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Birthing Consciously: The 5 Phases of Each Contraction

By Wintergreen

Within the time frame of giving birth, the relationship you had with your baby will profoundly change. Previously, your body’s job was to nourish and protect your baby. As your baby announces more and more strongly its desire to be born, you will increasingly focus on the arrival of the next contraction, how long it lasts, and how sensitive each one is. Your body’s job now is to let your baby out, and your mental job is to work with your baby’s efforts to do so. 

In a real sense, your baby’s efforts to be born capture your full, undivided attention. During the early part of labor, when contraction pain is not intense, you will still be aware of everything around you but will begin to live within the 5 phases of each contraction. This is the time for you to use skills to consciously move through each phase. 

As your cervix dilates, thus increasing the pain, you will be much less attentive to the familiar sense of the environment around you, yet each moment will highlight the activity that your baby is stimulating in your body. The growth in internal sensations will bring you deeper into yourself. This is where the 5 phases become much more pronounced and your ability to use skills within each phase heightens. As one woman said, “I could have given birth on the main street square and not noticed anyone or cared.”

What is a “conscious” birth? 

At the present moment in childbirth, a “conscious birth” is mainly about making choices via a Birth Plan. When it comes down to it, we cannot know what our birth will be like, which makes it difficult to plan for. We can make plans about what we want others to do or not do, yet rarely does the birth follow the plan. 

However, making a choice-based birth plan is only one way to be conscious for birth. Another way to be conscious for birth is to become conscious of skills that you and your partner will use during your baby’s activity of being born. This means that your consciousness expands to how you will behave and act during the 5 phases of each contraction, among many other things. 

Here’s an analogy of how the word “conscious” can be used differently by people. On the subject of eating habits, someone can say she eats “consciously.” When asked to define what that is, she’ll say it means being aware of how her food was grown and choosing what ingredients are in it. But for someone else, being “conscious” is all about making certain to chew well before swallowing and how much food to eat. They both may use the same words “conscious eating” but have very different interpretations!

So, being conscious during birth from the skills-based perspective means:

  • Being aware of the 5 phases of each contraction.
  • Using and honing your skills for each phase.

When you participate in the rhythm of childbirth through the time frame of the 5 phases, you have the ability to do this activity on a moment-to-moment basis in a conscious manner so that your inner self-direction and your outer behaviors become aligned. You can thus see yourself as acting, behaving, managing, coping, and handling the birth well.

Here are some words from women reflecting on their births realizing they never had any skills: 

“Yes, I was disappointed that I had more medical care than I had wanted, but I was much more disappointed with my inability to cope with the pain.” 

“I will never forget how overwhelmed I was giving birth. I didn’t want to even look at my daughter, much less hold her. It took me months to bond with her.” 

“Everyone says you forget how painful birth is, but you don’t forget that you suffered.”

Here are some words from women who had learned skills: 

“After the birth, I was so pleased with myself. I hated the experience, but boy I am so proud of how I handled it.” 

“The difference between my second birth and first one was simple: I knew how to relax.” 

“During my first birth, I was restless, jumping up at each contraction, feeling unsettled, and moaning heaps. My midwives told me I was ‘wasting my energy,’ so I never made another peep and never moved off the bed. After the birth, everyone praised me for how well I handled the birth! I hated it. At my second birth, I used my breathing skills as my primary focus, and the sounds I made sounded to me and everyone around like I was coping, which I was. After the birth, my midwives told me how well I handled the birth! I still hated it, but I wasn’t confused about myself. Next birth? I now know how to give birth, and I’m incredibly proud of that. Will I still hate it? Don’t care. That’s not the goal.”

The 5 Phases of Every Contraction 

Every woman who labors will have contractions, and all contractions have the same 5 phases, distinctive from one another, each providing an opportunity to use skills. In reality, the 5 phases represent a macro time frame of each individual contraction, but there’s also a micro time frame—each breath cycle of an inhalation and exhalation. 

