What Happens During
Labour?
No one will tell you that giving birth is easy, but if you know
what to expect, you're much less likely to panic and more likely
to feel confident about any choices you are asked to make. Labour
is commonly divided into three stages. In the first stage, you will
experience shorter, less painful contractions as your cervix begins
to dilate and thin out (called effacement of the cervix). Later
in the first stage, your contractions will be more frequent and
painful as you reach transition, when your cervix will be fully
dilated. The second stage involves actually delivering your baby,
and the third stage refers to the delivery of the placenta.
Most women dread the pain of labour more than they dread the series
of sleepless nights that will follow. Every woman experiences pain
during labour differently, and it is very difficult to describe
the pain of contractions. In early labour they can feel like menstrual
cramps, or can be confined to your back and feel like a lower backache.
Some describe contractions as waves of tightening of the stomach
and accompanying discomfort. You can often see your stomach harden
with the contraction. You can't control your contractions, but your
state of mind can greatly affect the amount of pain you feel. If
you are having a hospital birth, you should thoroughly discuss your
pain relief options in advance when you choose your hospital. Remember,
the medical staff are there to help you, and there is no "right"
or "wrong" way to give birth. There's nothing wrong with asking
for pain relief if you want it. It is important to know what all
the options are, and to be fully aware of the implications that
your choice will have.
Labour is usually longest with a first child, lasting 12-14 hours
in most cases. Typically if you have light contractions, your labour
will be longer.
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First
Stage of Labour
During the first stage of labour, your cervix will dilate
and thin out to allow the baby to pass through the birth canal.
Dilatation is measured in centimetres, so when your midwife or doctor
says that you have reached ten centimetres dilatation, you know
that your baby is ready to be born. The so-called transitional stage
at the end of the first stage of labour can be difficult, as you
may be quite uncomfortable and yet not be allowed to push. You may
shiver or tremble; some women experience nausea or vomiting. Try
to employ the breathing techniques you have learned, and try varying
your position to make things a little easier.
If you have asked for an epidural, the anaesthetist will visit
you shortly after your admission to hospital. Your baby's heart
rate will be monitored by fetoscope, sonicaid, or by a machine.
You will have a number of internal examinations to determine how
dilated you are. If a long period of time has gone by, or you are
experiencing particularly strong contractions, or you are feeling
discouraged, ask for an exam so you'll know what progress you've
made.
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Second
Stage of Labour
The average duration of the second stage of labour for
first-time mothers is about an hour, although it can be as long
as two hours or as short as 15 minutes for some. You will feel an
overwhelming urge to bear down. When the midwife or doctor tells
you, take a deep breath, bend your knees and push. Pushing is very
hard work, so don't despair if you're feeling a bit exhausted. It
is much easier if you are in a sitting or squatting position, or
on your knees or all fours. Take your time with pushing in order
to give your tissues and muscles a chance to stretch and thereby
avoid the need for an episiotomy. Be sure to push during contractions,
not between them. Try to relax your pelvic floor (although this
sounds impossible, it can be done). Don't worry if you pass a little
urine or stool during pushing. Your midwives and doctors have seen
it all before, and it will be whisked away before anyone notices.
Try to relax gradually after each push so that the baby maintains
some momentum.
When the baby is about to be born, your perineum and anus will
begin to bulge. Your baby's head will appear more with each contraction,
although it may slip back a little in between contractions. After
the top of the baby's head appears (called "crowning"), the head
will be delivered in the next couple of contractions. As the baby's
head stretches the end of the birth canal, you will usually feel
a burning or stinging sensation. This lasts only a short time and
is followed by numbness as the baby's head stretches your tissues
so thin that the nerves are blocked. This creates a natural anaesthetic.
When you feel this burning sensation, stop pushing and allow your
uterus to push the baby out. This can help prevent tearing and avoid
the need for an episiotomy. If your doctor or midwife feels that
you will need an episiotomy, it will be performed now.
Once the baby's head has emerged, the midwife will ensure that
the cord is not around the baby's neck. She will then wipe the baby's
eyes, nose and mouth and remove any fluid from the baby's nose and
airway. The contractions may stop for a few moments and then restart
for the delivery of the baby's shoulders and body. Sometimes the
entire baby is delivered in just one contraction! The midwife will
probably help with the last part of the delivery by pulling the
baby out and lifting him up towards you.
Your new arrival will be quite a sight. He will be bluish in colour,
slippery and covered with blood, amniotic fluid, and vernix, the
white greasy substance that protected his skin from amniotic fluid
in the womb. His head may be pointy or misshapen from the delivery.
He may cry after the delivery and continue to cry for a short while.
If your baby is breathing normally, you should be able to hold him
and put him to your breast immediately. Both of you should be kept
warm.
The midwife or nurse will assess your baby and check to make sure
breathing is normal. Newborns are assessed by a series of five tests
called the Apgar score, administered at one minute and five minutes.
Each test is scored with 2,1, or 0. A breakdown of the tests and
their scores is shown below.
Heart rate
- Above 100 beats per minute – 2
- Below 100 beats per minute – 1
- Absent – 0
Breathing
- Regular – 2
- Irregular – 1
- Absent – 0
Movements
- Active – 2
- Some – 1
- Limp – 0
Skin Colour
- Pink – 2
- Bluish extremeties only – 1
- Blue – 0
Reflexes
- Cries – 2
- Whimpers – 1
- Absent – 0
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Third
Stage of Labour
After your baby is born, the uterus will probably stop
contracting for a few minutes. Eventually it will start up again,
perhaps helped along by an injection in your thigh of syntometrine
or ergometrine, synthetic hormones which speed up the delivery of
the placenta. The third stage of labour is basically nothing more
than the delivery of the placenta. The placenta will detach from
the uterine wall and be expelled painlessly by the contractions
of the uterus. The large blood vessels attached to the placenta
will be torn apart and then clamped together by the tightening of
the uterine muscles, Nature's way of stanching the flow of blood.
It is absolutely essential that the entire placenta be delivered,
otherwise there is a risk of prolonged bleeding and infection. The
midwife will inspect the placenta after it is delivered to ensure
that it is intact. You can look at it as well if you're interested.
Don't be alarmed if you shake like a leaf after the delivery of
the placenta. The shivering and shaking should stop after a half
an hour or so. Get your birthing partner to fetch your jumper or
cover you with blankets. A glass of champagne should help, too,
if you feel up to it!
The umbilical cord will be clamped and cut, and you can put your
baby to the breast or simply cuddle up get to know one another.
Newborns are usually quite alert in that first hour after birth.
You will be washed, stitched if you had an episiotomy, and asked
to urinate to ensure that your plumbing is functional. Your baby
will be wiped down and weighed, and placed in a cot beside your
bed or in a nursery.
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