Stages of Labour and Collusion

My New Years resolution is to stop colluding in the myth of stages of labour. Will you join me? This may be a little difficult as a midwife and an educator but I’ll give it a go – will you?

The stages of labour

In current midwifery texts labour is divided into three distinct stages, and further divided into phases within those stages. The first stage of labour involves regular and coordinated uterine contractions accompanied by cervical dilatation. This stage includes three phases: latent, active and transitional. The second stage of labour begins when the cervix is fully dilated and ends when the ‘fetus is fully expelled from the birth canal’ (Stables and Rankin 2010, p.533). Again, the second stage is further broken down into three phases: latent, active and perineal. ‘The third stage of labour is the period from the birth of the baby through to delivery of the placenta and membranes and ends with the control of bleeding’ (Stables & Rankin 2010, p.547).

This concept of birth reflects the scientific, mechanistic model of how the body works (see ‘a quick history lesson’ ). It does not reflect women’s experience of birth or the physiology of birth.

Problems with assessment and categorisation

The idea of stages of labour contradicts what we know about the physiology of birth. Physical changes in the cervix and uterus occur during pregnancy and the onset of labour is a gradual happening without a distinct start time. The definition of ‘established labour’ includes regular rhythmic contractions (3:10 or more, lasting 45 secs or more) and progressive dilatation of the cervix (1cm per hour). However, women’s natural contraction patterns vary, and the idea that a cervix will follow a graph is outdated – see ‘the effective contraction’. What about a woman who only ever has contractions 2:10 but births her baby? Did she skip the first stage of labour? Women with OP babies often have different labour patterns that will not fit this definition.

The definition of the first and second stages of labour also assumes that a vaginal examination will be carried out because everything hinges on what the cervix is doing. However, this doesn’t quite work. If I examine a woman at 3pm and find out her cervix is fully dilated does that mean her second stage started at 3pm? What if her cervix had been fully dilated at 2pm but I didn’t know? The only time measurement we can know for sure is the end of the second stage of labour – because the baby emerges (assuming we remember to look at the clock). We could get a time for the birth of the placenta, but the end of the third stage ends with ‘control of bleeding’ which is open to interpretation.

The impact of collusion

Care providers have accepted this categorisation despite the lack of evidence or sense to support it. The stages of labour are like the emperors new clothes. We educate women on the stages of labour; we assess their progression through these stages; and we fill in documentation about their progression through the stages (eg. time of 2nd stage). Perinatal data forms require the precise hours and minutes that a women spends in each stage of labour.

How this translates into practice is that midwives basically make it up. There is a box to fill, so we fill it. This results in some comical paperwork conversations between midwives/midwifery students eg.: ‘What time would you say second stage started?’ ‘Umm not sure – she was making grunty noises around 5.30pm…’ ‘OK, I’ll put 6pm.’ Midwives also massage the paperwork to fit policies eg. ignoring that the woman was actually ‘pushing’ for 3 hours and only documenting a 1 hour second stage to avoid trouble.

These made up times are carefully recorded and then sent to organisations that collect and analyse the stats to provide information about labour and birth. By making our records fit the myth, we are colluding in maintaining the myth that labour can be compartmentalised into distinct stages and measured accurately.

Perhaps more importantly by colluding we are re-defining women’s birth experiences – often in contrast to their own experience. Have you tried explaining to a woman why we only record ‘established labour’ and disregard the hours or days that she experienced contractions before being assessed as in established (real) labour?

The future

I guess I have it easier than those working in hospitals with hospital documentation. I’m in control of my own paperwork and have already excluded the stages of labour from the birth notes I write at homebirths. However, I still have to complete perinatal data forms. So, the question is do I put a ‘?’ in the box or draw a line through it?

Merry Xmas readers and thanks for following my blog in 2010

*Update: This post has been expanded into an article for AIMS. You can read it here.

This post is also available in French

About midwifethinking

independent midwife, lecturer and student of all things birthy
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43 Responses to Stages of Labour and Collusion

  1. purpleanvil says:

    SA stat forms don’t include stages of labour or length. I also leave out identifying data and stuff that is unnecessary like age etc as this is private and confidential. We need not to feel confined by what we are lead to believe we have to do. The stats are legislated but we cannot give information without the clients consent.

    I think getting out of established medical norm is the easy part if you don’t put your fingers vagina’s and use a partogram or any other tool that is time orientated. Once a midwife feels free of these confines she soon observes lots of other ways of knowing a pattern of birthing.

