At last labour begins, it's scary and yet exciting! You know that it won't be long until you have your baby in your arms. You may be going into labour earlier than your due date and therefore are really surprised or perhaps you are over your due date, in which case you are probably relieved.
Many couples worry that they won't recognise the early stages of labour, and will end up with a rush to the hospital or an unplanned home birth. However it is very rare, especially in first pregnancies. What is more common is for couples to arrive at the hospital convinced that the birth is imminent only to find out that there are hours to go.
Signs of labour
In the lead up to when your baby is due your body is starting to prepare for labour and you may start to notice some of the signs. However this pre-labour stage can go on for 2,3 or even more weeks, so don't be surprised if things don't happen quickly.
Watch out for the following:
If your baby’s movements are reduced or changed:
You must contact your midwife or local maternity unit immediately. You must not wait until the next day to seek help.
You will be asked about your baby’s movements.
You will have a full antenatal check-up, including checking your baby’s heart beat.
You may have a show. This happens when the cervix is opening to let the baby through and so the plug of mucus, which has blocked the cervix throughout pregnancy, is expelled. You may notice it in your underwear or when you go to the toilet.
If you are bleeding a lot, enough to need a pad then tell your midwife.
Waters breaking or leaking - Although in films when you see a women go into labour it seems to happen with a sudden big "Splash", in reality that is less common. However it can happen and if it does you should contact the labour ward, as usually they will want to deliver the baby within 24 - 48 hours of the water sac rupturing so as to prevent infection.
You may experience weeks of Braxton Hicks (practice contractions). They tend to be quite variable, sometimes coming every 20 to 30 minutes or even at 5 - to 1 minute intervals for a short time then stop. Real labour contractions often start like severe cramps with pain radiating in your back and abdomen. They get stronger, last longer and become more closely spaced.
When to go to the hospital
Labour can last a long time from start to end, especially in first time pregnancies, which can normally last about 12 hours or more. It can be disappointing to arrive at the hospital to be told you are only a little bit dilated or even worse not dilated at all. So try to labour as long as possible at home where you will feel more comfortable. You can phone the labour ward and explain your symptoms to them and they will advise you on whether to come in or just stay at home and take a bath. If your contractions are coming 5 minutes apart or closer, if you feel as though you need help to get through the contractions (gas and air) or if your waters break or you are bleeding then it is probably time to make a move for the hospital.
Remember to phone first and let them know that you are on your way.
Arriving at the hospital
When you arrive at the hospital the midwife will discuss your symptoms and birth plan if you have one and look at your record book (make sure to bring this with you). Your midwife will then do routine checks on your temperature, blood pressure and your pulse will be taken, and your urine will be tested for blood, protein and sugar. You will then have your cervix examined to see how much you have progressed so far, you will be told how dilated you are. Your baby’s heart rate will be listened into to check its well being. If all is well you should be able to be as active as you like for the rest of the birth, but monitored intermittently.
If you are having a breech birth, multiple births or if there is anything else of concern then you may need continuous monitoring.
1st stage labour
In medical terms the first stage begins when your contractions bring about dilation and thinning of the cervix and ends when dilation is complete, when you are fully dilated and ready to push.
When you are well and truly in labour your contractions change from dull cramp like pain to a much more rhythmical, and painful feeling that comes at regular intervals. These contractions are completely out of your control and will not end until your baby is born.
You can time your contractions, which will help to give you an idea of how far into labour you are. In the early stage contractions normally last about 30-60 seconds and occur at intervals of about 5-20 minutes. Don't worry if yours seem to be a lot closer together, some women are not aware of their early contractions until they are about every 5 minutes. During the active phase (see section on dilation of the cervix) your contractions will probably last between 60 and 90 seconds at intervals of 2-4 minutes.
Women can experience contractions quite differently; some feel it more in their back, and others more in their abdomen. Early contractions tend to be similar in that they mostly feel like menstrual cramp. Don't worry if your contractions seem to vary, as it is quite common to have a strong contraction followed by a weaker contraction, or one contraction straight after another.
