Baby Life

Stages of Labour

2008-07-01 06:10:00

If television and movies were our only means of learning about childbirth, we would all be convinced that a woman’s labour begins when her water breaks, usually while she’s standing in line at the grocery store and surrounded by strangers who gasp as her amniotic fluid splashes on the floor.  Fortunately, few labours begin with such drama.  But if labour frequently starts without great fanfare, how is a mum to know that it has begun? 

Stages of Labour 

Let’s begin by looking at the stages of labour.  In the first stage of labour, the cervix completely dilates and effaces.  Dilation is the process in which the cervix opens.  A woman is considered “fully dilated” (and ready to push) when her cervix opens to ten centimetres.  Effacement is the process in which the cervix shortens and thins out.  The first stage of labour is almost always the longest.  For some women it lasts for days, but for others it may be as short as a few hours, or even less! 

 

The first stage of labour is often broken down into three parts.  In the early phase, mild contractions begin to open up the cervix and help the body prepare for the more intense contractions that accompany the active phase of the first stage of labour.

 

Practitioners consider a woman to be in the active phase of the first stage of labour when her cervix has dilated to about three or four centimetres. At this point, the contractions become more intense and last longer. 

 

When a woman enters transition, the third phase of the first stage of labour, her cervix dilates from about eight centimetres to ten centimetres.  This phase is the most intense and often the most painful.  Many women feel as though their contractions are coming right after each other without any break in the action. 

 

Once the cervix is fully dilated and completely effaced, it’s time to push!  This is the second stage of labour.  Uterine and abdominal contractions are now pushing the baby into the vagina, preparing her to make her appearance!  

 

Once the baby is out, the third stage of labour begins.  In the third stage of labour, the placenta is expelled.  Although a woman continues to feel some contractions during the third stage of labour, they are typically milder than the contractions during the first two stages of labour. 

The Beginning of Labour 

Now that that’s out of the way, let’s get back to the original question:  How do I know I’m in labour?  According to Susan McCutcheon, author of Natural Childbirth the Bradley Way, there are any number of ways that labour can begin.  As we mentioned before, some women know they are in labour when their water breaks.  This is also known as “rupture of membranes.”  But not every woman’s water breaks before labour begins. Some women know that they’re in labour because they feel mild menstrual-like cramps.  Other women experience an ache in the lower back that waxes and wanes every few minutes.  Sometimes a woman will notice leaking from between her legs that isn’t urine.  This is a leak of amniotic fluid, which may mean that the bag of waters has broken but that the baby’s head is blocking the opening of the cervix, letting only a little bit of fluid out at a time.

 

So I’m in Labour—Now What Do I Do? 

 

If you suspect you are in labour, try drinking several large glasses of water or juice.  Alternate between sitting, lying down, and walking around.  If you are truly in labour, your contractions will continue.  If you are not in labour, your fluid intake and change in activity will probably cause the contractions to stop.

 

One of the other myths often portrayed in movies and television is that a labouring woman must go to the hospital immediately.  Resist the urge to go to the hospital right away.  According to the Clinical Practice Guidelines of The Royal Women’s Hospital in Victoria, a labouring woman is not to be admitted to the hospital until she is in active labour, defined as dilation to 3 centimetres with measurable progress.  Some women will reach 3 centimetres quickly, while some will take hours.  Others may be dilated to 3 centimetres for weeks prior to the onset of labour, but are not considered active because dilation is not progressing.

 

Unless your doctor or midwife has instructed you otherwise or your bag of waters has broken, the best thing you can do is make yourself comfortable at home when labour begins.  Take a walk.  Soak in a warm bath. Watch a movie.  Better yet, take a nap.  But don’t go to the hospital.  And if you do go to the hospital before you’re in active labour, don’t fret.  While it may be discouraging to be sent home from the hospital, it’s not the end of the world.  You’ll be back soon enough.

 

A good rule of thumb is to remain at home until you find that you can’t talk during a contraction.  This seems to be a good indicator that you are in active labour and making progress.

