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Supporting you through pregnancy and the early stages of motherhood
1st Stage
2nd Stage
3rd Stage
Labour and the birth
At last labour begins, it's scary and yet exciting! You know that it won't be long until you have your little 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 and have been sick of all the phone calls each day asking if anything has happened yet, in which case you are probably relieved, especially if it has happened naturally and you have just narrowly escaped being induced.
Many couples worry (and I know I did) that they won't recognise the early stages of labour, and will end up with a mad rush to the hospital or an unplanned home birth. Yes this does sometimes happen, 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 staring to prepare for labour and if you are tuned into your body in the days and weeks leading up to the birth 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:
The baby moves less - Your baby is full term and so there is very little room for him to move in your uterus, plus babies tend to go quieter just before labour. Remember to contact your doctor or midwife if you are concerned that you are not feeling your baby move at least 10 times in 24hrs.
A nesting instinct - This is real by the way. It's amazing but you really do get this urge to rush around the house trying to get everything cleaned and in order before your baby arrives. I thought it was just an old wives' tale but I, and some of my friends who have had children experienced the nesting instinct.
Loss of weight - In the days before the birth it is normal to lose 2-3lbs.
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 (like 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 over 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 monitored using a cardiotocograph for about 20 minutes just to check that he is coping with the contractions. 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 you will know it, believe me, 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. Try to think in a positive way as you experience each contraction; think how each one is bringing you closer to the end, when you will have your baby in your arms. 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. It's a really strange feeling when one minute you are in severe pain from a contraction and then it ends and you are absolutely normal again, no pain, until the next wave of a contraction begins. A "wave", that is exactly what a contraction is like. It starts slowly and gently and then builds up to a peak and then eases off slowly until it is gone and you are left anticipating and most likely dreading the next one.
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 as this just makes it more painful. Try and let your whole body relax; remember your breathing exercises and you will find that the contractions will not hurt as much.
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, when the pain becomes much stronger.
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 (should not be longer than 2 hrs) 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. Any upright position is better than lying on your back in bed as you will be pushing your baby out uphill against gravity, thus causing delivery to be more uncomfortable and take longer. I remember being determined to speed up the delivery of my baby the best I could by making a point of only lying down on my back when I was having my cervix checked, the rest of the time I made sure I was always upright, by kneeling when I was in the birthing pool and standing or squatting when I was out of the pool. I definitely think it helped, the second stage of my labour lasted only 30 minutes and this was my first baby.
During pushing you should try to relax your pelvic floor area and anal area as best you can and remember to use the breathing techniques you will have been shown at your antenatal classes. You may loose a little stool or urinate but don't worry about this it is natural and especially don't be embarrassed as your midwifes will have seen it all before. At the end of a push, take two slow, deep breaths but make sure not to relax too quickly at the end of a contraction. Relax slowly and your baby will continue to maintain its forward progress. Forceps or a vacuum extractor may be used to assist the delivery of your baby, if the second stage is considered to be prolonged.
Normal delivery
During the second stage your baby is pushed through the bony structure of your pelvis and birth canal. The first sign that your baby is coming will be the bulging of your anus and perineum. Each contraction will bring him closer and closer to being born. As his head becomes level with your perineum he 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 very 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. This may be very hard to do as you will still have an intense urge to push and will just want it all to be over. I did not listen to my midwife and just continued pushing, knowing fine well that I would most likely tear. I did, and afterwards wished I had tried to pant through it.
When the head is born your baby will be face down, but almost immediately he will twist his head so that he is facing your left or right thigh. The midwife will then check the umbilical cord isn't looped around his neck. With the next two or three contractions his shoulders will be born, then the rest of his body will slide out quickly and easily. The midwife will probably deliver him onto your stomach. You may be a bit shocked by his appearance as he may still be covered in vernix, the greasy, cream-like substance that coated his skin in the womb, or he may be bloody. His face may be bright red or even blue, or could be bruised from the delivery. Your midwife will be watching to check that he breathes quite quickly, and if he is crying and moving around, these are signs that all's well. You may feel overwhelmed and exhausted by the whole experience or maybe re-energised and excited but either way lie back and relax with your baby, who you have waited so long to be able to hold in your arms and be proud of yourself, as you certainly deserve it.
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. You can help speed things up by breastfeeding as the sucking action helps your uterus to contract (if your baby is not ready to suck then stimulating your nipples with your fingers will have the same effect).
After the birth and delivery of the placenta and any stitching that you may need, the midwife will probably leave you and your partner alone with your baby. For both of you it will feel amazing, it is hard to believe that your little baby who has been in your tummy for the last 9 months is finally here. You are mummy and daddy now and the adventure of parenthood is just beginning. 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.
Pain relief
during labour
Most women, especially first-time mothers, worry loads about how they are going to cope with the pain during labour. You think that it is going to be the worst pain ever imaginable, I know I did as I am such a wimp when it comes to feeling pain, I'm scared of jags, doctors, dentists etc. However I can truthfully say and so have many of my friends and family who have had babies, that it was never more than I could cope with (with gas and air) and surprisingly it was not as bad as I expected it to be. I was lucky in that my labour went really smoothly and obviously every labour is different.
Labour invariably involves pain, we all know that, but you can build up your confidence by understanding your own limits of pain tolerance and by learning about different methods of pain relief. It helps to view the pain in a positive way - each contraction and pain brings your baby closer to being born, and all the pain of contractions to an end.