    • I agree 100% Lisa that keeping our hands to ourselves and observing women’s behaviour during labour is the best way of being there with women. However, many women access maternity services where the doctor is ‘in charge’ and midwives have to negotiate the ‘system’ in providing the best labour care they/we can in those often ‘birth hostile’ environments. That’s where the midwifery collusion comes in – with the best of intentions – aimed at ‘buying the woman time’ or ‘keeping her off the doctor’s radar’. The system often dictates regular vaginal examinations and there is ‘all hell to pay’ if the midwife does not conform. That situation is where a midwife becomes ‘creative’. ‘

    • You are right Lisa – there are so many other ways of knowing patterns of birth.
      RE. stats – women are usually happy for me to put their details in the form. I miss out a lot of stuff like ‘weight’ and ‘height’ and baby measurements because I don’t do them. But, most of my forms come back with queries about my entries or lack of. Do you get many queries about yours?

  2. Hi Rachel, I’ve been thinking about our collusion in the medical delusion about childbirth too. We midwives collude in many ways, some of which you have talked about in this post – you are right about the way we play out our role, in filling in the boxes and putting numbers to represent a process, is partly responsible for feeding that delusional state that helps medicos think they are in control of the intelligence of the untamed wilderness that is the birthing process…

    One of the other biggies is the ‘anterior lip’ lie – the way we say a woman has an anterior lip, to ‘buy her time’ or say she is six cms, when she is 7-8 cms and her labour is a bit ‘kangaroo’ like – stop/starting and we are seeking to again, ‘buy her time’ – that behaviour lulls medicos into a false sense of control too…

    Great conversation – not sure what the answer is … do you? Apart from not doing it any more … but then, the women wear the fall out of that, unless we have the sort of relationship with the doctors that means they are willing to ride the process with the woman and with us in wonderment, rather than as a time keeper. Time keeping is much more suited to sport than to birth.

    • Carolyn it sometime seems the only way to get a woman through the hospital system intact is to lie. I know I have been guilty in the past. It comes down to how much fight you have in you that day. Do you tell the truth and battle for her… or lie. We shouldn’t have to by ‘buying her time’ etc. The whole system needs an overhaul. We are in a situation where we are following practice that is not based on evidence, experience or more importantly the reality of birth. I wish I knew the answer.

  3. littlefrankie says:

    My first and only birth to date was a planned UC. I cannot imagine having been interrupted, checked, examined, quantified, qualified, analysed, etc. during that time. I was so ‘in the zone’ that I would say my birth was near painless, save for the three times my husband spoke and the one time I opened my eyes and saw him there (I had forgotten anyone was there at all) which brought me back to earth each time, causing pain only at those moments before I could get back ‘in the zone’ again. Just the act of someone’s presence, let alone their interference, affects the birthing woman. Then add in the analysis of her state and it’s no wonder to me that women feel pain and don’t progress.

    A PP mentions the woman must authorise the information to be released, does this mean she must give permission for the information to be submitted at all? As in, a MW could explain the dilemma and ask her to refuse the submittal altogether?

    • I wish more women trusted themselves enough to birth like this. It is great that this is your first experience of birth. For so many the first is traumatic.
      The woman must authorise information shared about her and most are happy to have their perinatal stat forms sent in. Another thing to consider with the forms is that without homebirth forms being sent, the national stats are not accurate. For many homebirths forms are not submitted because a registered midwife was not involved. This means that those stats are not collected and usually the birth was great with good outcomes. However, when a homebirth transfers to hospital due to complications (which is rare) the hospital will submit a form and the ‘homebirth’ box will be ticked. So, we are collecting stats on homebirths that transfer but not homebirths that don’t. This is one of the reasons the obs can argue homebirth stats are not good or that there is insufficient data on Australian homebirths.

  4. littlefrankie says:

    Forgot to check notify boxes… Sorry ;^)

  5. purpleanvil says:

    I never have any returns, I have had a few calls but I do not feed into the myth that stats can save us, or are important in any way. I do what I am legally obliged to do and even then there is doubt whether they could enforce it. All these things add to the feeling of midwives that they have to lie or work around the medics or the policy to “get women” a good birth. The truth is women have the right to say no and so do midwives. Power only comes from confidence and knowledge that is within. Until we understand that no amount of posts about not defining stages of labour or re routing the information we know, will make any difference to the majority of women giving birth inside the cattle market of the labour ward.

