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How Long Will Labor Last?
It is impossible to predict how long any particular labor will last. A perfectly normal labor can take between 2 and 24 hours following the hours or days of prelabor.
Presentation refers to the part of the baby, top of the head (the vertex), brow, face, buttocks, feet, shoulders that is lowest in the uterus. The vertex almost always presents first; problems occur in delivery if any of the others present first. Position refers to the placement of the presenting part within the mother’s pelvis. The most common positions are:
– OA (occiput anterior): The back of the baby’s head (the occiput) points toward the mother’s front (anterior).
– OT (occiput transverse): The back of the baby’s head points toward the mother’s side (transverse).
– OP (occiput posterior): The back of the baby’s head points toward the mother’s back (posterior).
Although babies can and do change position during labor and during the pushing (second) stage, at birth the OA position is much more common than OP or OT. When the baby is in the OP position in labor, with the back of his head toward the mother’s back, labor is sometimes backache. There are many other reasons for back pain in labor, however (see page 185), and you should not assume the baby is OP just because the mother has back pain, prolonged, and the mother may experience intense
Many factors influence the length of labor: Whether this is a first or later baby. The condition of the cervix (soft and thin or firm and thick) when progressing contractions begin. The size of the baby, particularly the head, in relation to the size of the mother’s pelvis. The presentation and position of the baby’s head within the mother’s body. The strength and frequency of the contractions. The mother’s emotional state, if she is lonely, frightened, or angry, she may have a longer labor than if she is confident, content, and calm.
Labor Progresses in Six Ways
A woman makes progress toward birth in the following ways. Note that significant dilation does not take place until step 4. The first three steps usually occur simultaneously and gradually over the last weeks of pregnancy.
1. The cervix softens (ripens). While still thick, the cervix, through the action of hormones and prostaglandins, softens and becomes more pliable.
2. The position of the cervix changes. The cervix points toward the mother’s back during most of pregnancy, then gradually moves forward. The position of the cervix is assessed by an exam and is described as posterior (pointing toward the back), midline, or anterior (pointing toward the front).
3. The cervix thins and shortens (effaces). Usually about 1½ inches (or 3 to 4 centimeters) long, the cervix gradually shortens and becomes paper-thin. The amount of thinning (effacement) is measured in two ways:
Percentages. Zero percent means no thinning or shortening has occurred; 50 percent means the cervix is about half its former thickness; 100 percent means it is paper-thin.
Centimeters of length. Three to 4 centimeters long is the same as 0 percent effaced; 2 centimeters long is the same as 50 percent effaced; and less than 1 centimeter long means 80 to 90 percent effaced. Be sure not to confuse centimeters of cervical length with centimeters of cervical dilation!
4. The cervix opens (dilates). The opening (dilation) of the cervix is also measured in centimeters. The measurement is estimated by the caregiver who inserts two fingers through the cervix, spreads the fingers to the edges of the cervix, and estimates how far apart (in centimeters) the fingers are; it is not an exact science. Dilation usually occurs with progressing contractions, after the cervix has undergone the changes just described, but it is common for the cervix to dilate 1 to 3 centimeters before the woman has Positive Signs of labor. The cervix must open to approximately 10 centimeters (almost 4 inches) in diameter to allow the baby through.
5. The baby’s chin tucks onto his chest (this is called flexion) and his head rotates. The rotation makes it easier for the baby to pass through the birth canal. (Sometimes, especially if the head is large, it must mold before it can rotate. This means that the head changes shape, becoming longer and thinner. Molding is normal, although some babies’ heads look somewhat misshapen for a day or two following birth, after which they return to a round shape.) The most favorable position for birth is usually the OA (occiput anterior) position; see page 43 for information on other positions.
6. The baby descends. The head continues to mold as necessary to fit and descends to the outside. The descent is described in terms of station, which (a) tells how far above or below the mother’s mid-pelvis the baby’s head is (or buttocks or feet, in the case of a breech presentation; see page 190); (b) is measured in centimeters; and (c) ranges from minus 4 to plus 4. A zero station means the baby’s head is right at the mother’s mid-pelvis. Minus 1, 2, 3, or 4 means the head is that number of centimeters above the midfloatingpelvis. The greater the plus number, the closer the baby’s head is to the outside and to being born.
Some descent usually takes place before labor begins, especially with first-time mothers. When the baby drops, it settles into the pelvis to about minus 2 or minus 1. Most of the descent occurs late in labor.
Steps 4 through 6 (dilation beyond 2 to 3 centimeters, rotation, and descent) cannot take place until the first three steps are well under way. In other words, a cervix that is firm, thick, or posterior won’t open. It simply is not ready. And a baby won’t rotate and descend significantly until the cervix is open. For many women the first three steps take place imperceptibly and gradually in late pregnancy. For others they take place in a few days, with strong or even painful non-progressing contractions, which are referred to as prelabor contractions.
Timing Contractions
In early labor, one of the important jobs of the birth partner is to time contractions. Since changes in the length, strength, and frequency of contractions are the all-important hallmarks of true, progressing labor, it is a good idea for you to (1) know how to time correctly and (2) keep a written record. Then, when you call the mother’s caregiver, you will have accurate and concrete information to provide.
You may use a smart phone or computer with an application for timing contractions. There are many available. Search the Web or app store for labor contraction record, or something similar. The mother indicates the beginnings and ends of contractions and you or she taps the screen or presses a key. The smart phone keeps track of duration and frequency. You can enter other information like that shown in the Comments column in the table on page 55. Keep track of five or six in a row, to record the contraction pattern. Then you may wait until the contraction pattern seems to have changed. Time five or six more, and resume timing when she says the contractions are clearly stronger. Continue in this way until it is time to call the hospital.
Publisher : Harvard Common Press; 5th edition (Oct. 9 2018)
Language : English
Paperback : 440 pages
ISBN-10 : 1558329102
ISBN-13 : 978-1558329102
Item weight : 771 g
