The stages of labour and what to expect as a woman in labour
The stages of labour are divided in three
The First Stage of Labour
During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour. This first stage of labour is also known as the latent phase and it can take hours or even days before the labour is fully established and its is advised that the woman should eat and be hydrated as to have enough energy for when the labour is fully established. Established labour is when your cervix has dilated to about 4cm and regular contractions are opening your cervix.
What to expect during this first stage includes;
Here are some basic signs to know Backache (constant or with each contraction)
Lower abdominal pressure
A sensation of warmth in the abdomen
Some can be quite mild, like a period pain; others can be sharp and strong. Initially the contractions will be short (between 30 to 40 seconds) and irregular. Once contractions are five minutes apart are a minute or more in length and the cervix has dilated about 4cm , labour is said to be ‘established’.
The discharge of a plug of mucus that can be thick and stringy or blood-tinged. This may happen the day you go into labour, or up to a week before. Therefore for if you feel unbearable pain you should report to your team of midwives, nurses or doctors.
Breaking of your waters:-
Breaking the membrane that contains the fluid around your baby (your waters) is often enough to make contractions stronger and more regular. This is also known as artificial rupture of the membranes (ARM). Your midwife or doctor can do this by making a small break in the membrane during a vaginal examination. This may make your contractions feel stronger and more painful, so your midwife will talk to you about pain relief. This also simply means the amniotic sac around your baby has ruptured. If breaking your waters does not work, your doctor or midwife may suggest using a drug called oxytocin (also known as syntocinon) to make your contractions stronger. This is given through a drip that goes into a vein, usually in your wrist or arm. Oxytocin can make your contractions stronger and more regular and can start to work quite quickly. Labour can sometimes be slower than expected. This can happen if your contractions are not coming often enough, are not strong enough, or if your baby is in an awkward position. If this is the case, your doctor or midwife may talk to you about 2 ways to speed up your labour: breaking your waters or an oxytocin drip.
Throughout the first stage of labour, careful monitoring and recording of your wellbeing and that of your baby, and the progress of your labour, is important. This is to ensure that labour is progressing normally and that any problems are recognised early and well communicated.
The Second Stage of Labour
The 2nd stage of labour lasts from when your cervix is fully dilated until the birth of your baby. The midwife will help you figure out the best position to stay in to make it easy for you to push your baby.
When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. You may get an urge to push that feels a bit like you need to poo or even pee.You can push during contractions whenever you feel the urge. You may not feel the urge to push immediately. If you have had an epidural, you may not even feel an urge to push at all. If you’re having your 1st baby, this pushing stage should last no longer than 3 hours. If you have had a baby before, it should take no more than 2 hours or mostly less. This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you if possible.
When your baby’s head is almost ready to come out, your midwife will ask you to stop pushing and take some short breaths, blowing them out through your mouth. This is so your baby’s head can be born slowly and gently, giving the skin and muscles in the area between your vagina and anus (the perineum) time to stretch. Sometimes your midwife or doctor will suggest an episiotomy to avoid a tear or to speed up delivery. This is a small cut made in your perineum (just below your vagina). You’ll be given a local anaesthetic injection to numb the area before the cut is made. Once your baby is born, an episiotomy, or any large tears, will be stitched closed.Once your baby’s head is born, most of the hard work is over the rest of their body is usually born during the next 1 or 2 contractions. You’ll usually be able to hold your baby immediately and enjoy some skin-to-skin time together. You can breastfeed your baby as soon as you like. Ideally, your baby will have their 1st feed within 1 hour of birth. Find out about your body after the birth, including how to deal with stitches.
Monitoring of your condition and that of your baby is increased during the second stage of labour. A long second stage of labour can result in risks for you and your baby. If your labour is not progressing, it is important that the reason is worked out and steps are taken to help you.
Third Stage of Labour
The 3rd stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.
There are 2 ways to manage this stage of labour:
When you have a medication to make it happen faster
When you have no treatment and this stage happens naturally
Your midwife will explain both ways to you while you’re still pregnant or during early labour, so you can decide which you would prefer. There are some situations where physiological management is not advisable. Your midwife or doctor can explain if this is the case for you.
What is active management?
Your midwife will give you an injection of oxytocin into your thigh as you give birth, or soon after. This makes your womb contract. Evidence suggests it’s better not to cut the umbilical cord immediately, so your midwife will wait to do this between 1 and 5 minutes after birth. Once the placenta has come away from your womb, your midwife pulls the cord which is attached to the placenta and pulls the placenta out through your vagina. This usually happens within 30 minutes of your baby being born.
Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth (postpartum haemorrhage), but it increases the chance of you feeling and being sick. It can also make afterpains (contraction-like pains after birth) worse.
What is physiological management?
No oxytocin injection is given, and the 3rd stage of labour happens naturally.This usually takes around 2 to 4 minutes. Once the placenta has come away from your womb, you should feel some pressure in your bottom and you’ll need to push the placenta out. It can take up to an hour but mostly less for the placenta to come away, but it usually only takes a few minutes to push it out. If the placenta does not come away naturally or you begin to bleed heavily, you’ll be advised by your midwife or doctor to switch to active management. You can do this at any time during the 3rd stage of labour.