  6. Bethany says:

    All this is good to chat about, it especially draws our attention to the fact that most stats are worded and collected in such a way as to provide support to the medico model. Also, that they arenot worth the paper, or memory space accorded them. As has been pointed out, and as all practising midwives know, lots of the stats are estimates, total guesses, or outright lies. In science, this means that the stats are if no empirical usewhat so ever. Unreliable data is the death to all the suppositions based on them. It would be interesting to do do some realtime research as to the real differences found in labour and what stats are recorded, with the stats collected including details that the midwife and the birthing woman thought was important.

    • It certainly would be interesting to do research on the difference between what happens and what is recorded. As you point out the paperwork is designed to record particular stats which actually have no worth and are incorrect anyhow.

  7. Helena says:

    Life is out of the box!
    I think we have to help women survive the medical experience as whole as possible. We are going to another country when we transport and we have to try to speak the language to get what we want. I don’t think that is really collusion. We have to be aware of what we are doing and also discuss with the parents the differences and how we are negotiating them to get the best for them.
    I also am tired of speaking the medical language and think they should learn to speak ours. Perhaps our charts/birth story record can help them do that. We can have a sheet with some boxes and then a narrative.
    Good point that stats are therefore not valid! We need to do our own research that gets the knowledge out of the boxes. If you are a MANA member you can help with the statistics. At peer reviews we can speak our own language instead of the medical. Most of all speak it with the women (with translation of the medical when needed)
    Anne Frye’s midwifery texts do a lot to get things out of the narrow perspective.
    Great blog post!

  8. Thank you for this frank discussion! I am preparing for my second home birth (for my second baby) in February. While I’m thoroughly grateful to my midwife for bending the paperwork to fit me instead of the other way around, it bothers me that she has felt pressured to do so. When licensing and other authorities punish midwives for honesty, there’s a serious threat to scientific understanding, personal trust, and women’s choice.

    To answer your question, I think a line, “not applicable,” or “not relevant” would be more appropriate than a question mark. It’s not that you don’t remember, weren’t there, or forgot to check, and no one reading the form should be able to stay in the mechanized-model comfort zone by assuming that a question mark means a failing on your part. You made a deliberate choice not to collect that data because it was not relevant to your client’s health or labor progress. Neither you nor your client was broken, it’s the form and its assumptions that are faulty. :)

    • That is a great idea and rationale. I agree a ? suggests I/we don’t know something I/we should. I will take up your idea of writing ‘not applicable’ or ‘not relevant’. Because really it’s not.
      Thanks!

      • Ahmie says:

        I filled out my own paperwork on the statistics for my 2nd and 3rd children’s births (both at home, with a midwife attending but not really assisting, in a state where she doesn’t have the legal right to practice). There were a lot of “N/A”s written on the form (shorthand for not applicable). I had no problem with the authoirities. What annoyed me most was that I had to list who delivered the baby or something to that effect. I listed my husband but dammit *I* delivered the baby, he just received it & held it for a moment before handing the baby back to me once I was in a better position to hold him (both were waterbirths, one sidelying and the other on hands/knees with butt nearly on the floor of the pool… I could have just let the baby free float out, move myself, then pick him up but was OK with daddy holding him first… though actually it MIGHT have been the midwife that recieved my 3rd son and handed him over to me after I flipped over, hubby was pressing on my back and that one went QUICK once things really got in gear… I’d had contractions with kangaroo dialation for 6 weeks, went 10 days past due after pulling a groin muscle while sitting on a birth ball and losing my balance, then the midwife almost missedthe birth altogether because I was in denial that it was so imminent – I thought I was maybe 7cm when she got to my house, the baby was born less than an hour after her arrival and I didn’t realize my body was pushing until he crowned, then he was fully born on the next contration without stopping at the shoulders first, same thing my first did… my middle son is the only one to birth head, then wait, then shoulders/body on the next contraction).

  9. sara r. says:

    Love this post, as usual!

    This is a very interesting post to me, as I had recently been reading (as part of my doula training) about the different “stages” of labor, and it had me confused as it related to my own experience of labor and childbirth.

    I mean, I can see someone who has never either 1) experience childbirth or 2) experienced childbirth but never an uninterrupted one, can see it as reasonable that the process of labor would have defined stages and substages to be measured, but, as you mention, one can only “measure” such stages if they are interfering with the process in the first place, and can only document their findings at the moment that they interfere, knowing that such “measurements” are frequently subjective. However, I think to impose such limits and borders on the process of labor takes makes the woman less comfortable with letting her body do what it needs to do.

