Active labor begins when your cervix is dilated to 3 centimeters and ends when it is fully dilated to 10 centimeters (about 4 inches across). Effacement, or thinning of the cervix, is usually complete or almost complete. Contractions are stronger and longer (30 to 60 seconds) and occur every two to three minutes. You may become serious and quite, focused on only one thing, labor. At this point, support, encouragement, help, and comforting gestures from your partner will be appreciated. You may experience emotional ups and downs throughout your labor, at times even becoming weepy and frustrated. But if you know what to expect and accept labor as it comes, these periods will be easier to tolerate.

During your labor, the nurse or midwife may place her fingertips over your uterus and feel your contractions from the time one begins to the time another begins. This helps determine the timing and strengths of your contractions. If an electronic fetal monitor is used, contractions are measured from the peak of one to the peak of the next.

Membranes can rupture at any time during early or active labor, resulting in a gush, trickle, or leakage of fluid from your vagina. To determine whether your membranes have ruptured, an exam may be done to obtain a sample of amniotic fluid. In some cases, our doctors and nurses may choose to artificially rupture membranes. This procedure may speed up a slow labor. Vaginal exams may also be performed throughout the course of your labor to determine cervical effacement and dilation and/or to apply an internal fetal monitor. This examination may not be done if you are experiencing vaginal bleeding.

At some point during active labor, you may experience irritability, extreme heat or cold, trembling of your arms and legs, nausea, vomiting, and diarrhea. If you have chosen an epidural for pain management, it is generally given when your cervix is dilated to between 3 and 7 centimeters.

Changing positions every 20 to 30 minutes, kneeling on your hands and knees, alternating application of an ice pack and a hot pack, can relieve back pain and a firm massage with the fist or heel of the hand. Breathing and relaxation techniques learned in childbirth preparation classes may provide you additional relief.

The choice for body position during labor may be determined by custom, comfort, fetal well-being, and the need for certain procedures, such as listening to your baby's heart rate. Positions that may assist in the first stage of labor and in reducing pain include standing and walking, sitting or squatting, and laying on either your left or right side. For the safety of you and your baby, it is recommended that you avoid lying on your back for prolonged periods of time during labor. When your uterine contractions become very strong or you have been given pain medication, you will probably be asked to remain in bed to avoid injury.

As you complete labor and prepare for actual birth, known as the "transition phase", your cervix is dilated from 7 or 8 centimeters to 10 centimeters. You may feel almost out of control, as if you are being swept along in a wave of intense sensation. It becomes even more important for you to focus on relaxing; tensing up and fighting each contraction will only slow labor and exhaust you. However, you may feel the urge to push. Be sure to tell your midwife or nurse if you feel this urge. It is very important to resist the urge to push until your cervix is completely dilated and our doctors and nurses have instructed you to do so.

The Second Stage - Also called the "pushing stage" this stage of labor begins when your cervix is 10 centimeters dilated, and ends with the delivery of your baby. If this is your first baby, this stage may last about one to two hours. If you have previously given birth, it may last 15 to 60 minutes. The pushing stage is the most exhausting and demanding part of labor, but it is also an exciting time, with lots of cheering and praise for your efforts.

There are many positions for pushing and you may wish to discuss these with our doctors and nurses in advance. Lying on your side is a good position if the baby is coming fast, if you have painful hemorrhoids, or if you must lie down for some reason. Squatting allows more room for the baby to come down through your pelvis than any other position. Resting on your hands and knees may help if the baby is large. Semi-setting is a good position because you can see our doctors and nurses and the baby as he/she come out. Lying flat is the least effective and can cause problems with blood flow to the baby. You may use several different positions during the pushing phase. Whatever position helps you feel the most comfortable is most likely the one you should use.