Labor & Delivery
Signs of labor, all 3 stages detailed, evidence-based pain management options, induction methods, VBAC success rates, and delivery complications.
Stages of Labor
| Stage | Cervix | Duration | Contractions |
|---|---|---|---|
| Stage 1: Early Labor | 0-6 cm | 6-12 hours | Mild, 5-30 min apart, 30-45 sec |
| Stage 1: Active Labor | 6-10 cm | 4-8 hours | Strong, 3-5 min apart, 45-60 sec |
| Stage 1: Transition | 8-10 cm | 30 min - 2 hours | Intense, 2-3 min apart, 60-90 sec |
| Stage 2: Pushing | Fully dilated | 20 min - 3 hours | Urge to push, 2-5 min apart |
| Stage 3: Placenta | N/A | 5-30 minutes | Mild |
Pain Management Options
| Method | Effectiveness | Evidence |
|---|---|---|
| Epidural | 9/10 | Cochrane (15,752 women): NO increased cesarean risk. Gold standard for labor pain. |
| Walking Epidural | 7/10 | Low-dose combined spinal-epidural. Fewer instrumental deliveries. Preserves mobility. |
| Nitrous Oxide | 5/10 | Used in 50%+ of UK/Australian births. Takes edge off, does not eliminate pain. |
| IV Opioids | 5/10 | Fentanyl preferred. Crosses placenta — timing matters to avoid neonatal respiratory depression. |
| Hydrotherapy | 4/10 | Reduces pain scores and anxiety. Warm water relaxes muscles. |
| TENS Unit | 3/10 | Most helpful in early labor. Modest pain reduction. |
VBAC (Vaginal Birth After Cesarean)
Overall TOLAC (trial of labor after cesarean) success rate: 60-80%. With prior vaginal delivery: 87-90%. Uterine rupture risk: 0.5-0.7% with low transverse scar.