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Pregnancy Article

What to Expect During Each Stage of Labor

You’re nearing that time when it might be hard to tell if the sensations you are experiencing are false labor, often referred to as prodromal labor, or early labor. If you have been having braxton hicks contractions for a while, it might be even tougher to distinguish whether or not it’s go time! Let’s get into the nitty gritty on the different stages of labor, and what to expect for each one. My hope is that you will go into your birth feeling educated and empowered knowing what your body is doing in each stage. 

Stage One

If you don’t know for sure whether you are in labor, you are probably in the very early stages! Ignore it until you can’t anymore! Stage One of labor lasts the longest, and early labor can last up to 12 hours for some women. The hardest part about preparing your mind for labor is not knowing what cards you will be dealt. Labor is like a marathon, except it could be shorter or longer than 26.2 miles. You won’t know until you go through it! That is why it is so important to conserve energy and hydrate well in early labor. 

The first stage of labor is defined by the period of time it takes to go from zero centimeters dilated to fully dilated. Contractions, or surges, may start slow and infrequent, occurring between five and 30 minutes apart and lasting around 30-45 seconds each time. The surges in early labor are mild to moderate, and get gradually stronger and closer together. This is how you will know it is the real deal! If it were prodromal labor, contractions would start and stop in an unpredictable manner; this could sometimes last for days! 

You might experience some cramping, diarrhea, and the loss of your mucus plug. Fun fact: only about 10% of women have their water break before labor begins, and most women experience a slow leak of fluid rather than the sudden gushing you see in the movies! 

Stage Two

Stage two of labor is often described as the “pushing stage,” as your cervix has reached full dilation and effacement. It is marked by the time you reach 10 centimeters until your baby is born. By this point, contractions have reached peak intensity. Each surge is longer and stronger, and you will experience less of a break in between the surges. 

Your perineum has stretched quite a bit at this point, so you might be feeling some burning sensations as the baby crowns. Research shows that performing perineal massage starting around week 34-36 in first time mothers reduces the risk of tearing in labor. Bonus: it also gets you used to that burning sensation you will feel during the pushing stage! Additionally, studies show that laboring in a birth pool reduces the likelihood of tearing. You can achieve the same effect by having a member of your birth team apply a warm, wet rag on your perineum!

It is important to note that just because your cervix is dilated to 10 cm does not necessarily mean your body is ready to push. Women who labor down without an epidural often wait until they feel the urge to push. It is harder to feel that urge when you have an epidural, which is why coached pushing is sometimes necessary! Next week, we will explore how to labor down, how to breathe during contractions, and how to push without straining your pelvic floor.

Stage Three

Congratulations! Your baby is here, and now you need to birth your placenta. This is the marker of the third and final stage of labor. It sometimes can take up to 30 minutes for your body to expel the placenta, during which you will feel more contractions. If you are in the hospital, a nurse might perform a fundal massage by pressing on your uterus to help your body along. Once the placenta is birthed, the baby’s cord will be clamped. How long you want to wait to clamp the cord is up to you and your birth plan! 

Sara French, ACSM CPT, NASM CNC

Sources

https://www.hopkinsmedicine.org/health/wellness-and-prevention/labor

https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour#:~:text=There%20are%20three%20stages%20of,is%20happening%20during%20your%20labour.

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Weekly Tips

Energy Expenditure During Pregnancy

Caloric intake should increase by approximately 300 kcal/day during pregnancy. This value is derived from an estimate of 80,000 kcal needed to support a full-term pregnancy and accounts not only for increased maternal and fetal metabolism but for fetal and placental growth. Dividing the gross energy cost by the mean pregnancy duration (250 days after the first month) yields the 300 kcal/day estimate for the entire pregnancy.1,2 However, energy requirements are generally the same as non-pregnant women in the first trimester and then increase in the second trimester, estimated at 340 kcal and 452 kcal per day in the second and third trimesters, respectively. Furthermore, energy requirements vary significantly depending on a woman’s age, BMI, and activity level. Caloric intake should therefore be individualized based on these factors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202

Macronutrients during pregnancy 

Concerning protein, the recommended dietary allowance is 71 grams per day, but realistically, 1.1 g/kg body weight is more accurate. Carbohydrates should comprise 45-64% of daily calories and this includes approximately 6-9 servings of whole grain daily. Total fat intake should comprise 20-35% of daily calories, similar to non-pregnant women.

