part of the baby’s birth; once the head is out, the rest of the body will follow swiftly.
The placenta delivery takes about thirty minutes to an hour, and you’ll likely only need to push once for it to happen. It may come as a relief to know that the contractions before the placenta is delivered are less painful. You should have time between the birth of your baby and the placenta delivery to snuggle your baby and even have your first attempt at breastfeeding.
Now that we have briefly covered the phases of labor, we will get to the heart of the article and cover, in-depth, the first stage of labor.
First Stage of Labor
The first stage of labor includes early labor, also known as the latent phase, and active labor. Stage one involves cervical dilation and effacement of the cervix. Dilation is when the opening in your cervix widens, and effacement is the thinning and softening of your cervix.
Once the cervix is 6 cm dilated, your body moves into the active phase. Effacement is measured in percentages. The final stage of effacement and dilation is known as the transition phase, and this is the most intense time for most women. When the cervix completes effacing and dilating to 10 cm, you are ready to push.
The first stage of labor occurs when you begin to feel early and mild contractions.
Early labor can vary from lasting just a few hours to several days. These early labor contractions may remind you of Braxton Hicks contractions which you may have felt as early as the midpoint of your pregnancy. However, unlike Braxton Hicks contractions, real contractions will move closer together and become more intense as time goes on. You are also likely to feel real contractions in your lower back.
One of the first signs of early labor is sometimes called a bloody show. This may happen when your cervix begins to open and the mucus plug that blocks the opening to the cervix dislodges. The mucus plug is usually a thick, yellowish vaginal discharge that may be streaked with reddish-brown blood.
If you see a significant amount of blood or your water breaks, you should phone your obstetrics office to get their advice on the next steps.
As you approach your due date, your healthcare provider will advise when you should consider going to the hospital or reaching out to a doula or birth support team.
To help with early labor, you can practice breathing techniques, go for a walk, or experiment with sitting or moving in different positions.
Once you have been admitted to the hospital or birthing center, you will enter the later part of the first stage of labor, known as active labor. During active labor, your care team will monitor you and your baby closely, and at this point, you can ask for an epidural if it is part of your birth plan. In most cases, you can ask for pain relief during any point of active labor, so don’t feel as if you have to have your mind made up pre-delivery; however, you should discuss your options with your doctor ahead of time.
While you are pregnant, your cervix is usually around 2 to 3 cm long. Cervical effacement is the shortening and thinning of the cervix. Braxton Hicks or practice contractions start to shorten and soften the cervix in the third trimester of pregnancy.
For most women, the cervix shortens to 1 cm during the very early stages of labor. This is also referred to as 50 percent effaced. As the cervix continues to shorten, the cervix is gradually drawn up by the uterus, and by the time it is 100 percent effaced, the cervix will have started to open.
"I always think about it as a pie chart. If you have 2cm (out of 10) dilated, you are 20% done with dilation. If you are 80% effaced, you are 80% done with effacement. It's important to know that for a cervix to dilate, it must first thin out (efface)," explains HeHe Stewart, a Birth, and Postpartum Doula. "A pregnant person may walk around weeks effaced and dilated just a bit as their body prepares for labor. It's not uncommon to see someone be 2-3cm dilated and 50-60% effaced when labor starts.”
As your cervix is stretched and softened, it will also dilate, allowing your baby to pass through the vagina. Regular contractions cause the cervix to dilate. During first-time labor, the cervix typically dilates at an average of 1 cm per hour; this rate is often faster for subsequent labor.
Dilation — 6 cm
At 6 cm dilation, you are in active labor. Therefore, your contractions will be more frequent, regular, and stronger.
Unless you need to be in a specific position to allow for close monitoring of you and your baby, consider these ways to promote comfort during active labor:
- Change positions
- Roll on a large rubber ball (birthing ball)
- Take a warm shower or bath
- Take a walk, stopping to breathe through contractions
- Have a gentle massage between contractions
Dilation — 10 cm
At 10 cm dilation, you have reached full dilation. Contractions may be almost continuous, and you are nearly ready to start pushing your baby through the birth canal in a vaginal delivery. You will feel an overwhelming urge to push the baby out and feel pressure in your back and rectum. Contractions could be as close as 60 to 90 seconds apart.
The station refers to the position of your baby's head in relation to your pelvis. This is recorded as a number between -5 and +5. Zero station means the head is "engaged" and has entered the vaginal canal within the pelvic bones. A negative number (-5 to 0) means that the head isn't engaged in the pelvis. A positive number (0 to +4) means that your baby's head is moving down the pelvis, and +5 means your baby is crowning (being born). Ideally, you should not push until the head is engaged in the pelvis, even if you're fully dilated.
Signs of Early Labor
As your due date approaches, it is natural to look for labor signs. One early sign of labor could include when your baby drops, which means it descends into the pelvis. This can happen a few weeks before actual labor begins.
Other signs of early labor include:
- Regular contractions
- Leaking amniotic fluid
- Rupturing of your membranes (water breaking)
- Back pain
- Feeling pressure or fullness
- Increase in blood pressure or heart rate
- Nausea or vomiting
- A sudden burst of energy
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