Stages of Labor: 2nd Stage Active Labor


During the second phase of labor (active labor), you should be at the hospital or have a midwife on hand if birthing at home or at a birthing center. Phase two labor can vary in time from 1 to 5 hours. During active labor you can expect the dilation of the cervix to accelerate. You will get more “bang for your labor buck”. In other words, you will typically see more evidence that your contractions are paying off in the form of dilation of the cervix.  Remember that the baby cannot be born (at least not vaginally) until you cervix is fully dilated. As a very general rule you can expect the cervix to dilate between 1 and 1.5 cm per hour of active labor. You will dilate from 4 to 7 cm during this stage of labor.

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Contractions are more intense lasting on average 45 to 60 seconds spaced 2 to 5 minutes apart. Make an effort to relax as much as possible between contractions. Try changing positions to get into the most comfortable position. Change positions often. This may help alleviate some of the pain. In addition to uterine contractions, you may have increasing backache, fatigue, leg discomfort and a tightening in the pubic area.
You are going to want to urinate frequently; approximately every hour. During this phase of labor, it may be difficult to feel the urge to urinate due to the increased pressure on your pelvis. You will also want to keep eating to a minimum. You do not want to vomit later in the birthing process. You may want to ask your coach to help you remember to urinate frequently and to suggest you change positions. This will help you take your mind off all the things you need to remember to do and to focus on your contractions and relaxation techniques.

Because active labor is the most intense portion of the labor process, this is the phase where it helps to be as comfortable as possible. It also helps to have a good coach – a spouse or friend, to help you manage the process. Breathing techniques can be utilized to distract your mind from the intensity of the contractions. However, in order to be effective, breathing techniques need to be practiced in advance. Otherwise they become an additional psychological burden instead of a help.

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Be prepared for a change in your general attitude and personality during the active phase of labor. Even the most gentle and soft-spoken individual will often transform temporarily during active labor. Small things will annoy and simple things will trip your trigger. Your spouse and/or support network need to be aware of this probability and not take offense.

Active labor is the point where you also need to consider whether you will receive medication to ease the intensity of the contractions. Be aware that this is a personal choice. Epidurals are routinely administered in this day and age with little documented negative effect on the baby. The most problematic consequence of an epidural or spinal block is the apparent correlation between the administration of anesthetics and the incidence of cesarean sections. C-sections are most frequently performed for “failure to progress” and the act of administering a strong anesthesia during active labor has as one of its unintended consequences the slowing of labor. This is not to discourage you from receiving an epidural, only to make you aware of the additional risks. Frankly, this risk can be managed quite nicely by having an honest discussion with your physician or caregiver up front about your desire not to have a cesarean section unless there is clear evidence that the health of the baby or mother are in jeopardy.

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