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Getting Closer: Active & Transitional Labour

Active labour follows the first stage. It involves the continued dilation (opening) of the cervix.

Active Labour – 3 to 5 hours

During active labour, the cervix dilates to four to seven centimetres.

You May:

  • Wake up in active labour if you slept through the early, first stage.
  • Focus on the work of labour – you’re not in the mood for ‘small talk.’
  • Have moments of feeling frightened/trapped.
  • Become frustrated if progress is slow.
  • Find walking helps maintain or speed up the progress of labour.
  • Eat lightly, if you’re still at home (in the hospital, you generally receive clear fluids only).
  • Concentrate on relaxation and breathing to work effectively with labour.
  • Start or continue mental exercises such as hypnosis and visualization.
  • Find massage and/or a bath soothing (or shower, if membranes have ruptured).
  • Find position changes helpful, and use extra pillows (such as in between knees and behind the back, when side-lying). Positions that work with gravity are helpful, such as standing or kneeling, supported by your partner.
  • Experience lower back pain with contractions, or continuously if baby is posterior, (back of baby’s head facing mothers spine). You’ll be more comfortable with your weight off your back, such as on hands and knees.
  • Want to allow the epidural to wear off (if it was administered) to push more effectively in the second stage.

In Your Body:

  • Contractions may occur every two to four minutes, lasting up to a minute. They may be moderately or very painful.
  • Cervix will dilate from three to four centimetres to seven to eight centimetres, and continue to efface.
  • Membranes may rupture spontaneously, with a gush or trickle.
  • If epidural administered, pain of contractions is usually eliminated, although the uterus continues to contract. A ‘walking epidural’ allows a mother more mobility.
  • You may feel very warm or have chills.

Medical Staff Or Midwife May:

  • Want to check your temperature, urine, blood pressure, cervical dilation and baby’s heartbeat upon arrival at the hospital. The latter three points are checked regularly during labour.
  • Help make you comfortable.
  • Ask about your expectations, hopes and plans for labour.
  • Encourage you to start or continue breathing and/or relaxation exercises.
  • Offer reassurance and support.
  • Offer explanations if a problem arises.
  • Offer pain medication; if epidural used, an electronic fetal heart monitor is attached and an intravenous (IV) started.
  • Encourage urination about once per hour (a bedpan is used if there has been an epidural).

TRANSITION – 1/2 to 1-1/2 hours

During transitional labour, the cervix completes its dilation process, opening to 10 centimetres, and fully effaces (thins and shortens).

You May:

  • Be exhausted, confused, irritable, frustrated, panicky.
  • Have no sense of time.
  • Shake (especially the legs).
  • Sweat, hiccup, vomit.
  • Get ‘the chills’ on and off; have cold feet.
  • Have a dry mouth and dry lips.
  • Not want to be touched, or you may want only firm touch. You may prefer to be held.
  • Hyperventilate.
  • Moan, cry or scream.
  • Have urge to push or have rectal pressure.
  • Be resistant to changing position.
  • Sleep in between contractions.

In Your Body:

  • Contractions are at their most intense. They may occur as often as every 30 seconds (but are erratic), last up to 90 seconds, and may have double peaks.
  • Cervix completes its dilation process to 10 centimetres, and fully effaces.
  • Bloody show may increase.

Medical Staff Or Midwife May:

  • Conduct a vaginal exam.
  • Reassure that the labour intensity is normal.
  • Stay with you.
  • Be ready for imminent birth.
  • Ready the room for birth (if you are in labour room/birthing room).
  • Take your blood pressure and check the fetal heart rate.

Nancy Levy, RN, MS, is a former childbirth educator at Womens College Hospital in Toronto and York Central Hospital in Richmond Hill, Ont.

Published Labour & Birth Guide, March 2007.

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