    Telling a woman that her labor will follow THIS pattern and we will have to check to make sure that it is, seems to be contrary to the concept that Her Body knows how to labor and unless there is a problem, we won’t bother you while you do the work of labor and birthing.

    In my case, I had planned to stay at home as long as possible anyway, and that was easy when my first mild contractions started close to 12 midnight. 3 hours later, after contractions that were not-so-bad and about 6 minutes apart, I seemingly rocketed into what I can only assume was transition, and 30 minutes later I was pushing instinctively and could feel my daughter’s head at the perineum. By the time we got to the hospital, about 1 hour later, she was crowning. As I was reading about all of the “stages” of labor I kept thinking to myself, “but they only know this based on cervical checks, and who wants those?!” I never had a cervical check since I was at home, and so I can only go on what I felt. I didn’t need the checks to tell me that I was in “early labor”, “transition”, “pushing”, etc. I just did what felt right. We almost didn’t make it to the hospital (which honestly wouldn’t have bothered me that much) because my labor didn’t fit the “normal progression” of labor.

    I do hope to be a midwife in the near future, so I as I go through my training I will have to think about how to be as truthful as possible without sabotaging the confidence of the women that I serve.

    • The stages rely on cervical checks which are unpleasant and pointless most of the time. It is sad that antenatal classes/books tell women all about the stages of labour rather than helping them to build trust in their ability to birth.
      Good luck with your studies!

      • Joyce Pula says:

        I have been a child birth educator for 9 years, and only recently (after (doula) trainings with Debra Pascali-Bonaro and Barbara Harper), thankfully, have come accross this kind of information. It has transformed my antenatal classes. I see even more than before that antenatal classes are very important in the forming of the image of birth in the woman (and her partner). In the hour of birth, one cannot do a whole lot if the woman is very much into her thinking mind & stuck with the ‘text book progress of birth’. It has inspired me to challenge myself & my students even more in the antenatal classes to go really deep inside & discover our (old) thought patterns/ believe systems & release them, and to find the innate wisdom. So thank you for such posts, they help others around the world :-)

    • I agree with you that being told that labour follows a certain specific pattern (based on cervical dilation and timeframes) isn’t helpful. With my first, I’d been told about the hour per cm and that there will always be at least 30-60 seconds between contractions, etc. Well, my body didn’t get that memo. I was at 3cm just before transition, but I lost the will to fight for a normal birth at that time, because I remembered the 1cm/hour rule, and didn’t think I could make it 7 more hours, so I got the pethidine. I was pushing an hour later, but was too doped up to push effectively (not to mention that I was on my back with horrible sciatic pain – my son was posterior), and thus had a ventouse delivery. Also, my contractions had been on top of each other with little break. I attribute this to my waters having broken before contractions started. I should note that the contractions were never that bad, it was the sciatic pain.

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  11. I love this post! Even in the doula world we are also so caught up in times and documentation of the stages of labor. Progression of birth is not something that can be plotted on a chart; it does not follow a linear pattern. This is what is so challenging about supporting births in the hospital setting: The CLOCK is always ticking and the mother is expected to dilate in a “normal” fashion.

    Sigh…..

  12. Nora says:

    I Completely agree! Today’s birth, perfect example. Came in at 815 am, 4 cm. Srom at 1015. Complete & pushing & we could see head @ 4:40. Checked her, reduced anterior lip which had returned. Between contractions she said, the baby moved. Checked her again ..& he had flipped to rop, asynclitic, now only 5-6 cms, & back to -2. Did knee chest, hands & knees in tub, lunges with pelvic rocks, r side with l leg over side if bed for 2 hours, flipped to l side with r leg off bed for over an hour, got her up to sit on toilet, & voila. 30 min later, anterior lip. 34 minutes later, baby boy arrived! Have only seen this a few times. Seriously, we were seeing baby head & hair at 4:40 before he pulled his trick. Just wanted his birthday to be 12/31 not 12/30, I guess. Mom & Dad were so grateful, & so awesome, & positive, tho I could tell he was worried (so was I.). SO did not want to transfer to hospital as we know what would have happened, was just worried that drama baby would outlast his parents’ endurance.

  13. Pingback: The Anterior Cervical Lip: how to ruin a perfectly good birth | Midwife Thinking's Blog

  14. Anna says:

    Sigh. What’s a normal-birth-believing-homebirthing-mama-and-student-midwife to do? I mean, seriously? How on earth do I get through my degree (direct entry, of course) believing as I do? How do I go in to births knowing I’ll likely contribute to some women’s distress and trauma?

