The stages of labor and delivery

The process of labor and delivery is divided into three stages. The first stage of labor
begins when you start having contractions, and ends when your cervix is fully dilated
(open). The second stage of labor begins when you're fully dilated and ends with the
birth of your baby. The third stage of labor starts right after the birth of your baby and
ends with the delivery of the placenta.

What are the stages of labor?

There are three stages of labor. Here's what they include:

Stage 1: Early labor contractions, active labor, and full dilation of the cervix

Stage 3: Delivering the placenta

The first stage of labor is the longest. A lot happens in this stage – so much that it's
divided into three phases:

 Early labor: Your cervix gradually thins out and opens to about 6 centimeters (cm) by

the end of this phase.

 Active labor: Your cervix begins to dilate more rapidly and opens up further to 10 cm.

Contractions are longer, stronger, and closer together.

 Transition: During the last part of active labor, contractions are even longer, stronger,

and closer together. This can be the most difficult part of your entire labor.
 First stage of labor

The first stage of labor is the longest stage, especially if you're giving birth for the first
time. Early labor usually takes the longest amount of time and transition the shortest.

Early labor

You may have had signs of early labor – such as more frequent Braxton Hicks
contractions, loss of your mucus plug, bloody show, and even some cervical dilation
and effacement – for days or even weeks now. Or maybe not! Either way, once you
start having regular, persistent contractions, you're in labor.

What to expect:

 Contractions start. You'll start having contractions at relatively regular intervals. Early

labor contractions are sometimes hard to distinguish from "false labor" (that is, irregular

Braxton Hicks contractions). True labor contractions get closer together as time goes on

and are more regular than Braxton Hicks contractions. If you aren't sure whether you're

in true labor, see whether you can hold a complete conversation. If you have to stop,

especially mid-sentence, to breathe through contractions, you're probably moving into

early labor.
 Contractions get longer, stronger, and closer together. Eventually they'll be coming

every four to five minutes and lasting 40 to 60 seconds each. (Some women have much

more frequent contractions during this phase, but the contractions will still tend to be

relatively mild and last no more than a minute.) Early labor ends when your cervix is

about 6 cm dilated and your progress starts to accelerate.

 You may feel some pain. If your labor is typical, your early contractions will be mild

enough for you to talk through them and putter around the house, or even doze off

between them. But as your labor progresses, your contractions will become painful.

 You may feel pelvic pressure or back pain as your baby moves down. If you have

lower back pain with your contractions, you may be having back labor.

 You may see a mucousy vaginal discharge. This may be tinged with blood – the so-

called bloody show. This is perfectly normal, but if you see more than a tinge of blood,

be sure to call your doctor or midwife.

 Your water may break. Call your provider if your water breaks. It may feel like a

slow trickle of liquid or a strong gush.

What to do:

 Time contractions periodically. Don't become a slave to the stopwatch just yet – it's

stressful and exhausting to record every contraction over the many long hours of labor,

and it isn't necessary. Instead, you may want to time your contractionsperiodically to

get a sense of what's going on. In most cases, your contractions will let you know in no

uncertain terms when it's time to take them more seriously.

 Rest. It's important to do your best to stay rested, since you may have a long day (or

night) ahead of you. If you're tired, try to doze off between contractions.

 Relax. If you're feeling anxious, you may want to try some relaxation exercises, take a

warm bath, or do something to distract yourself a bit – like watching a movie.

 Drink plenty of fluids to keep well hydrated. And don't forget to urinate often, even if

you don't feel the urge. A full bladder may make it more difficult for your uterus to

contract efficiently, and an empty bladder leaves more room for your baby to descend.

Active labor

There's no doubt now that your baby is on the way. Your doctor or midwife may have
given you instructions about when to go to the hospital or birth center, but usually once
you have regular, painful contractions (lasting about 60 seconds each) every four to five
minutes for an hour or more, it's time to grab your hospital bag and head out.

What to expect:

 Contractions become intense. Active labor is when things really get rolling. Your

contractions become increasingly intense – more regular, longer, and stronger – and

you'll no longer be able to talk through them.

