The most common question I’m asked when I’m with a woman in active labor is, “How much LONGER is it going to be?” This question is usually asked when the mom feels exhausted and is doubting her ability to handle one more contraction. She is hoping for reassurance that she will soon be pushing her little one out into the world.
While the dynamic of labor patterns can fluctuate during birth, there are some strong indicators that give us a good idea of how quickly labor is progressing and how soon the cervix will be fully dilated and the mom will be ready to push. Recognizing these signs is very helpful, whether you are supporting a mom in labor or whether you are preparing for your own labor and birth.
Most of the time, when a woman is in transition labor, she doesn’t want to be bothered with trying to decipher all the changes taking place, so it helps to have an observant person spot these indicators and encourage the mom as needed.
Contraction pattern + mom’s emotional signs
Bulge of muscles in low back/sacrum area
Rising of belly towards the bra line/breast area
These signs aren’t guaranteed, but they are remarkably accurate most of the time.
Contraction pattern + mom’s emotional signs
So, when the contractions are coming 2-3 minutes apart and are lasting 70-90 seconds and they feel stronger and more intense than at any previous point in labor, that is a very good indicator that the mom is getting very close to the pushing stage. To define this even more, look at the body language of the woman in labor and listen to her emotional expressions carefully. If she seems to be tuning out the rest of the room and is directing her focus inward, perhaps rocking and moaning, with eyes closed or with a distant look in her eyes, that is a good indicator of what I like to call “deep labor.” She will usually have difficulty answering questions at this point and may fall asleep in the short breaks between contractions. Then…very often, the woman in labor will begin to express doubt in her ability to give birth. She may answer every question, “I don’t know,” and may seem confused or express panic or desperation. While these emotions seem negative, they are actually a very good sign that the woman in labor is very close to the pushing stage.
back to top
After you notice an increase in the frequency, intensity and duration of contractions (with an increase in the intensity of the woman’s emotions), you may then notice a change. The mom’s discomfort level may decrease and she may report feelings of intense pressure in her bottom area. You might hear a slight “catch” in her breathing or moaning, almost like a grunting sound. Sometimes, the contractions space out some (maybe only occur every 5 minutes instead of every 2 minutes). Those changes are a good indicator that the cervix may be completely dilated and she will soon be pushing.
back to top
Bulge in muscles of low back/sacrum area
Something I have often noticed and husbands frequently point out is a bulging of the muscles in the very low back or sacrum area of the birthing woman. It can sometimes look like two half-tennis balls (maybe slightly deflated) under the skin in that area. If you put your hand on those contracting muscles there, they will feel very hard. Please use warm, moist heat and counterpressure to relieve discomfort in those contracted muscles. If the woman is having a burning sensation or a difficult painful sensation there, use an ice pack instead. The bulging muscles are possibly a result of the outward expansion of the pelvis (the wings of the ilium) as the baby descends. This may be seen not long before the mom starts pushing.
back to top
Rising of belly toward the bra line/breast area
I honestly can’t remember where I first read about this little sign, but I was immediately intrigued because the physiology of why that occurs made complete sense to me. (I explain this thoroughly in my birth prep series, but for those interested, here’s a short explanation: As the uterus contracts and pulls the cervix open, it also pulls the cervical tissue into the body of the uterus. The extra tissue collects at the top (fundus) of the uterus, making the muscle thicker there. This process is brilliant because the uterus then has a thicker band of muscle at the top to use as a piston while pushing the baby out. I decided to test this indicator as a sign of dilation with one of my moms and it worked! Without saying a word, I estimated how much space there was between the bra line and the fundus of the uterus, and when the care provider did a cervical check, my estimation was exactly right! It’s a sort of fun (at least it was for me), non-invasive way of estimating dilation and how soon the mom will be pushing. Some say the mom has to be on her back for this method of estimating dilation to be accurate, but I’ve observed it’s accuracy on a mom who was sitting in a birth pool, too. (To be most accurate, look at the fundal height during the peak of a contraction.) It is reportedly more accurate in women who have previously had a baby. (I’ve found that to be true, so far.)
back to top
Some studies indicate that this method of estimating dilation is more accurate than vaginal exams. If you’d like to see an actual image of the purple line, this article in Birth Without Fear has some good illustrations, and this article in Science and Sensibility has a good image showing how to measure the line.
back to top
Since many factors can influence the progress of labor, these indicators are not a guarantee that the pushing stage will soon begin, but they are remarkably accurate. If you see a few of these signs together, you can feel fairly confident that the dilating phase will soon be over.