    All I can figure is that I need to suck it up, inform myself, observe and become aware of what I don’t want to replicate, and get qualified so that perhaps I can make a difference too. And hopefully there will be a pathway so I too can become a private midwife, working with women in the kind of way I really wish to.

    Sigh.

    • It is soooo hard and we’ve all been there. You have to see it as an important part of your journey towards the midwife you will be. You can learn lots from observing lots of different practitioners/practices – good and bad. It is hard knowing that the women could have had a different birth experience, but you can’t take responsibility for that. Those women chose to birth in hospital and you cannot control hospital policy.
      If you can come out the other end still trusting birth and being able to see the rest for what it is – you will be fine. Women need more midwives like you so don’t give up :)

      • Anna says:

        Thanks Rachel. It’s nice to hear that perspective on responsibility and decision ownership. And yes, a good portion of knowing what you want to do is knowing what you don’t want to do. It’s just distressing knowing just how many things – little things (shut the fricking curtain/door please!) – can and should be done differently. And women like my sister, who had 3 fairly normal, average, garden-variety births in hospital wish they could have done it differently now she knows better. Sad.

        “It made a difference for that one”.

        • Emma Someone says:

          Same boat here Anna and the advice of “Those women chose to birth in hospital and you cannot control hospital policy.” is so true and what keeps me going. I try to make a difference to the small % of women that I come into contact with, and learn as much as I can. At this stage I’m in a co-operate and graduate mindframe as well – final year!

  15. Helena says:

    As a student you can honestly ask questions! For example- I’ve been reading ___ about anterior lips and cervical dilation. What do you think of this? Maybe you can educate by questioning and exposing them to different resources/facts. Write papers on the practices and topics that bug you.
    Make sure you have a safe place/people to rant when you need to.

    • Anna says:

      Thanks Helena. I do, and it is certainly a useful tool, although often they come back with this reason or that reason which is mythical ‘evidence’. After my first hospital placement I wrote an article, mostly for myself, and called it ‘Modern Midwifery: Are we really being ‘with woman’?’ It was filled with the possibly/probably naive musings of a 1st year BMid student who’d had one homebirth and was planning a second.

      And a lot of it is having the information in my brain – the studies and resources that will make it easy for me to ask those questions and have something to back it up with – which is somewhat scary cos after 2 kids my brain, previously something I was quite proud of, has become a little mushy ;)

      And yes, fortunately I have a wonderful group of friends – lay experts if you will – and a great midwife/mentor to talk things over with. And hubby is wonderful too – he really does get it.

  16. Heather says:

    So then, how can we educate families on labor and birth so that they can be prepared for what is going on when they get into it without the technicalities tripping them up? I’m curious for my own childbirth classes how I can keep the focus off of the limiting terminology while still defining things they will be in contact with in the hospital. I remember thinking I was moving backward in labor when I went from 60sec ctx every 5 min to 90sec every 10 min. They were so much stronger, and that’s why I even timed them again. I was confused because they were becoming more spaced apart. But I had my baby 2 hours later with my midwife running into my house, barely making it for the birth. Perhaps I’m answering my own question? Honesty goes a long way, just telling the couples: *this* is how labor is defined by the medical community, but *these* are the different ways we really experience it.

    • Heather says:

      I forgot to check the notify box also.

    • Hi Heather
      I think you did answer your own question! The whole aim of CBE (in my opinion) is to reinforce women’s expertise and individuality so that they approach birth knowing they can do it, and trusting themselves. But, if they are birthing in hospital, they need to be warned that the system often does not acknowledge their expertise and power. When I used to facilitate hospital CBE classes a lot of the content was about why the system is how it is and how to develop skills/strategies to negotiate it. I think honesty is definitely the best policy :)

  17. Christina says:

    THANK YOU!!! “Have you tried explaining to a woman why we only record ‘established labour’ and disregard the hours or days that she experienced contractions before being assessed as in established (real) labour?” I experience, and almost always do, WEEKS of “pre-labor”, then I have 45 minutes to 3 hours of “real” labor. During this “pre-labor” or “false-labor” my cervix effaces and dilates and the baby travels south. By the time I begin “real” labor I’m in “transistion” though I have skipped that entirely and gone straight to one or two contractions then pushing. It took me a few births to realize that my weeks of “pre-labor” were “real” labor, and doing the job it is meant to do. But when I have gone into the hospital (before I learned I could birth at home!) the nurses ALWAYS said, no you’re fine, don’t push, you’re not ready… then freak out when they “checked” me – running from the room, paging the doctor. Now I am learning not the catagorize my labors, or even stages of pregnancy. Trusting my body more and more to do what it’s made to do. THank you for this post!!

