In Gilmore Girls' episode 13 of Season 3, viewers see flashbacks of Lorelei's birth experience. We join her in the waiting room, watch as she's wheeled into the delivery room, and listen as she gets yelled at by Emily... again, about the way she's chosen to deliver . But we never get to see what really happens in your body when you're in labor. Like Gilmore Girls, most TV portrayals of birth include scenes like the pregnant woman aching of contractions, the moment when the water breaks, and the hysterical drive to the hospital. Sometimes we join the mom-to-be in the delivery room where a very loud, very painful birth occurs. But always, after few seamless pushes or a maybe even a (very rare) c-section, a baby is born — just like that.
This dramatic and quick visual of birth is certainly not the entire story. For some women, medication to induce birth or medication for pain management is a very real, very important piece of their birth story. For others, a birth plan is integral to their labor and delivery. Crying, screaming, even pooping on the table during delivery are all very real possibilities that become bits and pieces of the birth stories of mothers everywhere. But have you ever wondered what's happening in your body when you're in labor? Contractions, Pitocin, epidurals, doulas, "natural" — they've all become different ways we describe what happens when we're in labor, but do you ever stop and wonder what's going on in your brain, or in your uterus?
Instead of being weighed down by the medical terms you don't recognize (and can barely pronounce), here's what going on in your body as baby makes its way into the world.
First thing's first: Pre-labor is the first stage of labor, and lots of hormonal action occurs as your body prepares to bear a child. The two major players here are the main female sex hormone estrogen and the "cuddle hormone," oxytocin. The placenta releases estrogen and that triggers a few physiological events, such as the increase of teeny tiny particles in your uterus. (Your placenta is an organ your body creates during pregnancy and together with the umbilical cord, it provides nutrients and oxygen to your baby.) These teeny tiny particles result in what's known as Braxton Hicks contractions — you know, those weak, irregular contractions that send you to the hospital days (sometimes weeks) before you deliver only to be told that you're in false labor. Then, cells inside your baby make a great deal of the cuddle hormone and this causes stronger, more semi-regular contractions. The production of oxytocin also causes the placenta to let out another very important hormone called prostaglandin. Together with oxytocin, the combination is significant throughout labor, but the latter is the true hero, bringing about consistent contractions that make you want to scream during labor.
All this pain prompts a small but mighty part of your brain called the hypothalamus (which is responsible for the production of many of your body's hormones) to say, "Hey, posterior pituitary, start releasing oxytocin!" The posterior pituitary is a hormone-releasing part of the brain, and the more oxytocin released, the more often your uterus is stimulated to contract, which means the faster and stronger your labor becomes. Another substance working inside your body is a protein, fetal fibronectin, which transforms from a binding-like substance to a lubricant-like substance. Fetal fibronection helps support contractions as labor begins.
Dilation is the longest stage of labor, and it can last up to 12 hours... or more. So, that's like 16 episodes of Gilmore Girls, if you want to think about it like that.
Oftentimes, however, we aren’t sure when the body transitions from pre-labor to labor. Dr. Eva Martin, CEO of Elm Tree Medical, Inc. shares with Romper her thoughts on these early moments during birth:
Each hospital uses slightly different numbers to determine when a mother is actually considered in labor. There isn’t a golden number, and the transition point can be ambiguous because birth and the stages of labor are a natural process. Your human body is natural, not a computer program.
Martin's comments are important to keep in mind as we dive deeper into the science of labor. These internal processes are nearly the same inside of a pregnant body, but each birth is still unique. The amount of time in each of the following stages varies. Some external signs of pre-labor include diarrhea, greater back pain, looser joints, and more cramping. These pre-labor signs usually occur one to four weeks before your body is ready to go into labor. And honestly, there's no telling what different symptoms different women will experience.
However, while signs of labor are easy to spell out, if you maintain a fever, feel extremely tired, and/or experience pain or pressure in your lower belly, lower back, or pelvic area, that may be a sign that you're experiencing preterm labor, which happens between 20 and 37 weeks into pregnancy. Two other common symptoms of preterm labor are steady contractions and the premature rupture of membranes (PROM), which is very rare. (A sign of PROM is pink or reddish liquid coming from your vagina.) But only 12 percent of labors are diagnosed as preterm labors, and if this happens, some health providers delay birth while others may allow your body go into labor. Together with your birth team, you decide what is the best and safest route for you and your baby.
Your body does so much work going through labor and delivery, and all that work can be summed up as "the most meaningful experience of your life," or, as Lorelai thinks, is "something more akin to doing the splits on a crate of dynamite."
Stage 1: Dilation
Dilation is the longest stage of labor, and it can last up to 12 hours... or more. So, that's like 16 episodes of Gilmore Girls, if you want to think about it like that. But hey, fast births can happen too.
The contractions you feel at the beginning of true labor last between 10-to-30 seconds and occur every 15-to 30-minutes. They eventually occur much faster and with a lot of force, and that's because your baby's head presses up against your cervix with every contraction, which causes it to efface and dilate, meaning your cervix thins out and widens. All this helps make room for baby to exit. When the baby's head finally reaches the pelvis, this event is known as "engagement." Towards the end of dilation, your baby will rotate to better maneuver itself out.
Your water also breaks during this stage of labor. It's not actually water; it's amniotic fluid: the liquid that surrounds your baby. According to the Mayo Clinic, if your water doesn't break on its own, your healthcare provider will perform an amniotomy to start labor contractions (or make them stronger).