As one woman said, “I had a choice at every moment—how I inhaled and how I exhaled.” Fortunately, this woman had the Birthing Better skills so she chose to open her pelvis with each inhalation and soften inside her pelvis with each exhalation. She still rated the pain of contractions to be 13 out of 10, but she knew if she let the pain get the best of her that her inhalations and exhalations would have become stressed.

Here are the 5 phases of each contraction: 

1) Just before the contraction starts and the start—this lasts for a very few seconds. 

2) Buildup; pain becomes more intense. 

3) Peak; pain is the most intense. 

4) Easing off; pain decreases with an attempt to “let go of this one” so the rest period can be effective. 

5) Rest period between contractions. Usually, the pain is gone entirely, unless you have back labor or other localized pain. 

During early labor, when your baby is beginning to open your body, only phases 1, 4, and 5 may be obvious. If this period is gentle and not painful, thank your baby. Regardless, this is the time to begin to use your Birthing Better skills. It is during these early contractions that you can condition yourself to work with what is happening in your body and get your teamwork going. Together, your job is to begin to open, relax, and soften what is now a birthing body.

Practice leads to skillful adaptation 

Even though you can’t literally practice giving birth to a baby, use your imagination, or watch a number of birth videos, and notice how the women behave. Plan how you can improve on that behavior with the use of your skills. If you’ve already gone through labor, you can practice to the memories of your last birth. 

Whether your birth lasts for 3 days or 3 hours, whether you are lying in bed hooked up to every machine available or walking outdoors, contractions will always follow the same rhythm—one contraction following another, with a rest space in between. Each contraction will have 5 phases, and each phase will have a number of inhalations and exhalations. So, you have ample opportunity to use your breathing skills. 

In every contraction, your body is also in a position you may have practiced. This means you can also use some positioning and relaxation skills. If you and your partner will be together, you can always use communication (verbal and non-verbal) and touch to achieve deeper relaxation. 

Any variations of the birth (of which there can be many) will all stay within the same theme of contractions and their phases. The reason you must take time to learn skills is so you can better adapt them to your particular set of variations.

Breathing exercises and the 5 phases 

You will now learn how to build breathing skills into the 5 phases of a contraction. Each inhalation and exhalation is one breath cycle. While you practice, you will keep in mind the 5 distinct phases until they become second nature. The below exercises build one on another. It’s important that both of you experience every exercise and, when applicable, take turns being the “doer” and “receiver.” (This article only shows one exercise. Visit BirthingBetter.org for more.) 

Once both of you feel in your own body what happens as you use your breath in these different ways, you are more likely to feel reassured the other person understands you. This opens up communication and enhances your separate, yet equally important roles as the birthing woman and man.

Exercise: breath awareness using “slack-jaw” exhalation 

Phase 1 (beginning): Breathe in gently through your nose, then gently exhale through your nose. Remember to relax any tense places in your body on your exhalation. Repeat this 2x. This is the time when you set up your breathing pattern for this contraction. 

Phase 2 (pain increase): Breathe more deeply in through your nose, then exhale through your mouth with a slack jaw. Remember to relax your body more fully with each exhalation. Repeat 4x. This will take you up to the peak. 

Phase 3 (peak): Inhale as deeply as you can through your nose, then exhale through your mouth with a slack jaw, as fully as you can, relaxing even more deeply. Do this 2x. This will take you over the peak of the contraction. 

Phase 4 (pain decrease): As the contraction starts to go away, repeat phase 2 instructions, doing that breathing 4x. This time you are intentionally calming yourself at each breath cycle. Then take 3 Cleansing Breaths to reduce all your tension. (See below.) 

Phase 5 (rest): Go back to breathing in and out of your nose during this space before the next contraction. Scan inside your body, and let go of any remaining tension. 