  18. Emma Someone says:

    Christina I was going to post a similar question/pet hate – that of the completely ignoring the early stage of labour for many women. I love it when women are “too early” to stay in hospital and are sent home but despair when they say they weren’t in labour until someone told them so and gave them a tick. It was a huge part of my HB journey to have to call my midwife and tell her I was in labour, based on how I felt, and that I wanted her to attend me. Not the other way around. Antenatally I try to explain to women that getting to hospital early won’t get them a baby any earlier.

    • It is sad that women have to hang on until the last minute if they want to birth normally in hospital. I understand that hospitals cannot have lots of women hanging about in early labour. But, women like to nest and get settled in order to relax and let labour progress. Getting into a car, travelling to hospital, getting admitted and meeting new people is stressful. Doing this while in strong labour is difficult. I’m not sure what the answer is… except to stay at home for the whole labour and birth.

  19. Lisa says:

    I couldn’t agree more with this post. I have now had 2 births. both of which i stayed home as long as i felt comfy, but i didn’t trust my body enough the first time. I had been in ‘labour’ for hours, not established as in 3:10, but lasting a min or more when came, but irratic. after 18hrs of quite painful contractions i wanted drugs, i also asked for VE’s and the ‘lack’ of progress made me undermine my confidence, so being as fatigued as i was I asked for drugs etc to ‘help’ me cope, ended with forceps delivery due to late decels post peth and epi, with cervix going from 5-ant lip, when forceps were done 40min post epi.

    Second time I had a middie friend be my middie, she came to my house, when i wasn’t coping we went to hospy, she did 1 VE with permission prior to leaving so she could ‘say’ where we were at (and she downgraded it to ‘give’ me more time before i was bothered by policy), then she just watched me, filled out paperwork etc, i had bub 1 hr 14min after getting to hospy. was a much better birth because i wasn’t worried about following a time line, and knew my middie would stand up for me if i didn’t

  20. I had all 5 of my children in an industrial town hospital in central queensland, I remember the dance my midwives had to do to extend my time so the dr’s would leave me be. As an experienced Doula of 15 years, I see it still happens in the hospitals today. I agree, that a system overhaul is way overdue.

  21. Pingback: The Anterior Cervical Lip: how to ruin a perfectly good birth | Midwife Thinking « natural birth resource

  22. Brigitte says:

    This has been good for me to read! When I think back upon my labour with my first child, I cannot identify any stages other than “active labour” and “pushing” and then suddenly I was holding a baby. (I don’t actually have any memory of the moment of birth, I was too exhausted. No drugs were involved. Thank goodness my husband witnessed it on my behalf!) I suppose someone noted when the placenta came out but I was no longer paying attention at that point.

    I did not experience any latent labour at the beginning. I was lying awake at night because my baby was thrashing about and keeping me up. I felt worried. And then, at 2:22AM, I felt a wave of hormones hitting my bloodstream, like I imagine a drug addict must feel when they get their hit. I knew in that moment that labour had begun, and I no longer felt any fear. Within a few minutes my first contraction came, and they established a regular active pattern immediately.

    The other stage that seems to be missing from my experience is “transition”. A few days after the birth, I asked my doula if she could help me identify when that had been for me. She had mostly been reading a book in another room while I was labouring at home, since I was coping perfectly well on my own without assistance. She says that she came into my room when she heard a distinct lowering in pitch in my vocalizations, and in retrospect she thinks that this was my transition. I remember this part of labour as simply another gradual step forwards in the intensity of my contractions, and not in any way like I’ve heard transition described. At this point we decided to call the midwife. She arrived 45 minutes later, checked my cervix and found me to be 7 cm dilated. Apparently everyone was surprised, as it was my first labour and I had only been at it for 7 hours and was coping very well. My doula told me later that she would have guessed I was about 4 cm at the time. We decided to go to the hospital where I was planning to give birth. I suppose it makes sense that my labour pattern held steady at this point until I got settled in the tub at the hospital, and I first felt the urge to push shortly after getting comfortable there.

    So, if in retrospect my doula believes that transition must have happened when my vocal pitch changed, then the lines between the stages was blurry indeed! I was only 7 cm or less at that point, and I didn’t start pushing until an hour or two later.

  23. Pingback: Labor Progress and a call to discard the Cervical Dilation Exam

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