The Stages of Labor Third Edition: A Visual Guide has been a perennial favorite of childbirth educators for many, many years. In fact, I clearly remember watching the Injoy precursor to this video in my own childbirth classes with my first daughter and she is almost 17 years old now. The Stages of Labor video, first released in 1999, has always offered great animated visuals of what the mother's body and her baby are doing during each phase and stage of labor. I have been showing the second edition of this film to childbirth class families and doula trainees since it came out in 2006. Sidenote: I was probably not the only one happy to say good bye to funny first edition phrases like 'Roger, Roger, it doesn't look like a baby!' and 'We were interested in seeing what was coming down the pike.'

I was excited to be able to review the changes in this new third edition to see what had been updated and the information it contained. My colleague, Penny Simkin, mentioned that she was delighted with some new material included on third and fourth stage information and I was very curious to see the updates.

Included with the 34 minute DVD is a downloadable Facilitator's guide (that includes handouts appropriate for families) and a collection of digital posters.

The DVD

As in previous editions, the DVD is divided up into sections that cover anatomy of pregnancy, pre-labor signs, onset of labor, as well as sections on the four (yes four!) stages of labor and birth.

At the beginning of the film, we meet four families who are ethnically diverse and include a partner-less mother who is supported by her family. One partner does not speak English, and his comments are translated into English sub-titles. For the most part, the families look contemporary and current, one partner even has ear plugs/tunnels (some hip earring term that I am not sure of the name of!) in his ears and a hipster haircut! The families share how excited they are to meet their babies.

The anatomy for pregnancy section quickly covers the organs and parts most likely to be discussed in childbirth classes. I wish that the animated visuals included women with heads attached. I find it disconcerting when images used in childbirth classes belong to faceless women.

Pre-labor

Pre-labor is covered thoroughly and in a very positive way. We are told that these contractions are warm up contractions, or pre-labor contractions and while a woman may not be in labor, they are normal and are helping to prepare her body and her baby for labor and may last for several weeks. Women are told what to look out for in the case of preterm labor and advised, as they should be, to contact their health care provider if Braxton-Hicks contractions are frequent, or other warning signs appear. I like that the film doesn't specify doctor or midwife, but uses the term health care provider.

Onset of labor

Onset of labor is covered, from both the emotional and physical side, and families learn that normally it is the baby that starts labor when it is ready to breathe. 37 to 42 weeks is perfectly normal for most families, we are told. One of the things that Injoy always does well in their Stages of Labor films, as they cover many topics, is they let people know that there is always a wide range of normal, no one feels excluded and each woman's experience might be different. I believe that families will be very reassured by this and the educator can reinforce this point.

First stage of labor

The film moves into the first stage of labor, which is divided into early, active and transition. I love that Injoy has acknowledged the recent change to identify active labor as beginning at 6 centimeters and states that in early labor the cervix effaces and dilates to 4-5 centimeters. I also loved that viewers are told that early labor can take many hours or even a day or longer! Families are told what to look for when their water breaks, and this edition goes into more detail about the acronym 'COAT' so families know what they are looking for, for example; 'color may be either clear or brown.' Families are reassured that fluid may continue to leak after breaking.

More than once in the film, we see the families using a smart phone to time contractions, as I believe happens very frequently with today's families.

Easy to follow graphics showing the length, frequency and intensity of contractions in each phase are included, and a family will easily be able to understand how to time contractions.

Women are shown in early labor resting, eating, drinking, walking, showering and being supported by partners and family at home. One mother appears to be admitted to a hospital already in early labor but she looks relaxed and upbeat, and is seen walking and changing positions frequently.

It is suggested that women move to the hospital or birth center when they appear to be in active labor, and the women share how they knew that their labor was changing into active labor. One family appears to arrive at what looks like a birth center when they hit active labor, where they stay through transition, with a large log bed, in what looks like a cozy bedroom, but later we see her deliver in a standard hospital bed/room in a hospital gown, so I became a bit confused as to how she got there. Another mother arrives at the hospital in active labor and has a cervical exam and is determined to be 4 centimeters dilated, which earlier had been stated to be early labor. The 4-1-1 or 5-1-1 rule is used as a suggested guide on when to go to the birth location.

Women are seen changing positions frequently, receiving lots of verbal and physical support from partners and families and are using the tub, laboring on their hands and knees and using a birth ball. All the things we want to encourage for our families.

Transition pulls no punches and it is clear that this is an intense and often difficult phase of labor. I liked the scene of the single mother's support person holding a large basin nearby for her in case she vomits. Those tiny emesis basins are useless and this woman has the right tool for the job! The level of support is stepped up for all the mothers, to help them through this challenging part of labor.

