Practically synonymous in our culture with "pain", a contraction can be a scary concept for the first time pregnant mom. Understandably so, when we remember that -unlike getting your appendix removed, for example - each woman's labor is different. It looks different and feels different so a pregnant woman can't rely on another woman's experiences as a guide to what her own will look like. That's scary! But, let's keep in mind an unalterable fact: your body is designed to give birth. Amazing, right? So while you can't control what your labor will look like or how similar it will be to your sister's, education and support go a long way to diminishing fear and building confidence. So let's start there-

Contractions are often a sign that labor has begun. [But they aren't always! Click here for a terrific article by Lamaze childbirth educator Robin Weiss on five things that can cause contractions.] So, what exactly is happening during a contraction?

A contraction is the word for the uterus pulling back on the cervix to open the birth canal (the passageway that will deliver your baby from the uterus through the cervix, vagina and vulva). The uterus is the largest and strongest muscle in a woman's body. A contraction is the tightening and release of the uterus. Prostaglandin is the hormone that helps facilitate this process by starting the softening of the cervix in the final weeks of pregnancy. The hormone oxytocin is what is makes your uterus contract.

Over the course of your labor, your cervix will expand (talked about as "dilation") and soften (talked about as "effacement"). In early labor then, as you might guess, a contraction might not feel like very much. You might suddenly not feel like yourself, or maybe feel crampy* or like you're coming down with a bug. There will be pressure but not usually pain per se in early labor.

In early labor, I remember feeling like I had bad menstrual cramps but I had felt that way before so I just ignored the feeling, imagining that it would go away. The feelings weren't painful, just uncomfortable and it wasn't anything that I couldn't talk through. These feelings were irregular. They were contractions although I did not realize that at the time!

As your body releases more and more oxytocin the contractions get stronger and stronger. When this is happening, you are moving from early labor (when your cervix is dilated anywhere from 0 to 6 cm) to active labor (from 6 cm onto 8 cm).

A contraction in active labor is something that you can't miss. No longer will you feel like taking a bath or finishing the baby's room; things are now serious, you'll realize. You might feel irritable, apprehensive or suddenly concerned. Contractions in active labor get longer and stronger and are closer together. They are like waves, steady and unwavering no matter what you do or what position you are in. This is around the point where you might call your doctor, doula or midwife. [Note: definitely call one of these folks before you head to the hospital. Heading to the hospital can stall labor because essentially you are heading from the safety and comfort of your own home to the relative unfamiliarity of the hospital. That can feel unsafe and your body need to feel safe for you to have your baby. I'll talk about this more in a future post.

Ideally when you are at the hospital, you're in active labor. Contractions continue and soon your cervix is dilated to 8 cm. When that happens, you are "in transition". Your labor is literally readying to transition from contractions that open the cervix to contractions that will push your baby out. This is a brief phase.

Helping with the pain of those contractions at this point are hormones called endorphins. Endorphins are a naturally occurring opiate, a feel-good drug basically. Endorphins recognize that your body is going through a tremendous amount and they work in two important ways related to labor:

...acting as painkillers, helping to decrease your perception of the pain;
...helping you turn inward, concentrate better and find a rhythm that works.

Remember that a contraction is a tightening and a release. Things don't stay "tight"! This means that the pain is intermittent, not continuous. And when you break down a contraction, into pieces (isn't it always easier to tackle something bit by bit?) it actually looks like a wave: there is the build-up where you can feel it coming, the cresting when the pain is at its peak and the downslide where the pain is ebbing away. You will be in "build-up" and the "downslide" more longer and more often than you will be in the cresting phase. That's good news! If it helps to look at the wave mathematically, you will likely be in the crest for 20-30 seconds every 5 minutes (assuming your contractions are about 5 minutes apart and last about 1 minute). In my childbirth class we talk about how to maximize those rest periods because labor is a long haul.

From here, we head into pushing but there's not much new to share about contractions during that point so I'm going to save that conversation for a future post. Something to keep in mind: all of the above will happen but how quickly and efficiently things progress depends a great deal on letting labor begin on its own, being able to move/walk/change position and having minimal or no interventions. An epidural, for example, can complicate how your labor progresses, among other things.

Questions, thoughts? Leave me a comment below!

Pregnant and need a childbirth ed class? Click here for details on my Fall class for couples and click here for my Fall virtual session for survivors.

Thanks, as always for reading.