 Contractions get more frequent. In most cases, contractions eventually happen every

2 1/2 to 3 minutes, although some women never have them more often than every 5

minutes, even during transition.

 Cervix opens wider. Your cervix dilates more quickly. (The last part of active labor,

when the cervix dilates fully from 8 to 10 cm, is called transition, which is described in

the next section.)

 Your baby may begin to descend toward the end of active labor, although they might

have started to descend earlier, or might not start until the next stage.

 Nausea and vomiting. This is fairly common now, sometimes from epiduralanesthesia

causing the blood pressure to drop, and sometimes from stimulation of nerves that cause

vomiting.

 Get pain relief if you need it. Most women opt for pain medication, such as an

epidural, at some point during the active labor phase.

 Try relaxation techniques. Many pain-management and relaxation techniques used

in natural childbirth – such as breathing exercises and visualization – can help you

during labor, whether or not you're planning to receive medication.

 Lean on your support person. Your partner, a friend or family member, or a

hired doula can be a huge help now. You'll probably appreciate lots of gentle

encouragement.

 Move. It may feel good to walk, but you'll probably want to stop and lean against

something (or someone) during each contraction. You should be able to move around

the room freely after your caregiver evaluates you, as long as there are no

complications.

 Sit or lie down on your side. If you're tired, try sitting in a rocking chair or lying in

bed on your left side.

 Get a massage. This might be a good time to ask your birth partner or doula for a

massage to help ease labor pain.

 Take a warm shower or bath if you have access to a tub and your water hasn't broken.

Even if your water has broken, a shower is probably okay, as the risk of infection is

low. (Don't take a bath if your water has broken.)

Transition

The last part of active labor is called the transition period because it marks the shift to
the second stage of labor. Your contractions are at their strongest, and your cervix
completely opens up so that your baby can pass through.

What to expect:

 A fully dilated cervix. Your cervix dilates from 8 cm to a full 10 cm.

 Very strong contractions. This is the most intense part of labor. Contractions are

usually very strong, coming every 2 1/2 to 3 minutes or so and lasting a minute or more.

You may start shaking and shivering.

 Pressure on your rectum. By the time your cervix is fully dilated and transition is

over, your baby has usually descended somewhat into your pelvis. This is when you

might begin to feel rectal pressure, as if you have to move your bowels.

 Discharge. There's often a lot of bloody discharge.

 Nausea. You may feel nauseated or even vomit.

 An urge to push. Some babies descend earlier and the mom feels the urge to push

before she's fully dilated. Other babies descend later and the mom reaches full dilation

without feeling pressure. If you've had an epidural, the pressure you'll feel will depend

on the type and amount of medication you're getting and how low your baby is in your

pelvis.

Second stage of labor

Once your cervix is fully dilated, the second stage of labor begins: pushing and the final
descent and birth of your baby.

The entire second stage can last anywhere from a few minutes to several hours.

What to expect:

 More spaced-out contractions. At the beginning of the second stage, your

contractions may be a little further apart, giving you the chance for a much-needed rest

between them.

 Less intensity as pushing begins. Many women find their contractions in the second

stage easier to handle than the contractions in active labor because bearing down offers

some relief. Others don't like the sensation of pushing.

 The urge to push. As your uterus contracts, it exerts pressure on your baby, moving

them down the birth canal. If your baby is very low in your pelvis, you may feel an urge

to push early in the second stage (and sometimes even before). But if your baby's still

relatively high, you probably won't have this sensation right away.
 You might want to take it slow. If everything's going well, you might want to take it

slowly and let your uterus do the work until you feel the urge to push. Waiting a while

may leave you less exhausted in the end.

 You may be instructed to push. In many hospitals it's routine to coach women to push

with each contraction in an effort to speed up the baby's descent. Let your caregiver

know if you'd prefer to wait until you feel a spontaneous urge to bear down. This

practice, known as laboring down, has been shown to be as effective as coached

pushing, although delivery may take a little longer.

 Epidurals can reduce the urge to push. If you have an epidural, the loss of sensation

can blunt the urge to push, so you may not feel it until your baby's head has descended

quite a bit. You may need explicit directions to help you push effectively.

