klok In your last weeks of pregnancy you have had instructions when to call and when to come in. When you come in the birth center or hospital you will be checked to see if you are in labor.

When the diagnosis ‘labor has started’ is confirmed, the clock starts ticking. If your labor is well managed you can be sure to hold your baby in your arms within 12 hours.

When labor has started  your birth plan comes  into effect.  Your caregiver will monitor your labor and keep a partogram. This is a graph in which the course of the labor is plotted in time. That can be done on paper, or in the partogramapp. Especially with first baby’s, by and large, the most common complication is: ineffective contractions. You have regular painful contractions but no progress to show for it. The muscle fibers in the uterus are not working together well.

If your labor progresses well then your contractions are effective contractions and there will be no need for interventions. You and your partner are laboring together and the midwife and doula and/or L&D nurse are there to Support you. The midwife will regularly listen to the  baby’s heartbeat  to check that he or she is still OK. Insufficient progress happens somehow less when women have good support. A known and trusted midwife or doula can make a difference.

The progress of labor is monitored with a vaginal exam. Some women are uncomfortable with a vaginal exam. Try to discuss this during pregnancy.

Women who are diagnosed as being in labor with less than 3 cm dilatation are the most at risk for insufficient progress. Some midwives and obstetricians therefor will avoid the diagnosis: ‘labor has started’. They will tell you that you are in the latent phase of labor with less than 3 cm. Latent phase doesn’t  exist! Labor has started or not. Compare it to: you’re a little bit pregnant, or this cloth is semi-sterile.

It is important to discuss this in advance : do you believe in latent phase? Because, according to the believers, latent phase can last for as long as 8 hours. That means: 8 hours of hard work, coping with painful contractions without progress. That is an incredibly demoralizing experience for most women and not to mention their partners who can feel quite helpless seeing their loved one suffer.

As you can see on the picture of the partogram there is a diagonal line in it. In a well-supported and well-monitored birth  the line of the dilatation runs parallel to the diagonal or bends to the left. The diagonal is the line that demarcates the limit of normality. When the line of your dilatation crosses the diagonal you are at risk  for a protracted, painful birth.