I really liked how the animated sections during the first stage frequently showed the baby's head and body moving back and forth as if trying to find their way. I like to tell my families that babies are not passive passengers, but rather active participants in the birth process, and this animated movement supports my statement that baby is trying to find the best way out too! I must confess that I found the little scattered pieces of hair drawn on the baby's head to be rather distracting to me, and wished for a full head of hair or a bald little baby!

Second stage - pushing and birth

While there are some parts of this section that I really liked, I think the second stage section was the segment that I was most disappointed in. Second stage seems a little bit 'cleaner' in this third edition of Stages of Labor. The animation and drawings of crowning show a sterile looking perineum (the drawing has no pubic hair) and we cannot see an anus in the drawing, which makes it look a bit unnatural and out of context. Overall, the entire film is very modest, the women are clothed and any shots of cervical exams or babies being born are very tastefully staged for privacy.

The possible length of the pushing phase is accurate though no woman in class will be happy to hear that she might push for 3 plus hours, women should recognize that it is indeed a possibility. All the women are shown pushing on their backs, with the support people holding the mother's legs for her (do they have epidurals?) and there are just a very few brief shots of a woman using a squat bar, as she discusses how pushing on your back closes the pelvic outlet. Unfortunately, this theme is not carried over to most of the second stage segment. Even the animated graphics have baby being born while mother is on her back. Each baby is seen being delivered to a woman who is flat on her back. It would have been lovely to have even one baby born to an upright mother.

I missed the use of the mirror or touching the head of the baby as the mother is birthing as is seen in the second edition. I believe those are good tools for women to use during pushing. We also don't see the mother pushing on her hands and knees or even side-lying, as in previous films.

None of the babies are suctioned and all are passed up to the mother's gowned chest immediately. Most of the women have their family close by, but one poor father gets all teared up, but seems far away from his partner and their baby. Even during the delivery of the placenta, he was still standing alone, I wanted to gently lead him to the head of the bed to be reunited with them.

Third stage - delivery of the placenta

This part of the process was presented very briefly but adequately. The babies are all seen skin to skin with mom, and viewers are told that this helps calm baby and helps her to adapt to life on the outside. We are told that the cord is cut a few minutes after birth, but no mention is made of the benefits to the baby of delaying the clamping or cutting of the umbilical cord.

Fourth stage - recovery

This section of the film is an absolutely lovely new addition! I was thrilled to see it being included in this third edition of Stages of Labor. The physical changes (uterus shrinking, afterpains, and bleeding) are mentioned and viewers are told that both mother and baby will be monitored to make sure the transitions after birth are occurring normally for both. Families learn about hormones that are present to help mother and baby bond in these first hours and in what I believe to be my favorite part of the film, viewers are told 'in the hours and weeks after birth, think of mom and baby as one unit that stays together just like it was during pregnancy''keeping mom and baby together with regular skin to skin contact helps the whole family bond.' I think this is very significant and am so happy hear this. It would have been nice to see more of the laid back breastfeeding positions, but babies are skin to skin and happy to be nursing and connecting with their mothers. Perfect!

Summary

This third edition of the well loved and long running childbirth education film 'Stages of Labor' offers some of the same great qualities of previous versions; great animation, a diverse group of families and clearly presented information that is easy to understand. Showing this film in class can be a very effective way of covering a lot of ground and sharing accurate information. There are many discussions that can be had after watching this film it and it has easy stopping and starting points if you want to break it into segments. The addition of the importance of the fourth stage of labor and birth - keeping mother and baby together was long overdue and makes this video even more valuable to childbirth educators and others who work with birthing families. It is suitable to show to all ages and is a very modest film, in terms of nudity or potentially 'disturbing' scenes. I recall the first edition as being the most 'revealing' of all three films.

The animations really do a wonderful job of showing what is happening to the mother and the baby during the labor and birth process that static pictures could never do. I would have preferred seeing women push in upright positions. This DVD is an expensive purchase at $289.95 for the independent educator (or even for some hospital programs) but I believe it is well worth it. You will use it over and over, it feels very much updated and reflects the new thoughts around active labor and the new fourth stage segment is very well done. Much of the text and language is very similar to previous versions, but after watching it many times for this review, I find that it will be a nice change of pace and will feel very contemporary in my classroom. The Spanish version of this DVD will be released in February, 2014.

Injoy Videos has asked me to extend a special offer to Science & Sensibility readers who would like to make a purchase of this DVD. Receive free shipping on the purchase of Stages of Labor Third Edition: A Visual Guide by using code BSOL3SM14 at checkout. This code expires on 1/31/14.

Have you seen this new edition yet? Are you already using it in your classes? Please share your thoughts in our comments section, I would love to know your opinion.

Please note that I did receive a review copy of the film for the purpose of writing this review.

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