Takeaway: 

1) As each contraction builds through phase 1, 2, and 3, make each breath cycle deeper while you breathe in your nose, and fully exhale your breath, as your exhalations move from your nose to your mouth. Then, after the peak passes and you’re moving through phase 4, make your breath gradually becomes less intense, eventually coming back to just nose breathing for phase 5. 

2) When you work with the 5 phases of each contraction, labor becomes like a dance, flowing through a series of “steps” that repeat themselves, with possible variations.

3) Pay attention to how you feel when you use a slack jaw to exhale. 

The Cleansing Breath 

If you store the energy from the contraction that has just passed, you will anticipate the next contraction with fear, and you won’t be able to manage it as well. There is no doubt that the Cleansing Breath is absolutely vital in discharging the excess energy that builds up inside women during intense contractions. Practice this and use it. Work on it together. Take turns in each role so you both know what it feels like. 

1) Breathing together with eye contact, or with the woman focused on an object, mental image, or with her eyes closed, the coach models a deep in-breath (in through the nose) and a very relaxing out-breath (out through the mouth, with a slack jaw). Both the in-breath and out-breath are very exaggerated, which is what makes it so cleansing: The in-breath brings in fresh energy and the out-breath lets go of stored energy. 

2) Repeat the inhale and exhale two more times. Relax more fully each time. 

Labor will happen one contraction at a time. After each contraction, you need to let it go completely with your Cleansing Breath. Don’t think about the next one—just apply relaxation skills to your rest period. Cope with the present.

The 5 Phases of Every Contraction

Phase 1 

When a contraction starts, even with breathing skills, you might still find yourself saying to yourself or others, “Oh, no, here it comes again!” Each phase has its own importance. The importance of phase 1 is simple: CHOOSE to use your breathing skills. This gets you off on good footing immediately, rather than feeling out of control. As you recognize that the contractions are feeling more painful, adapt your breathing skills by increasing your focus and commitment to each inhalation and exhalation. Some women have called Phase 1 the most important phase. 

“This was the most important phase for me. If I could go into each contraction with a set of skills to be used, then I could cope. There were a few times that I wasn’t able to do that, and right after I was checked by the staff or when labor got more intense. Both these times disoriented me for a few contractions, but I knew I had to set up my skills again right at the beginning. Yes, when I couldn’t do that, I did feel out of control, but I refused to believe I couldn’t get it back.” 

Phase 1 takeaway: 

1) Have a breathing plan. 

2) Keep your breathing as relaxed as possible. Focus your mind on ONE contraction at a time. 

3) If this contraction is more intense than the last one, recognize that this means your labor is progressing—yippee!

Phase 2 

As the contraction builds, permit yourself to use a deeper inhalation and make intentionally relaxing exhalations. This phase requires a great deal of willpower and determination, and it’s where fear of the pain takes hold. It’s very tempting to just succumb to the stress. However, it compels a deeper involvement: 

“My breathing changed during this phase along with my internal dialogue. As the contraction went up, each inhale got deeper, and each exhale had to give me deeper relaxation. My mind actually directed me.” 

Phase 2 takeaway: 

1) Remember to have your partner breathe with you if that helps. 

2) Use counting in and out as a mental focus. 

3) Close your eyes or focus on a specific object or your partner’s eyes as another focus. 

4) Don’t be afraid. This phase is just the really hard work of giving birth.

Phase 3 

Here, the contraction peaks. This is the hardest part of each contraction but it’s also the shortest. This phase requires you to dig the deepest into your willpower. It is when you are least likely to want any type of distraction. Though some women can tell themselves otherwise: 

“Everyone told me that the peak of the contractions were the worst, but that’s not what happened to me. Whenever I felt the pain was too intense, my inner voice told me ‘The worst is over.’ As soon as I heard that, the pain decreased enough for me to really focus on my breathing. That was so neat.” 