It is important to go into labour with an open mind, especially if it is your first. You may want a natural birth with no pain relief from drugs, that's fine but you do not want to be disappointed if the pain becomes too much and you end up asking for some pain relief. Instead why not go into it thinking, "well yes I am going to try and manage without any form of drugs however if it starts to become more than I can cope with, then I will at that point decide on what form of pain relief I will need". It may be a case of just a little gas and air might be enough to take the edge of the contractions or you may decide that you do not want to feel any pain and opt for an epidural. Don't think of this as a sign of cowardice, remember your labour is not a test to see how strong you are and how much pain you can cope with, in some cases the use of drugs may even be essential for you to deliver your baby.
Pain releiving drugs
• Entonox (Gas and Air)
Entonox is a mixture of nitrous oxide gas and oxygen, which you inhale at the start of a contraction and carry on until the contraction peaks or you have had enough. It takes the edge off the pain at the height of the contraction. Gas works by numbing the pain centre in the brain, and can make you feel as though you are floating. In my opinion this stuff is amazing, it really worked well for me from about halfway through the first stage of labour right through to pushing, when I had to stop as you can't inhale and push at the same time. Gas and air is not for everyone, some women find it makes them feel sick or just is not strong enough for them. My top tip, if you do decide to use gas and air is, don't just inhale once and say "oh, it isn't working" you need to really inhale deeply and keep on doing so through the contraction and believe me you will soon be feeling as though you have had a few glasses of wine.
• Narcotics - Pethidine
Pethidine is derived from morphine and is given by injection in the thigh or buttock in varying dosages during the first stage of labour. It acts on the nerve cells in the brain and spine thus dulling the sensation of pain. It should not be given too close to the birth as it can make your baby sleepy. If you choose to take a narcotic, it is probably best to ask for a small dose so as to see how it affects you; some women say it makes them feel sick. Narcotics take about 20 minutes to work.
• Epidural Block
An epidural block prevents pain spreading from your uterus by acting as a "nerve block" in your spine. A well-managed epidural removes all sensation from your waist down to your knees, but you remain alert. It is most likely to be advised if you have a difficult labour, pre-eclampsia, or severe asthma, or if you have a forceps delivery. In most cases of a caesarean you will have an epidural rather than a general anaesthetic, which means you get to stay awake during the birth. First of all you will be given an injection of local anaesthetic in your back to numb the area for the epidural. A fine, hollow needle will then be inserted into the epidural space and a thin tube known as a catheter is threaded down inside the hollow needle. The needle is then removed, leaving the catheter in position. The catheter is then taped firmly in position and anaesthetic is then syringed down it, then it is sealed although it can be topped up if needed. You will have to let your midwife know in advance if you would like an epidural as it has to be done by a skilled anaesthetist and it usually takes about 10-20 minutes to be set up. It will take effect within a few minutes.
Natural methods
of pain relief
There are plenty of other methods of pain relief that do not require the use of drugs, although you may find that you need to use more than just one to get a more complete relief.
• Positions
Moving around and changing your position during labour is a good way of not only speeding up labour but also easing some of the pain and making you more comfortable. Walking around, leaning against your partner or a wall will probably help you feel much more comfortable than lying in a bed. You will find what positions work best for you and more than likely find your own little technique of coping with contractions. I found that bouncing gently on my big silver birthing ball helped a lot during my early contractions while I was still at home.
• Distraction
Using some means of distraction to take your mind off of the pain of contractions can be useful. Try counting backwards from 100 at each contraction or you could try using visualisation, which can be helpful in not only calming fear but also distracting you from the pain. Try imagining something that you find particularly soothing, for example warm, bright sunshine.
• Massage
Massage can be very effective in relieving discomfort during labour and can be done by your partner or midwife. In particular, massage of the lower back can be a big help. If you attend anti-natal classes you will be shown a variety of techniques, so it is a good idea to have your birthing partner with you when you attend them.
• Water
Lying in warm water is very relaxing and soothing. Your contractions will feel more painful when you tense up so by lying in a warm bath you are more likely to relax your whole body. You could have a bath while you are still at home in labour, or if you are in the hospital you can usually use their baths or birthing pools if they have one. The use of birthing pools during labour is becoming increasingly popular. I used one when I was in labour with my son and I was amazed with the amount of pain relief it provided, I felt really relaxed and ended up staying in the pool right up until I was ready to push. In some hospitals you are able to actually give birth in the pool. If you are planning a home birth then you could look into hiring a pool.
• A TENS Machine
(Trans-cutaneous Electrical Nerve Stimulation)
A TENS Machine is a battery-operated box with wires that are attached to electrodes that are then placed on either side of your spine. You have a handset that allows you to control and regulate the tiny electrical current that reduces the pain messages to your brain, and also stimulates the production of endorphins. Check with your hospital first and see if they provide them, if not you can hire your own, they are not very expensive.
• Acupuncture
You should only use acupuncture as a form of pain relief if you have already used it before and it has been effective in relieving pain for you. It is also important that your acupuncturist is familiar with labour and delivery. Acupuncture can also be helpful in stopping nausea.
• Hypnosis
If you have never had hypnosis before then you will need to do a period of practice sessions first to see if you actually respond to hypnosis easily. Women who go into a deep trance have been able to have forceps delivery and stitches without feeling any pain. It is important that if you choose to go with hypnosis as a method of pain relief that both you and your hypnotist are completely familiar with what you will have to do during labour and delivery.
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