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First stage A typical childbirth will begin with the onset of labor contractions of the uterus. The uterus begins rhythmic contractions which steadily increase in strength and frequency, gradually widening and thinning the cervix. The frequency and duration of these contractions varies with the individual. The onset of labor may be sudden or gradual, and is defined as regular uterine activity in the presence of cervical dilatation. During a contraction the long muscles of the uterus contract, starting at the top of the uterus and working their way down to the bottom. At the end of the contraction, the muscles relax to a state shorter than at the beginning of the contraction. This draws the cervix up over the baby's head. Each contraction dilates the cervix until it becomes completely dilated, often referred to as 10+ cm (4") in diameter. A gradual onset with slow cervical change towards 3 cm (just over 1 inch) dilation is referred to as the "latent phase". A woman is said to be in "active labor" when contractions have become regular in frequency (3-4 in 10 minutes) and about 60 seconds in duration. The cervix must shorten (efface) before it can dilate; for first time mothers this can take a substantial period of time and can often be a very tiring and disheartening time. However, it is also a very positive time, as once the cervix is effaced dilatation can occur and the downward journey of the fetus can commence. The now powerful contractions are accompanied by cervical effacement and dilation greater than 3 cm. The labor may begin with breaking of the water (a rupture of the amniotic sac). The contractions will accelerate in frequency and strengthen after the waters breaking.
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