Phase 3 is also when you are most likely to say things like, “I can’t,” “It’s too hard,” “Give me something.” Remember, how you behave will guide other people in how they respond. If you begin to act stressed or say “I can’t do this; it hurts!” you will stimulate your birth provider to encourage you to use pain relief, which you might not really want. 

Phase 3 takeaway: 

1) It’s fine to say anything you want, just remember to keep using skills to cope. 

2) This phase is very short, so even if you lose it, be committed to getting back into the flow during Phase 4.

Phase 4 

“I looked forward to recognizing that the peak was over. I immediately started to relax my breathing. The Cleansing Breathing was essential. I loved doing it with my husband—in fact, everyone in the room. Somehow, having others join me helped me discharge the energy faster.”

Here, the contraction eases off. If you lost it a bit at the peak, now is the time to work to get your breathing and relaxation back. You’ll notice that, as the pain decreases, your deeper breathing is less necessary. Now you can use each inhalation to breathe in beautiful, good energy, expanding and relaxing inside your pelvic zone. Use each exhalation to more deeply relax and prepare yourself for the time between contractions when you absolutely MUST rest and restore yourself. At the end of this period, remember to take three deep and satisfying Cleansing Breaths. As one woman exclaimed: 

“I looked forward to recognizing that the peak was over. I immediately started to relax my breathing. The Cleansing Breathing was essential. I loved doing it with my husband—in fact, everyone in the room. Somehow, having others join me helped me discharge the energy faster.” 

Phase 4 takeaway: 

1) This phase means this contraction is almost over. 

2) While phase 1 is the beginning of your working period, Phase 4 begins your resting period. You still might have to work to relax. 

3) Think about the present. Don’t think about the future.

Phase 5 

This is the rest period after a contraction. After your three Cleansing Breaths, do your best to switch as quickly as possible to a relaxed inhalation and exhalation. What you do during this rest period is vital to how you will continue to work with your baby’s efforts. Now is the time to soften and relax inside your pelvis, letting go of any energy that has built up in your body or mind during this last contraction. Here are some women reflecting on their work through Phase 5: 

“Blessed relief. Another contraction finished, and now a rest. For several hours earlier, I could just slow down and rest, but for the last few hours, I actually slept and snored. I never snore.” 

“The back labor didn’t go away. That was hard, and I got restless. This made me tired because I couldn’t seem to ever relax.” 

“Thank goodness for our Birthing Better skills. I had terrible back labor but knew how to open my sacrum, so I continued to use my inhalation to open my pelvis during the space in between. This kept me focused, gave me something to do, and gave me a sense that I could continue to work with my body and baby even though the pain didn’t go away.” 

Phase 5 takeaway: 

1) Let go of this contraction, it’s finished. 

2) Being able to do this is one of the hidden resources that very skilled birthing women use. They intentionally do this so that, when the next contraction comes, they are ready to start their conscious, skillful work. 

3) Take the next contraction as “This one,” rather than “Oh no, not another one!” This is mental trickery for sure, but it works time and again.

Important Tips for Dads 

Once you understand how you can use your wonderful observation and listening skills, you’ll really know how helpful you can be to your partner and your baby. Basically, your job as a husband or partner is to keep labor as progressive as possible. But don’t do it with a whip-in-hand approach—instead, help your partner work with the 5 phases.

“Can’t praise my husband enough. We followed the Birthing Better resource suggestions to see each phase of each contraction as unique as we used our skills. Knowing he was observing and hearing how I responded helped me to hear and see myself. He was so aware and maintained that for hours, when he could have just as easily left me. Yes, he did go to the toilet and eat, but we worked out how to do that so I didn’t feel on my own. Thanks to the Birthing Better skills, he knew my body well and basically worked with both me and our baby to have just an incredible birth experience.” 

