Expert advice

giving birth

Giving Birth – Recognizing Birth Stages and Contractions

with MAM experts and midwives Anja & Marie

As the pregnancy progresses and baby's due date gets closer, many women find there are so many questions whirling around in their head. These almost certainly include what will my birth be like, how smoothly will it go, and how bad will the contractions actually be? So in this article we will explain a little about the individual birth stages and provide you with some general information about contractions.

Birth Stages

The birth is divided into three different stages. The dilation stage, the delivery stage, and the afterbirth stage. These birth stages are defined differently because they describe various periods and processes that occur during the birth.


The Dilation Stage

The dilation stage is further divided into two different phases. The first is the latent phase, while the second is the active dilation phase. The latent phase begins when the birth starts, in other words when regular, painful, and progressive contraction activity starts. Once the cervix is 4–6 centimeters dilated, you will transition to the active dilation phase. This describes the period from when the cervix is 4-6 cm dilated until it is fully dilated to 10 cm.


The Delivery Stage

The delivery stage is also further divided into two different phases. These are the latent passive delivery phase and the active late delivery phase.

The latent passive delivery phase starts when the cervix is fully dilated to 10 cm and the baby begins to turn through the pelvis and into the birth canal. In this phase you will not yet be feeling the urge to actively push. That won't happen until you enter the next phase – active late delivery. This is when you will start to feel a reflexive urge to push as this actively helps the child to be born.


The Afterbirth Stage

The final stage of the birth is known as the afterbirth stage. A lot of people do not realize that the birth as such has not yet ended at this point for the obstetricians, even though the baby has actually been delivered. That does not happen until the placenta (afterbirth) has been fully expelled together with its amniotic membranes. This can take up to one hour.

Recognizing Contractions 

Towards the end of their pregnancy, many women start to worry about how the contractions will feel, how to identify one, and how they will recognize when the birth is really underway.

What exactly is a contraction?
A contraction is the pulling together of the muscles in the uterus. This prepares the fetus for the birth and ultimately helps it to be delivered. Towards the end of pregnancy, various types of contraction can occur and they all do different things. We will explain in more detail what they actually do in the next section.

What is the difference between prodromal contractions and labor contractions?

Prodromal Contractions
Prodromal contractions or false labor are contractions that lower the fetus towards the pelvis from around the 35th pregnancy week; this moves it into the right starting position for the birth. How these pains are perceived differs from one woman to woman. Some barely feel them at all or, if they do, then it is simply a slight hardening of the belly. Other women, however, find they are regular, painful and persist for several hours. In such cases, many women find it very difficult to distinguish them from labor contractions, especially if it is their first child. Many women also notice that there are physical changes which result from the prodromal contractions. These include a sudden improvement in existing complaints such as shortness of breath and heartburn. But often the immediate impression, even for outsiders, is that something has changed because the "bump" visibly and noticeably drops.

The Labor Contractions
We talk of labor contractions when the contraction activity starts to affect the cervix. They are shortening the cervix and opening the mouth of the uterus.
Again, they are perceived differently by individual women. Some women feel these as a strong tugging sensation in the groin, while in others the pain radiates out into the back or even to the legs. It is not possible to say how labor contractions are generally perceived as it is very individual. Equally it is important to remember that they can be perceived and felt differently from one birth to another.

So how do I know If I am having prodromal contractions or labor contractions?
As we have already said, some women cannot easily tell the two apart. They can feel like labor contractions in terms of both frequency and intensity. This can often create a feeling of uncertainty, especially if you are expecting your first child. To be on the safe side, check with your gynecologist, midwife, or your chosen birthing center if you are unsure. They will give you an individual physical examination, such as an ultrasound or vaginal exam, to diagnose exactly what sort of contractions you are experiencing.
One small hint at this point is that a hot bath can often help you to distinguish between prodromal and labor contractions. If you are unsure which contractions you are feeling, fill a bath with water at body temperature (36-37 degrees C). Lie in it for 10 to 15 minutes. Prodromal contractions can generally be soothed away in the bath and disappear. Labor contractions on the other hand don't go away and often even become more regular and stronger.

How long do labor contractions last?
Every woman is different, so every birth lasts for a different length of time. Often the birth starts when the contractions are still a long way apart, they then become more frequent and more intense as the birth progresses. In the past it was said that the cervix should dilate at 1 cm per hour during the dilation stage. This advice has now been withdrawn. What can be said as a rule is that first babies generally take longer than the second, third, or fourth ... even if they are all born vaginally.

MAM Experts

Midwives Anja & Marie
@hallohebamme

Anja and Marie are two midwives from Heidelberg. In 2019, they established "hallohebamme", a project very close to their hearts.

With hallohebamme they provide parents with lots of information on the topics of pregnancy, birth, and the postnatal period via social media platforms such as Instagram, TikTok, YouTube, and their own podcast and blog.

They also work in the labor ward of a large hospital in Heidelberg and as freelance midwives offering preventive services, postnatal support and courses.

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