 

You can also time your contractions.  Using a stopwatch, note how much time passes between the beginning of one contraction and the beginning of the next.  Since contractions are not always consistent, time several in a row and take a conservative average. According to the Bradley method, you should remain at home until your contractions are four minutes apart and at least one minute long.  Once they have remained in this pattern for one hour, it is probably time to go to the hospital.  If you’re concerned about getting to the hospital in time, ask your midwife to give you some concrete guidelines for when she wants you to come in.

What Should I Expect While I’m in Labour? 

Labour is not only a physical event but an emotional one, too.  So be prepared for a rush of different emotions that coincide with the changes occurring inside your body.  When labour first begins, you may feel excited and elated, even giddy.  You will probably also feel restless and may want to move around a lot.  According to Ina May Gaskin, author of Ina May’s Guide to Childbirth, the urge to move around is your body’s way of jostling the baby into position. 

 

As your contractions become more intense, you will probably feel more serious. You may want to lie down by yourself.  It’s completely normal to want to be left alone.  You’re doing serious work, and interruptions are not helpful. 

 

This “serious” phase usually coincides with active labour, and it is probably the point at which you will go to the hospital.  Every hospital has different policies about when to admit a labouring woman, how to help her manage pain, how to monitor her, and how to coach her through labour.  Plan to visit the hospital where you will give birth at least four weeks before your due date to talk to the personnel there about their policies.  Talk to your midwife or doctor about her philosophy of childbirth and how she typically helps a woman manage her labour.  Make a plan with all of your caregivers that will allow you to have the birth you want.

 

Once you are admitted to the hospital, your practitioners may encourage you to move around to help speed up labour.  They may also encourage you to relax in a bath to manage pain.  Each hospital has a different policy about fetal monitoring, but be prepared to have a fetal monitor attached to your belly so that the hospital caregivers can keep track of your baby’s heart rate.  Regardless of what the hospital’s policies are, never be afraid to ask for what you need. 

 

As you progress through the first stage of labour, you will eventually experience transition.  This is the most difficult phase of birth for most women. Up until now, you have experienced regular contractions with a short rest in between. During transition, however, you may feel like your contractions are coming right after each other with no break.  The bad news about transition is that it can feel almost unbearable.  The good news about transition is that it means you’re almost ready to push!

 

For many women, pushing is a relief.  While the contractions are still present and intense, they are now being used to push the baby out rather than open up the cervix.  Many women feel that, as long as they are pushing through a contraction, the pain is quite manageable.  How will you know when it’s time to push?  Your body will tell you.  While many textbooks describe an “urge to push,” the feeling is more like an uncontrollable heave gripping your whole body.  Once this urge strikes, you are no longer in control—your body is going to send that baby into the world, with or without your help. 

 

You will be asked to push during contractions and rest between contractions.  Some women push once before the baby comes out while some women push for hours.  Once your midwife can see the baby’s head, she will prepare to catch him as he emerges.  She may ask you to stop pushing, even during a contraction, so that she can stretch your perineum around the baby’s head.  This will help avoid tearing.  She may also ask you to push while you’re not having a contraction.  Listen to her.  She will talk you through every detail. 

 

Once the baby has arrived, he will be placed on your chest for some mommy-baby bonding time.  The cord will be cut and you will be given a chance to get to know your miracle.  Different hospitals have different policies regarding what comes next.  Some will let you start breastfeeding right away, and some will want to clean the baby and weigh him immediately.  Be sure to let your caregivers know what you prefer so that they can meet your needs.  While you’re bonding with baby, you will be in the third stage of labour.  You probably won’t even notice that you’ve pushed out the placenta or that your doctor is stitching up any tearing that you might have experienced.  You’ll be too busy counting fingers and toes, and kissing little noses.

Communication

Communication is the key to a happy, healthy labour and delivery experience.  Ask your midwife what you can expect while under her care.  Ask the hospital personnel about their policies. But most of all, ask for what you need.  And enjoy this amazing experience!

 

Stages of Labour