With each contraction, the force of your uterus – combined with the force of your
abdominal muscles if you're actively pushing – exerts pressure on your baby to continue
to move down the birth canal. The descent may be rapid. Or, especially if this is your
first baby, the descent may be gradual.

When a contraction is over and your uterus is relaxed, your baby's head will recede
slightly in a "two steps forward, one step back" kind of progression.

Learn more about how to push during labor.

 Crowning

What to expect:

 Your baby's scalp will appear. After a time, your perineum (the tissue between your

vagina and anus) will begin to bulge with each push, and before long your baby's scalp

will become visible – a very exciting moment and a sign that the end is in sight. You

can ask for a mirror to get that first glimpse of your baby, or you may want to reach

down and touch the top of their head.

 A powerful pushing urge. Now the urge to push becomes even stronger. With each

contraction, more and more of your baby's head becomes visible. The pressure of their

head on your perineum feels very intense, and you may notice a strong burning or

stinging sensation as your tissue begins to stretch. This is called "the ring of fire," and it

lasts just a few minutes.

 Instructions to slow down or pant. At some point, your caregiver may ask you to

push more gently or to stop pushing altogether so your baby's head has a chance to
 gradually stretch out your vaginal opening and perineum. A slow, controlled delivery

can help prevent perineal tearing. By now, the urge to push may be so overwhelming

that you'll be coached to blow or pant during contractions to help counter it. Sometimes,

gently coughing instead of pushing can result in a slower, easier descent of your baby's

head.

 The whole head appears. Your baby's head continues to advance with each push until

it crowns – that's when the widest part of their head is finally visible. The excitement in

the room will grow as your baby's face begins to appear: their forehead, their nose, their

mouth, and, finally, their chin.

 Provider removes any blockages. After your baby's head emerges,

your doctor or midwife may suction their mouth and nose and will feel around their

neck for the umbilical cord. If the cord is around your baby's neck, your caregiver will

either slip it over their head or, if need be, clamp and cut it.

 The body emerges. Your baby's head then turns to the side as their shoulders rotate

inside your pelvis to get into position for their exit. With the next contraction, you'll be

coached to push as their shoulders emerge, one at a time, followed by their body.
 Third stage of labor

Minutes after giving birth, your uterus begins to contract again. The first few
contractions usually separate the placenta from your uterine wall.

When your caregiver sees signs of separation, they may ask you to gently push to help
expel the placenta. This is usually one short push that's not at all difficult or painful. On
average, the third stage of labor lasts just five or six minutes, with 90 percent of
placentas delivered by 15 minutes from the birth of your baby.

If the placenta is still attached 30 minutes after birth (or sooner if there's heavy
bleeding), your provider might need to take action to assist in its delivery. This might
mean giving you a drug to help your uterus contract, massaging the top of the uterus to
encourage placental separation, or gently tugging on the umbilical cord.

In the meantime, nurses and doctors will be caring for your baby:

 They need to be dried off with a towel and kept warm.

 Your doctor or midwife may quickly suction your baby's mouth and nasal passages if

they seem to have a lot of mucus.

 If there are no complications, they'll be lifted onto your bare belly so you can touch,

kiss, and simply marvel at them. Skin-to-skin contact will keep your baby nice and
 toasty, and they'll be covered with a warm blanket – and perhaps given their first hat –

to prevent heat loss.

 Your caregiver will clamp the umbilical cord in two places and then cut between the

two clamps – or your partner can do the honors.

You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement
(to name a few), and, of course, intense relief that it's almost over. Exhausted as you
may be, you'll also probably feel a burst of energy.

VARIATION

Variation is all the differences that exist in a population of the same species. These
differences are caused by:
 Genetic variation - these are differences between individuals that are inherited from
parents, such as the colour of your eyes, hair and skin.
 Environmental variation - these are differences between individuals that are not
inherited but caused by the environment that the organism lives in, including scars and
tattoos.
 Genetic and environmental variation - differences between individuals that are caused
by both genetic and environmental factors, such as height and weight.
Data on variation is collected by surveying the population. This data can be described as
either continuous variation or discontinuous variation. It is important to remember that
these are not the causes of variation, which are described above, but how we analyse the
results of the surveys.