Dilation finally ends when your cervix is about 10 centimeters wide. Jeanne Faulkner, registered nurse/podcaster/writer and maternal health expert, tells Romper that the earliest stages of labor and dilation are often the hardest to explain to her patients. Faulkner says:
When we see birth in the media, we see women in the pushing stage of birth. But the reality is that a ton of work needs to happen in the body before that, and that can take quite a while. That’s hard for people to get. They think if I’m not making progress, something is wrong with me when in fact, everything is probably OK; it [just] takes a while.
But what happens when you go beyond your due date? Often times, women can ask to have an induced labor, induced with medication like Pitocin, which helps the cervix efface and dilate. And as mentioned, health providers could also "pop" the amniotic sac to release a little amniotic fluid (known as performing an amniotomy). They might also use a catheter to open the cervix with a balloon-type tool. Though it depends on your provider and the hospital's policies, some women are able to go seven-to-10 days past their due date before their doctor will step in and schedule an induction procedure.
Here's something you might not totally know: Women in labor continue to have strong contractions even after their baby comes out. And that's a good thing!
Labor induction also happens if you experience certain medical conditions that would increase a risk in either mom or baby before birth. When women in labor have high blood pressure or preeclampsia, for example, their labor might be induced. Women with diabetes or lung disease are also potential candidates for induction.
Now... ready for some intense action?
Stage 2: Expulsion
Expulsion or "forceful exiting" can be the toughest part of labor. In this stage, your cervix continues to dilate and your contractions are happening every two-to-three minutes, lasting for about a minute each in length. This all means that your body is ready to deliver its baby. First-timers stay in the expulsion stage for about 50 minutes. For women who've given birth previously, it can happen as quickly as 20 minutes (though a quick expulsion is not a guarantee). The first main event that occurs is crowning, which is when your baby’s head emerges without "slipping back in," according to the American Pregnancy Association.
If you received epidural anesthesia, there is a possibility you'll feel some pressure, and that pressure will help you push. Fifty percent of women use epidural anesthesia in their births, according to the American Pregnancy Association, and it's considered the most common method of pain management.
However, if your healthcare provider senses baby is struggling to make its way into the world, your health provider may also perform an episiotomy. However, they're done far less often than they used to be. According to the Mayo Clinic, an episiotomy is an incision made between your vagina and your anus to enlarge your vaginal opening. Women in labor have the right to refuse an episiotomy; and like Faulker suggests, “the more you know, the better you can participate” in your birth and ask questions about potential procedures.
Giving birth is a scientific wonder. Think about it: all parts of your body are highly active and interacting with one another in order to deliver your baby. If that's not magic, I don't know what is.
Presentation is another major event in this stage of labor, which is basically the position your baby takes when it's ready to be delivered. Your baby can come out vertex (head first) or breech (butt first). If your baby is delivered head first, your baby's head dilates the cervix and comes out nearly mucus-free. Breech and other presentations, however, can be more difficult. And c-sections may be recommended for breech babies.
Finally, once your baby is out, that's when umbilical cord is cut. According to the American Congress of Obstetricians and Gynecologists, timing for delayed cord clamping has still "yet to be established," even though the World Health Organization (WHO) cited that, "late cord clamping (performed approximately 1–3 min after birth) is recommended for all births, while initiating simultaneous essential neonatal care."
Stage 3: Placenta Delivery
Here's something you might not totally know: Women in labor continue to have strong contractions even after their baby comes out. And that's a good thing! These contractions restrict bleeding and help detach the placenta from your uterine wall. After about 30 minutes, afterbirth is complete, and this means that the placenta is delivered. If any placenta is left inside your body, it can lead to heavy bleeding and a lot of pain. One specific complication of retained placenta is postpartum hemorrhage (PPH), and it's rare but very serious. About 1 to 5 percent of women who give birth experience PPH.
Unfortunately, even if you don't experience PPH, pregnancy complications may still occur. You may get a urinary tract infection (UTI), develop preeclampsia (yes, even post-birth), or could experience depression during or after giving birth. Your body does so much work going through labor and delivery, and all that work can be summed up as "the most meaningful experience of your life," or, as Lorelai thinks, is "something more akin to doing the splits on a crate of dynamite."
So whether you have four-hour birth or 26-hour birth (sorry, mom!), labor — as Martin describes to Romper — is “a miracle and a marathon.” Giving birth is a scientific wonder. Think about it: all parts of your body are highly active and interacting with one another in order to deliver your baby. If that's not magic, I don't know what is.
Even though our knowledge of birth has grown exponentially over the years, medical scientists are still in the thick of researching new ways to support health providers and assist women in labor. Some scientists are looking into new methods of inducing labor, and current clinical trials in the works are each experimenting with hormones like estrogen or relaxin and drugs like hylauronidase and mifepristone to see if they too can aide in induction. Other scientists, like those working at Elm Tree Medical, Inc., are trying to improve the current method of measuring cervical dilation.
Health providers today use their fingers to guesstimate the width of a pregnant woman's cervix. Martin's device and similar projects, however, could improve the accuracy of these measurements, which would improve the way health providers support women as they move from pre-labor to the placenta stage. This is an exciting time, Martin says, because her company is nearly ready to begin clinical trials for their device. And overall, as scientists continue studying labor and delivery, it's just as essential women in labor (and those gearing up for labor) ask questions and learn alongside their providers.