The First Stage of Labor

Once you are having regular contractions, you are considered to be in true (or active) labor. The duration and distance between contractions will differ from labor to labor, but they may be around 5 minutes apart or less. You cervix will, at this point, probably be dilated to about 3 or 4 centimeters. You are entering the first stage of labor. The first stage of labor continues until it is time to push the baby out, which is the second stage of labor.

Throughout history, women have given birth in upright postures: sitting, standing, and mostly squatting. We know this is true because we see it over and over again in artwork from every civilization and every era. Margaret Mead said that whenever we see the same custom being used by many different peoples, it probably is based on some “very stubborn species-characteristic element that is worth following up.”

In the Renaissance, however, with the rise of science, the flat-on-your-back, or supine, position began to be used by doctors for difficult births. The reason for this was simple: it was more convenient for the physician.

Today the flat-on-your-back position is standard procedure in most American hospitals. Fortunately, the growing movement to return birth to a more natural process is slowly changing this. More and more hospitals now have birthing chairs or birthing beds in their labor rooms, and women are being taught alternative labor positions in childbirth education classes.

Why Upright is Best:

• The force of gravity assists the baby in coming straight down and out of the birth canal. There is less need for forceps and the chances of cesarean delivery are decreased.
• The mother is better able to use her abdominal muscles to assist her uterus in pushing the baby out. Imagine trying to have a bowel movement while lying flat on your back!
• Labor is, on average, 36 percent shorter when a woman works in an upright position.
• In an upright position, labor is less painful, with less need for painkilling drugs.
• There is less chance a woman will need an episiotomy, or that a perineal tear will happen.
• Women who are not confined to their backs on a table will naturally change positions and try new ones.
• Being upright encourages better drainage of fluids and tissues from the uterus.
• Pregnant women are advised not to lie on their backs for extended amounts of time in later pregnancy. That is because this position can reduce blood flow and oxygen to the uterus and to the baby. Why wouldn’t this be true during the labor process as well?

And finally, human beings tend to feel more vulnerable and less in control when they lie on their backs. This is a time when women need to feel powerful.

A Potpourri of Birth Positions
Here is a sample of the birth positions most commonly used around the world:

• Squatting. This is the classic, time-honored position for women all over the world and is a favorite of first-time mothers. Try a supported squat with your back against a wall, or with your partner or a doula sitting in a chair behind you. If a full squat is just too hard to manage even with support, try placing pillows between your thighs and calves to take some of the pressure off your legs.
• Kneeling. You can kneel on a pillow or soft rug and support yourself by leaning over onto a chair onto someone’s lap.
• Standing and walking. You can use your partner for support.
• Pelvic rocking. You may find it very helpful in labor to slowly rock your pelvis, like a belly dancer, during contractions.
• Bending forward. Stand and lean over onto a tall table or counter.
• Sitting. You can sit in a comfortable chair, in a birthing chair, or upright in bed. Try sitting backward on a straight-backed chair, with your legs open to either side, and support your upper body on the chair’s back.
• On the toilet. Many women report that laboring on the toilet was good for them. This is probably because the toilet is a place where women are used to relaxing their pelvic floors.
• Semi-reclining. This position involves sitting up at a 45-degree angle by propping yourself up with pillows or adjusting the angle of your hospital bed.
• Hands and knees. Second-time mothers especially favor this position. This is a good one for back labor because it takes the weight off your spinal area. You can also rest on your elbows, rather than your hands.