 Surveys into variation give data that are continuous, which means to come in a range,
or discontinuous, which means to come in groups.

Continuous variation
Surveys of continuous variation give us results that come in a range. Human height is an
example of continuous variation. It ranges from that of the shortest person in the world to
that of the tallest person. Any height is possible between these values, so this is
continuous variation. For example, you can be 150 cm tall, 151 cm tall, or any height in
between this - if you had a ruler that could measure small enough values.

So, a characteristic that changes gradually over a range of values shows continuous
variation. Examples of such characteristics are:

 height
 arm span
 weight

Results from surveys of continuous variation are presented in line graphs or bar charts
with a line of best fit drawn through them. If you record the heights of a group of people
and draw a graph of your results, it usually looks something like this:

Discontinuous variation
Surveys of discontinuous variation give us values that come in groups rather than a
range. Human blood groups are an example of discontinuous variation. In the ABO blood
group system, only four blood groups are possible - A, B, AB or O. You cannot have a
blood group in between these four groups, so this is discontinuous variation.

Here are some examples:

 blood group
 eye colour

Results from surveys of discontinuous variation are presented in charts. These is no line
of best fit drawn because the values on the x-axis - blood groups in the graph below -
could be placed in any order. If you record the blood groups of a group of people and
draw a graph of your results, it usually looks something like this:
More examples
Continuous variation Discontinuous variation
Height Blood group
Weight Hand used to write with
Arm span Eye colour
Head circumference at birth Ability to roll tongue

Genetic factors, environmental factors, or a combination of both cause phenotypic

variation,

Genetic Sources of Variation?

In sexually reproducing organisms containing diploid cells, genetic variation arises

from processes such as mutations, crossing over, independent assortment, and random
fertilisation.
Independent assortment is the random alignment of chromosomes during metaphase
which results in different combinations of alleles in each gamete
During metaphase, chromosome pairs are pulled towards the equator of the mitotic
spindle. Each pair can be randomly arranged with either chromosome on top. This
orientation is completely independent of the actions of any other pair. The
homologous chromosomes are then separated and pulled to different poles, leading to
different combinations of alleles in each gamete.

random fertilisation of gametes

Any sperm cell can fuse with any egg cell and share its genetic information, thus
creating genetic variation.
The random fertilisation of gametes explains why heterozygous or fraternal twins do
not look more alike than normal siblings.

the environmental sources of variation

Continuous variation is a characteristic that changes gradually over a range of
values, e.g., height and weight.
Discontinuous variation is a characteristic of any species with only a limited number
of possible values, e.g., sex and eye colour.
Continuous variations have the following characteristics:
– The variations fluctuate around an average or mean of species.
– Direction of continuous variations is predictable
– They are already present in the population.
– Continuous variations are formed due to chance segregation of chromosomes
during gamete formation, crossing over and chance pairing during fertilization.
– They can increase adaptability of the race but cannot form new species.
– Continuous variations are connected with the mean or average of the species
by intermediate stages.
– The continuous variations are also called fluctuations.
– When represented graphically, continuous variations give a smooth bell
shaped curve
– They are very common
– Continuous variations do not disturb the genetic system.
Discontinuous variations have the following characteristics:
– A mean or average is absent in discontinuous variations.
– The direction of discontinuous variations is unpredictable.
– Discontinuous variations are new variations though similar variations might
have occurred previously.
– Discontinuous variations are produced by changes in genome or genes.
– Discontinuous variations are the fountain head of continuous variations as well as
evolution
– These variations are not connected with the parental type by intermediate stages.
– Discontinuous variations are also known as mutations or sports.
– A curve is not produced when discontinuous variations are represented
graphically
These variations appear occasionally.
– They disturb the genetic system of the organism

