Labor

Signs of Labor
There are three distinctive signs that you're in labor -- or will be soon. Most women experience one or more of them:
 

1. Regular uterine contractions: These generally occur every five minutes, and last from 45 seconds to a minute each. Sometimes you can feel contractions that are "false labor" toward the end of pregnancy, but these cease after you rest, walk, or change position. But during true labor, these contractions continue and do not go away no matter what you do. The contractions usually feel like a lower backache or strong menstrual cramps. Uncomfortable but not necessarily debilitating, these contractions are accompanied by a definite hardening of the uterus, which you can feel by placing your hand on your abdomen.

2. Show, or bloody show: This is the passage of a small amount of bloodstained mucus or brownish blood that you may find on your underwear or toilet tissue. It's the mucus plug, which formed early in pregnancy to close off the cervix and prevent infection. If you discharge any fresh red blood or have a heavy, period-like flow, report it to your doctor immediately.

3. Rupture of the membranes, or bag of waters: In the uterus, your baby is surrounded by amniotic fluid, which is held by the amniotic sac, or bag of waters. Rupture of the membranes is most likely to occur during a later stage of labor, but it sometimes happens early. If the membranes rupture before you go to the hospital, call your doctor. The longer the period between the rupture of the membranes and delivery, the greater the likelihood of infection.
 

 
Stages of Labor
Once one or more of the signs of labor occur, it's time for the onset of labor. The process of labor and delivery is usually divided into three separate stages:
 

Stage I:
Extending from the start of labor to the time when the cervix -- the opening of the uterus -- is fully dilated, Stage I labor consists of three phases: early labor, active labor, and transition. The entire first stage of labor can last anywhere from 12 to 14 hours for a first-time mother, and from five to six hours for a second-time mother. The force of uterine contractions dilates the cervix. Dilation, or dilatation, is normally measured in centimeters. During the pelvic exam, your doctor uses one or two fingers to feel the size of the opening and estimate how much your cervix has dilated. Full dilation is 10 centimeters, or five finger widths.

Once labor is really underway, contractions become stronger and closer together. You can time them and note when each contraction begins and ends to mark progression through Stage I into Stage II.
 

Stage II:
Also known as delivery, Stage II begins at full dilation and ends with the birth of the baby. As the baby moves down the birth canal, your body will temporarily mold his skull. But don't worry -- there are soft spots on the baby's skull called fontanels for the very purpose of allowing the skull bones to overlap, thereby allowing the baby to fit more easily through the birth canal.
 

Stage III:
This stage lasts from the completion of delivery of the baby until the completion of the delivery of the afterbirth, or placenta.
 
 
http://www.americanbaby.com/ab/category.jhtml?categoryid=/templatedata/ab/category/data/fetaldev_0.xml

Positions for First Stage Labor

For Resting:

Rocking Chair	Sway on ball	Slow Dancing	Dance with Belly Lift

Activity: Walking, climbing stairs, lunging. Activity helps baby to descend, helps baby to rotate into position for birth. In early labor, be active occasionally, but don’t exhaust yourself by walking all through early labor. Walking is more effective in active labor and transition when baby has descended far enough to put pressure on mom’s cervix and encourage the cervix to open.

Lunge.	Stair Climbing	Tailor Stretching

Positions for Back Labor  (when mom has back pain, irregular contractions, or is progressing slowly)

Leaning Forward: Many women, especially those with back labor, find it most relaxing to lean forward during contractions.

Straddle a chair (or the toilet), and rest your arms and head on the back	Leaning against a wall, or your partner, or leaning over a table. Can sway.	Raise the head of a hospital bed, then kneel on bed with arms resting on top of bed.

Hands and knees / kneeling. Can relieve back pain, help a posterior baby rotate, allows easy access for backrubs / counterpressure massage; makes it possible to sway side to side, rock back and forth, or do pelvic tilts to aid rotation and increase comfort. Having knee pads or kneeling on something soft will help knees. Can rest upper body on pillows, chair, or birth ball.

Hands and knees	By a chair	Over birth ball	Knee-Chest

Positions for Second Stage

For second stage, an ideal position would: open the pelvic outlet as widely as possible, provide a smooth path for the baby to descend through the birth canal, use the advantages of gravity to help the baby move down, and give the mother a sense of being safe and in control of the process.

Try out a position for a few contractions. If it works, stay with it. If not, switch to a new position in between contractions. Depending on the caregiver, they may ask you to move to a specific position just prior to the birth.

“Standard” positions. These can be done by anyone. These are the positions that most OB’s are used to delivering babies in.

Semi-sitting. With pillows underneath knees, arms, and back. During contractions, can wrap hands around knees and pull knees up toward shoulders (as in squatting). Most common in hospital setting. For mom and baby: some help from gravity moving the baby down; mom feels more in control than in lithotomy position. Benefits for caregivers: good view of perineum, easy access to perineum.	**
Lateral / Side-Lying. Back curved, upper leg supported by partner. Gravity neutral, good for fast second stage. May be a comfort position for mom.

Kneeling positions. These work fine if you have no pain medication, or narcotics only. [If you have epidural anesthetic: These may be possible with a light epidural. You can ask your caregiver if it would be possible to try these positions, but you will need help getting into these positions (moving the IV tubing, catheter tube, monitor wires and so on so they’re not tangled around you is a production in and of itself!). Once you are in these positions, you would need to be “spotted” (have one person on each side of you, making sure you stay balanced and stable.)]

Kneeling. Hands on the bed, and knees comfortably apart. Or one knee up. Good for reducing tears and episiotomies. May be restful for mom.	**
Hands and knees. Arch your back occasionally for increased comfort. Great for back labor, big babies, posterior babies. Many find it most comfortable.

Upright positions / Squatting. These will not be possible if you have had an epidural, because with an epidural, you typically can not get up out of bed.

Sitting: On the toilet, on thighs of support person, on birthing stool/chair, on partner’s lap. Opens pelvis, gravity enhancing, natural pushing position.	**
Squatting / Supported Squat. Opens pelvis, gravity enhancing, sense of control for mom. During squatting, the average pelvic outlet is 28% greater than in the supine position. Stand, or sit back to relax in between contractions.
Dangle. Gravity, no external pressure on perineum / pelvis. Feeling of being well-supported. May be difficult for mom to see or touch baby during birth.