Established Labour

In Established Labour, the cervix opens up from 4-6 centimetres to 7-8 centimetres. Contractions become longer in length (50 seconds +), more intense and closer together. This is caused by an increase in the woman's oxytocin release, usually triggered by the baby's head stretching the cervix more evenly. These stronger contractions dilate the cervix more rapidly, which is why this is sometimes called the accelerated phase.

As the body's work intensifies, the woman's endorphin levels rise. Her awareness changes and she becomes internally focused as if in a trance-like state. This changed state of awareness is a helpful mechanism which enables the woman to manage her labour. However, it is highly dependent upon having a low-sensory, undisturbed environment.

The process

The cervix opens up from 4-6 centimetres to 7-8 centimetres in Established Labour. The work done by the woman in Early Labour has brought the baby into a position where the head is now triggering significant oxytocin release as it stretches the cervix. The contractions become much longer (50 seconds +), stronger and closer together (2 – 5 minutes apart) and so the cervix begins to dilate more rapidly.

The rising intensity of the work triggers further endorphin release and the hormones optimize, creating a shift in the woman’s state of consciousness. Her mind becomes quiet and she withdraws inside herself to focus upon the work. Women in established labour are invariably non-verbal and rhythmical in their movements.

The baby’s head moves lower into the pelvis and its face starts to rotate towards the mother’s back.

Women tend to dilate 0.5cm - 1cm/hour during this stage of labour, if this is a first baby, and 1cm/hour if it is a subsequent labour.

What you could do to help yourself

Although the work of your labour is more intense now, it is much simpler. Your body takes over once you reach Established Labour. The combined effect of oxytocin and endorphin will make you feel calmer and less concerned about what is happening around you. You will be able to respond instinctively to your labour and what your body needs to get the job done. Women typically become non-verbal, they move rhythmically and naturally gravitate to quiet, dark places. A particular kind of birth space supports this stage of labour, one in which you are feel undisturbed, warm and safe. If you have created a place like this in your home, you will probably find yourself heading there.

You might find significant comfort from warm water during this part of your labour. The shower or a deep bath can help you relax further into this quiet state and enables your labour to progress faster.

Your appetite will probably disappear from this point on, due to the high endorphin level in your body, but it is still important to drink with your thirst.

What partners can do to help

Not only does your partner need to feel undisturbed, warm and safe during established labour, the same as any other labouring mammal, she will also become sensitive to any kind of sensory distraction, including light, the use language and sometimes even touch. This is because her body is trying to quieten her mind so that she doesn’t have to think about how easy or hard the labour is. Her body achieves this by releasing powerful neuro-chemicals into her brain, these chemicals or hormones take her into 'the zone'. You can read more about this here.

You are going to see her behave in ways you have never seen her behave before. She will withdraw into herself, closing her eyes and becoming non-verbal. She might sway rhythmically and moan. If you start to see these behaviours, this is a very good sign that she is adapting well to the demands of the labour. Your partner is becoming intensely instinctive, it can actually look very sensual. You might find it exciting or you might become nervous and feel out of your depth.

Try to trust it and allow her to remain in 'the zone' as undisturbed as she needs to be. Resist talking to her if you can.

Continue to time the contractions. When contractions have been 60 seconds long for at least 2 hours OR are lasting for 60 seconds and coming every 3 minutes, call your midwife, doctor or hospital and tell them that labour is established and either you are coming in (hospital and Birth Centre) or you need them to come to you (planned home birth).

If you are planning to have your baby in hospital, your partner will find the car journey challenging because her body will release adrenaline which will bring her out of 'the zone'. Until you can create that undisturbed, safe, warm space again, she is going to need distraction techniques.

Once you are in hospital and Birth Centre there will be new people to meet and co-ordinate with. These additional personnel may keep your partner out of 'the zone' by providing her with instructions, turning on lights etc. Using a shower or deep bath will help her relax and find her way back to her instinctive responses. If your partner is frequently disturbed during her labour, she may continue to need considerable support, including:

• breathing along with her during contractions to help her lengthen her out breath, counting can sometime help with this;

• offering her affirmations and or something visual to focusing upon;

• any learnt relaxation techniques you have been practicing together;

• a TENS machine;

• heat packs on the lower back and under her belly;

• firm pressure on her lower back during contractions and massage in between contractions to get her good and relaxed;

• access to the shower and then after 5 centimetres, a deep warm bath.