eg: An example of this would be directional selection due to climate change. For
instance, a population of polar bears is usually distributed around average body
weight. Individuals with larger body sizes tend to survive better in colder climates,
while individuals in warmer climates are more likely to survive with smaller bodies.
An increase in global temperatures might shift the optimum body mass to the left of
the original optimum, thus creating directional selection towards smaller polar bears.
Directional selection can be seen in peppered moths. The peppered moth has a lighter
morph and a darker melanic morph. Against lichen-covered trees, lighter moths can
blend in well, whereas melanic moths stand out, making them vulnerable to predation
from insectivorous birds. As a result, the population underwent directional selection
favouring lighter moths; thus, melanic moths only made up a small fraction of the
population in the early 1800s.
However, about 50 years later, many more melanic moths were recorded in industrial
areas where trees and buildings were blackened by soot. Here, melanic moths can
blend in and light moths cannot, making the latter much more vulnerable. This time,
the population underwent selection in the opposite direction, favouring darker moths.
By the end of the century, the overwhelming majority of the pepper moth population
was composed of melanic moths.

Natural selection: the differential survival and reproduction of individuals due to

differences in their phenotype.
Natural selection describes the change in a population’s allele frequency (gene pool)
in favour of individuals that are better adapted to survive selection pressures.
These organisms harbour advantageous alleles and, therefore, a favourable phenotype
that increases their chances of survival. As a result, they will live on to reproduce and
create offspring, which inherit the advantageous allele.
These organisms harbour advantageous alleles and, therefore, a favourable phenotype
that increases their chances of survival. As a result, they will live on to reproduce and
create offspring, which inherit the advantageous allele.
Charles Darwin was the English naturalist who first developed the idea of natural
selection after a five-year voyage, during which he studied plants, animals, and fossils
in South America and on islands in the Pacific.

importance of natural selection

Favourable traits are inherited across generations. It is one of the processes

driving evolution and helps explain the diversity of organisms on earth.
Diversity is essential; without genetic variation, a population wouldn’t evolve in
response to the changing environment, which may increase the risk of extinction.

three types of natural selection

 Stabilising selection, which preserves the average phenotype
 Directional selection, which favours one extreme phenotype
 Disruptive selection, which favours more than one extreme phenotype

stabilising selection

selects for the average phenotypes and against more extreme phenotypes. This type of
selection occurs in populations where environmental conditions remain constant for
long periods. Therefore, this selection form keeps allele frequencies relatively steady
over generations and maintains (keeps stable) an intermediate phenotype.
eg: The number of eggs laid by birds also undergoes stabilising selection. When birds
lay too many eggs, they may not be able to feed all of the chicks sufficiently, leading
to malnourished offspring. In addition, laying too many eggs can be a significant
drain on the mother’s resources, reducing the number of eggs she can lay in the
future. On the other hand, laying too few eggs might result in no viable offspring. In
this case, an intermediate value would be selected.

directional selection

Directional selection would lead to one extreme phenotype being selected for rather
than the other.
The evolution of the peppered moth is an evolutionary instance of directional colour
change in the moth population as a consequence of air pollution during the Industrial
Revolution. The frequency of dark-coloured moths increased at that time, an example
of industrial melanism.
After industrialisation, barks got covered by smoke, so the white moths were
selectively picked up by birds. However, the black coloured moths escaped unnoticed
against a dark background and became abundant.
However, in recent year, reduced industrial pollution has led to the growth of lichens
again and thus, the population of light coloured moths is again increasing.
This evolutionary story of moths in England, thus reveals, that 'evolution is apparently
reversible'
Disruptive selection, also known as diversifying selection, favours several extreme
phenotypes rather than intermediate phenotypes and is the least common form of
selection. This type of selection occurs when the extreme phenotypes are more
successful than intermediate forms within the same habitat, as depicted below.

eg: Disruptive selection is seen in rabbits. In an environment with black and white
rocks, black and white rabbits will be camouflaged, whereas grey rabbits will be
visible and eaten by the predator.
Polymorphism in a population occurs when many genetically distinct forms (morphs)
of a species still interbreed in the same population.
Disruptive selection can lead to polymorphism in a population, wherein many (poly)
genetically distinct forms (morphs) of a species still interbreed and exist in the same
population.