Once you understand how you can use your wonderful observation and listening skills, you’ll really know how helpful you can be to your partner and your baby. Basically, your job as a husband or partner is to keep labor as progressive as possible. But don’t do it with a whip-in-hand approach—instead, help your partner work with the 5 phases. Your partner will basically do one of two things during labor. Either she will: 

“I had a moment when I thought, ‘This isn’t normal.’ But my skills kicked in, and my wife showed me how to help her and was very, very clear when what I was doing wasn’t the right thing at the right time. This is what I want to say to all other men: ‘Learn the skills! Help and don’t be surprised by anything.’”

1) Feel she can self-manage pretty much on her own, with you helping her as she requests, or 

2) Feel she needs your help more or less constantly. This can vary from one contraction to another, depending on how the pain changes as her cervix opens. It’s important not to be surprised, as one father relates: 

“In early labor, my wife was her normal, gorgeous self. We walked, had a bath together, cuddled through the night, and just felt so excited that we would soon meet our son. Ten hours into her labor, the pain definitely increased. She coped pretty well using her skills. About four hours later, she was a different person, and the changes became more dramatic over the next few hours. I had a moment when I thought, ‘This isn’t normal.’ But my skills kicked in, and my wife showed me how to help her and was very, very clear when what I was doing wasn’t the right thing at the right time. This is what I want to say to all other men: ‘Learn the skills! Help and don’t be surprised by anything.’”

Two important points to remember when working through the 5 phases with breathing skills:

  • It is unrealistic to believe that a woman can let go of all tension during each contraction, especially when they are very painful. 
  • It is also unrealistic to believe that a woman can always use focused, relaxed breathing at every second of the contraction’s wave unless she is very, very skilled. 

How to Help in Each Phase 

Micro-Manage 

Once you understand the 5 phases of a contraction, you will have five different places to work with successful breathing. You get to help your partner find all the moments within the rhythm of the 5 phases for her to feel in control. 

Most dads are only familiar with the idea that “one contraction follows another.” This means that, if a woman feels out of control during a contraction, he doesn’t know how to help her. So one out-of-control contraction follows another. 

Instead of feeling that you can’t help in any way at any time, you have to figure out when to help, and then how to help in each of the phases. Just like driving a car, there are no linear actions that repeat again and again. Every moment of driving requires moment-to-moment creative decisions about which skills to use and how to use each skill. Men can excel at this! 

Her micro-management is exactly what keeps a woman feeling on top of the pain. Sure, she’s going to get through every contraction whether she micro-manages or not, because the process of labor cannot be stopped. But women feel better when they are doing something for themselves at each moment, and they feel even better when you help them do just that. 

Remember that a woman can’t often “tell” you how to help her. You have to observe and listen. Her actions, behaviors, and sounds will tell you how she is coping. Women desperately want to cope with labor pain. Also keep in mind that you don’t have to be perfect or do something at every single moment. Just understand that every single moment can have a skill applied. 

The Bell-Shaped Curve 

Now that you’ve learned about the 5 phases, it’s necessary to add another dimension: The shape of an effective contraction. 

Through the 5 phases, contractions define a shape that can be drawn on a graph as they start, get more intense, reach a peak, subside, and end. This is called the Bell-Shaped Curve, and it is how you read whether each contraction is “efficacious.” 

What does that mean? A bell-shaped contraction is the message your baby gives you that there is nothing inside your birthing body that stops your baby’s ability to open its home and come down, through, and out. Although a bell shape implies that the rising and falling sides of the curve are even, that is not always true. Some contractions seem to come on very strong and subside very slowly. Others come on slowly, have a strong peak, and leave quickly. There are even some births when the contractions rise to a peak fast and the space between is very short. These will seem more like a very pointy bell-shaped curve. This type of birth is very progressive. Usually, this is indicative of a labor that will be relatively short. But it will still take time, from 3-6 hours (compared to the average 6-12 hours, or a longish labor of 12-24 hours). 