Nutrition Postpartum when breastfeeding 

When breastfeeding your baby, kilocalorie needs are 500 kcals for the first six months and 400 kcals for the second six months (Academy of Nutrition and Dietetics, n.d.). This amount could be a little less or a little more depending on how much milk you are producing. For example, if you doing a combination of formula-feeding and breastfeeding your baby, you likely do not need the full 500 calories; Or, if you are breastfeeding your baby and also pumping additional milk, you may need more than 500 extra calories. Try to get the extra calories from high-quality food sources (See list below). 

It is also important to remember than when producing milk, your body may want you to keep a couple of extra pounds on you in order maintain milk supply. Do not worry about a few extra pounds! It is also not unusual for some women to lose weight when breastfeeding. Everyone is different. Don’t compare yourself to anyone else! Focus on keeping a healthy weight for you and your baby! 

List of important nutrients for breastfeeding, and where to find them. 

  • Calcium: milk; cheese; yogurt; fish with edible bones; tofu processed with calcium sulfate; bok choy; broccoli; kale; collard, mustard, and turnip greens; breads made with milk.
  • Zinc: meat, poultry, seafood, eggs, seeds, legumes, yogurt, whole grains (bioavailability from this source is variable).
  • Magnesium: nuts, seeds, legumes, whole grains, green vegetables, scallops, and oysters (in general, this mineral is widely distributed in food rather than concentrated in a small number of foods).
  • Vitamin B6: bananas, poultry, meat, fish, potatoes, sweet potatoes, spinach, prunes, watermelon, some legumes, fortified cereals, and nuts.
  • Thiamin: pork, fish, whole grains, organ meats, legumes, corn, peas, seeds, nuts, fortified cereal grain (widely distributed in foods).
  • Folate: leafy vegetables, fruit, liver, green beans, fortified cereals, legumes, and whole-grain cereals.
https://www.ncbi.nlm.nih.gov/books/NBK235579
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202

Women who breastfeed require approximately 500 additional kcal/day beyond what is recommended for non-pregnant women.68 The estimate is derived from the mean volume of breast milk produced per day (mean 780 mL, range 450-1200 mL) and the energy content of milk (67 kcal/100 mL).69 During pregnancy, most women store an extra 2 to 5 kg (19,000 to 48,000 kcal) in tissue, mainly as fat, in physiologic preparation for lactation. If women do not consume the extra calories, then body stores are used to maintain lactation. It is not unusual for lactating women to lose 0.5-1.0 kg/month after the first postpartum month.70

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202

Macronutrients during pregnancy 

There are even less evidence-based recommendations for nutrient intake during breastfeeding compared to pregnancy. Lactation is considered successful when the breast-fed infant is gaining an appropriate amount of weight. The recommended daily allowance for protein during lactation is an additional 25 g/day. 

Maternal factors such as stress, anxiety, and smoking can decrease milk production, but the quantitative and caloric value of breast milk does not change with dieting and exercise.7683 Moreover, a woman’s weight, BMI, body fat percentage, and weight gain during pregnancy do not influence milk production.8486

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202

Reviewed and edited by Heather Emerson-Payne, RD, PhD, 2023.

References

Academy of Nutrition and Dietetics. Nutrition Care Manual. Comparative Standards, Breastfeeding/Lactation. https://www-nutritioncaremanual-org.wku.idm.oclc.org/topic.cfm?ncm_category_id=1&lv1=272980&lv2=144973&lv3=269509&ncm_toc_id=269509&ncm_heading=Normal%20Nutrition. Accessed July 12, 2023.

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