The Active Phase of Labor

Your practitioner has just rechecked your cervix. He or she tells you, "Seven centimeters dilated, and your baby's head is at +1 station. You're well into active phase labor." You don't really need anyone to tell you that you're in the active phase, though, because you can sense the difference. The contractions are now longer, stronger, and closer together. When did that start? You can't remember exactly, but it must have been shortly after you noticed that your membranes had ruptured. So now, in addition to enduring the contractions, you feel fluid leaking a bit at a time. During the active phase, most women also experience uncontrollable shaking in addition to the pain. No one knows why this happens, although hormonal changes are undoubtedly involved. Amazingly, women who have no labor and undergo Caesarean section deliveries (perhaps because the baby was breech) also experience shaking when the baby is delivered. There is no way to stop the shaking; it's just a normal part of the active phase. Overall, things feel out of control, and you may be worrying. Is everything okay?

The active phase of labor is the second part of the first stage, during which the cervix dilates from 0 to 10 cm. As the name implies, this phase tends to be faster and more efficient than the latent phase. The contractions are longer, lasting from 60 to 90 seconds, and they are often more frequent, coming regularly every 2 minutes. Many women report that the contractions are stronger and felt more intensely as well.

In active labor, your body is working at maximum capacity, and it's easy to become overwhelmed by all the different things that are happening to you that are completely beyond your control. If you know what to expect, though, you need not worry that these very powerful sensations indicate something is wrong. Generally, they are a sign that everything is all right, that your body is performing this most miraculous of tasks with all the strength and ability that nature intended.

What might you feel? Well, first and foremost is the pain. There are a few lucky women who have painless labor, but the vast majority do not. Strong, painful contractions regularly occurring every 2 minutes and lasting 60 to 90 seconds characterize active labor. And they are enough to test anyone's endurance, especially if the active phase lasts several hours, which it usually does in first labors. During the active phase, many women rely most heavily on the breathing exercises that they learned in childbirth classes.

Some women find that the breathing exercises are not enough. This should not be surprising when you consider that breathing exercises do not relieve the pain, they just help you to cope with it. At this point, a lot of women opt for some form of pain relief, either a short-acting medication such as Numorphan, which dulls the pain but wears off quickly, or epidural anesthesia, which stops the pain altogether by anesthetizing the lower spinal nerves. Both methods will be considered in detail in Chapter 24.

As the cervix dilates to 8-9 cm., the active phase becomes known as transition. This refers to the transition between the first stage, when the cervix dilates to 10 cm., and the second stage, when the baby is pushed out. Many women experience nausea and vomiting during transition, whether or not they have received anesthesia. No one understands why this happens, but it is a normal, if unpleasant, part of labor.

New sensations often develop during transition. As the baby’s head descends, you may experience an almost uncontrollable urge to bear down or push. That sensation is going to be very important and helpful when it's actually time to push the baby out. Unfortunately, the sensation often begins before 10 cm. dilation is reached. Pushing before the cervix is fully dilated may cause the cervix to swell or to tear and bleed, so it's very important to avoid pushing until your practitioner tells you when you're ready.

The breathing exercises specifically designed for transition can be very helpful. You can't push when you are blowing! If you have opted for epidural anesthesia, you will not feel the urge to push. This can be a big advantage during transition, but it can also make pushing less effective in the second stage.

The active phase of labor is a very intense experience. As you feel engulfed and overwhelmed by many strong sensations, it helps to remember that these are the signs that your labor is progressing normally. Most importantly, they are bringing you ever closer to seeing your baby.