Flat Contractions 

The real importance of the bell shape is in comparing it to a contraction that doesn’t quite seem to peak, but rather plateaus. When contractions are effective (contain a bell-shaped curve) then labor is progressive (changing every hour or so) until the birth. When contractions do not maintain the bell curve, the labor is often not progressing and lingers. When contractions are not efficacious, the birth process becomes tedious, boring, upsetting, annoying, and frustrating. This is the single, most common reason why women stop using their ability to act, manage, cope, handle, or deal with the birthing process and end up with increased medical interventions. 

The ability to notice whether contractions maintain their nice curve up, over, and down resides best in the birth coach or the father-to-be. 

As the birth coach, fathers are most likely to notice the difference between the two kinds of contractions by listening to the sounds their partner is making. An effective contraction will rise up and peak and then go away, whereas a flat contraction goes up and seems to just level off and then dissipate. It’s sort of like an “almost-sneeze.” 

Your Birthing Better skills will rise to the challenge of problem-solving. This does not mean there is necessarily a problem with well-being; it just means that the efforts of your baby are somehow hindered. Contractions that roughly follow the bell-shaped curve mean the baby is happy with its ability to do its job. Flat contractions simply indicate a need for change. 

You want to remember birth is basically an object that has to come out of a container—a lot like plumbing. You have to figure out how to keep the container—the laboring body—open, even when experiencing the normal pain of giving birth. 

Women don’t always like efficacious contractions. When labor is really progressing, they might find it very hard to accept the intensity and efficaciousness of the contractions. They might want to get into any position that will ease the contractions off. Sometimes, this is leaning forward or getting on hands and knees. Rest assured, this is NOT uncommon. Labor is intense, and sometimes a woman just wants to take a break. Some women express it quite clearly: “I’ll go off for lunch now. You take over and I’ll be back in an hour or so.” It’s not that she shouldn’t take a break. If she absolutely NEEDS to rest, do that, for anywhere from 15 minutes (3-5 contractions) to even 45 minutes, but keep talking together about how to help get her energy gathered again so she can get back into a position that keeps the labor progressive. 

Always keep a balance between resting and getting labor over with! As an alternative to flattening the contractions, perhaps all she needs is:

  • Some water to drink
  • Some sweet candy 
  • A bit of sleep 
  • A massage or shower 
  • To be left alone to figure out what she wants to do 
  • A hug 
  • The staff to check her 
  • For you to check her dilation or for herself to reach in and touch the baby’s head 

More than anything, she will want your encouragement and confidence that you’ll do everything in your power to help her cope with every moment of these very intense, progressive contractions. Resting and little distractions are not wrong or bad. They’re a way to conserve energy. Just recognize the need and then be willing to re-engage in the work. 

Most likely, if there is a point of REALLY wanting rest, this means she is close to giving birth. Neither of you want her to stay in labor longer than necessary, so, even if she is really tired, she needs to get back into positions that the baby likes. This is where the husband’s (or partner’s) behavior is most critical. Perform, operate, work, manage, take action, proceed, manage, handle, deal with it, hack it, get by, and muddle through. In other words, help your partner! This means to assist, aid, lend a hand, help out, facilitate, rally around, and be of assistance, rather than just be “there for her.” This is the difference between being a coach and a support. 

If the husband or partner is working together well, she will recognize that he is helping her and will see the reality of needing to get on with giving birth. Then she will overcome her resistance, gather her courage, and be willing to engage again in the progressive nature of the baby’s birth. 

Conclusion 

After the birth, in the privacy of your own home, this will be an extraordinarily special experience each of you will talk about again and again. She will want to know what you (the birth coach) saw or heard that helped you know when labor had stopped progressing. And you (the birth coach) will want to know what she was feeling and thinking about that caused her to lose confidence momentarily. And, together, you will relive how you worked together to bring your baby into the world in a way you are both proud of, which becomes the basis of a family dynamic that is both powerful and strong moving into the parenting stage.