The main thing to remember is to go with the contraction, don't tense up. Try and let your whole body relax; remember your breathing exercises and you will find that the contractions will be less painful.
Dilation of the cervix
The cervix is normally a thick-walled canal about 2cm long and firmly closed. Hormone changes during the last few weeks may soften your cervix, which is still closed. It is the intense contractions of first stage labour that are needed to dilate and thin it out. Your cervix will then start to stretch and open.
Dilation is measured in cm from 0-10 (up to roughly 4 inches). Your cervix will normally only dilate about 4cm during the latent phase, and then progress to 8cm (3 inches) in the active phase. It will then become fully dilated (10cm/4 inches) during the transitional phase.
LATENT PHASE - Your cervix is about 2cm long still, until contractions start to thin it out (effacing).
ACTIVE PHASE - This is when the cervical canal is fully effaced and further contractions will widen and dilate your cervix.
TRANSITIONAL PHASE - You are fully dilated when the last part of your cervix, the front, has fully opened to 10cm (4 inches) ready for your baby to pass through.
2nd stage labour: The delivery
The second stage of labour is when you are fully dilated and your body will push your baby out.
Contractions and pushing
Your contractions during the second stage of labour feel different from those you experience during the first stage, because it is the second stage contractions that give you the intense feeling of needing to bear down and start pushing. This compelling urge to push down is caused by your baby's head pressing down on your pelvic floor and rectum. You should make sure to try and keep your pushing smooth and slow, so as to allow the vaginal and perineal tissues and muscles to accommodate your baby's head. For first babies the average length of time of pushing till birth is 1 hour and for subsequent babies it could be as little as 15-20 minutes. Your contractions will be about 2-4 minutes apart and lasting 60-90 seconds.
When pushing, the most effective position to be in is upright so as to allow gravity to work along with the downward muscular movements of your body. This could be by sitting on a birthing stool, standing with your arms around your partner's neck or squatting.
During pushing you should try to relax your pelvic floor area as best you can and remember to use the breathing techniques you will have been shown at your antenatal classes.
During the second stage your baby is pushed through the bony structure of your pelvis and birth canal.
As the head becomes level with your perineum he/she will be visible for the first time to your partner and midwife but will disappear back into the birth canal between contractions for a while. When the head appears and does not slip back at all this is known as "crowning".
It is important at this point to listen to your midwife as she instructs you not to push to allow the tissues to stretch enough to avoid tearing. You will feel a stinging or burning sensation as the baby stretches the outlet of your vagina. As soon as you feel this, try to stop bearing down and just pant, allow the contractions of your uterus to push the baby out on its own or if instructed by your midwife, push gently.
When the head is born your baby will be face down, but almost immediately he/she will twist their head so that they are facing your left or right thigh. The midwife will then check the umbilical cord isn't looped around the neck. With the next two or three contractions the shoulders will be born, then the rest of his body will slide out quickly and easily.
Following delivery your midwife will be watching to check that he/she breathes quite quickly, and if he is crying and moving around, these are signs that all's well.
3rd stage labour
Delivery of placenta
The arrival of your baby marks the end of the second stage of labour, but there is a third stage - the delivery of the placenta. Once your baby has been born your midwife will give you a few minutes before placing her hand on your abdomen to feel if your uterus has started to contract again. If it has, this is a sign that the placenta is separating from the uterine wall and moving down the birth canal. Your midwife will gently pull on the umbilical cord so as to encourage delivery of the placenta and may also ask you to push at the same time. This stage is comparatively painless and easy. It will either be left to occur naturally or it will be aided by an injection of Syntometrine, given to you by your midwife as your baby's head was born.
With the aid of Syntometrine this stage may last from just a few minutes to 15-20 minutes however if you would prefer to give birth to the placenta naturally then it could take some minutes longer or even up to an hour.
After the birth and delivery of the placenta, the midwife will probably leave you and your partner alone with your baby. It is hard to believe that your baby who has been in your tummy for the last 9 months is finally here. At a distance of 20-30cm (8-10 inches) your baby will be able to see your face quite clearly and soon will recognize your voice from the sounds he heard when inside your uterus. Take time and enjoy this first family moment.