Labour is defined as the onset of painful, regular contractions with dilatation of the cervix. Each labour is unique and experienced differently by each woman, however, there are some common elements and ways in which you can help yourself through the journey to your baby’s arrival.
Prelude to labour
Some weeks before the birth of your baby, you may notice some of the following
- Lightening – as the baby drops into the pelvis, you will be aware of being able to breathe more easily, or the shape of your bump will change.
- Braxton Hicks – practice contractions causing hardening of the abdomen and a dull period type pain.
- Increased vaginal discharge.
- Increased pelvic pressure.
What you can do
- Have your hospital bag packed from 36 weeks.
- Conserve your energy, rest in the afternoons and simplify housework.
- Practice relaxation techniques.
What we can do
If you have not gone into labour by the due date, your midwife can offer you a vaginal examination called a stretch and sweep. During this examination, the midwife will try to insert her finger into the cervix and sweep around the membranes, in order to release hormones which may put you into labour.
Onset of labour
Signs that labour may be starting
- A show – a discharge of mucus which may be blood stained.
- Membrane rupture – the breaking of the sac of water surrounding your baby. This may be a large gush of water but may also be a trickle.
- Regular, painful contractions commence.
Unfortunately, sometimes there are signs of labour which fizzle out after a few hours. Although frustrating, this is quite normal.
What you can do
- In daytime, continue light activity. At night, try to sleep.
- Time your contractions and note their severity.
- Stay calm, have a bath, a massage, anything that helps.
- Wear loose fitting, comfortable clothing.
- Make sure you rest, empty your bladder eat little and often.
When to call the hospital
- If the show is heavily blood stained, or there is any bleeding from your vagina that you are worried about.
- When the waters break.
- When the contractions are five minutes apart or if you feel you need help with coping with them.
The first stage
The first stage of labour is from the onset of contractions to the full dilatation of the cervix. It is the longest phase of labour and very tiring. The following suggestions may help you cope.
- Eat easily digestible foods – small and frequent snacks.
- Stay upright and active in labour – walking, rocking from side to side and sitting astride a birthing ball seems to help most women.
- Have warm baths to aid relaxation.
- Empty your bladder at regular intervals.
- Visualise the end result –you holding your new born.
Transition is defined as the period when you may feel an urge to bear down, as if wanting to have a bowel motion, but the cervix may not be quite fully dilated. No harm will come to you if you bear down, but pushing may cause the cervix to swell and delay the onset of the second stage.
What you can do
- Lay down on your left side to ease pressure.
- Breathe shallowly, blowing out every time you feel like bearing down.
- Tell yourself this is nearly the final stage to keep yourself feeling positive.
- Make a noise if you want to – it sometimes helps.
The second stage
This is defined as the period between full dilatation of the cervix and the birth of your baby. Your midwife may not necessarily need to perform a vaginal examination to confirm this stage as there are external signs that this process has begun. The following points will help you to anticipate what to expect.
- The baby will be pressing on the nerves which usually cause you to open your bowels.. This is why it feels as if you need to go to the toilet badly. This is a physiological process and midwives are well used to it.
- The perineum. the area between your vagina and your anus will bulge and stretch as the baby descends.
- A stinging or burning sensation will occur as the baby’s head is emerging. This, although uncomfortable, will last a few minutes.
- Try to focus on your midwife’s voice at this time. She will be constantly assessing progress and will direct you in pushing and panting, to minimise any tearing.
- An episiotomy is a cut at the opening to the vagina. This is performed if the perineum looks to be tearing badly or if the baby needs a little more room to be born. Your prior consent to this procedure will be sought.
- Once the baby’s head is born, the baby is usually delivered with the next contraction.
- You or your partner will be invited to cut the cord once it is safely clamped, as long as you and your baby are well at this time.
The third stage
The third stage is defined as the time between the birth of your baby and the delivery of the placenta, or afterbirth. You may opt for either a physiological or a managed third stage.
Physiological third stage - This is where we wait for nature to take its course and as long as you are not bleeding heavily, this stage may take up to an hour to complete. We can help the third stage to progress by putting the baby to the breast if he/she is ready or by getting you to empty your bladder.
Managed third stage - An injection of Syntometrine will be given in your leg to contract the uterus. This will shear the placenta off the side of the womb and allow the midwife to carefully pull it out with the cord. This usually lasts around ten minutes. It is associated with less bleeding at the time of birth.
Post delivery examination
Although uncomfortable, it is very important to examine the vagina and surrounding tissues after the birth of your baby. This is to assess any damage that may require suturing. It may be helpful to use Entonox whilst this examination is taking place to help you. A record of your blood pressure, temperature and pulse will be taken to assess your physical wellbeing.