There can be a long time between the onset of labour and delivering a baby. Signs that you may be in labour can range from subtle things such as back pain and cramps, or they can be more obvious, such as leaking fluid if the waters break, or having a gush of discharge made up of mucus and blood known as “a show”.
Being in labour can sometimes be confused with Braxton Hicks contractions, which are merely a tightening of the uterine muscles. Although Braxton Hicks contractions do contribute to the onset of labour over time, they are not the same as actual uterine contractions - these are brought on by the production of a hormone called oxytocin, which stimulates the muscles needed for labour.
Labour is divided into three stages.
1) The first stage
Within the first stage there are three separate phases.
- The latent phase: This is the very beginning of labour as the cervix starts to soften and dilate to 4cm; contractions are usually restrained, inconsistent and not too painful during this time. Once the cervix has expanded to 4cm, labour is termed to be “established”. There is no need to be in the hospital during this stage of labour and you should try and rest. But if contractions are only a few minutes apart, your waters have broken or there is any sign of blood, it's wise to go to the hospital without delay.
For women who want to give birth as naturally as possible, gas and air can give some minor relief during contractions.
- Active phase: Contractions become stronger and more painful as the cervix gradually dilates to 7cm. Although some mothers may want to start pushing in this phase, this should be avoided until the cervix is fully dilated.
Because gravity assists with widening the cervix because of the pressure of the baby’s head bearing downwards, walking or being vertical can help with moving labour along. Take the opportunity to use the toilet before progressing into the next phase.
- Transition phase: Contractions will be very close together and forceful as the cervix dilates to the full 10cm needed to move into the second stage of labour. The urge to go to the toilet as the baby pushes its head towards the opening of the cervix and against the rectum is common. Many women fear having a bowel motion in this phase of labour - but midwives, nurses and doulas are all used to this and are prepared, don't worry!
Pethidine or an epidural will greatly ease pain in this stage, but it can also have the effect of slowing down labour, or increase intervention with instruments for a forceps or vacuum delivery. This is because these drugs can reduce your instinctive reflex to push. Alternatively, though, if medication makes a woman feel less anxious, this could help labour progress more smoothly.
Because pethidine and epidurals can cross the placenta, you'll need to ask for it during the early stages of labour. Leaving it too late means you may not be able to have it, because of the side effects that pose a risk to the health of the baby.
For women who want to give birth as naturally as possible, gas and air can give some minor relief during contractions. Some women also find meditation, Hypno-birthing and muscle relaxation techniques provide some help.
2) The second stage
Contractions will ebb and fade during the second stage of labour, allowing you to briefly relax between them. Feeling an ongoing need to push will accompany this stage of labour, and the contractions will steadily shift the baby through the birth canal to the entrance of the vagina. Then you might feel a stinging or burning sensation as the baby’s head emerges (this is known as crowning).
At this point, pushing should be more controlled, so the vaginal and perenium muscles can stretch around the baby’s head, reducing the risk of tearing. The doctor or midwife will then manoeuvre the baby so it can be born.
Labour can also slow down at this stage if there are any issues such as breech presentation, weak contractions or shoulder dystocia.
When the first stage of labour takes longer than 18 hours, or the second stage of labour continues after two hours, labour is considered to be prolonged. It's said to be more common in a first pregnancy or in older women.
If there's any indication that labour isn't progressing as quickly as it should be, the doctor or midwife could manually break a woman’s waters (if this hasn’t happened yet), or they could decide to intravenously induce contractions with a hormone called synctocinon, via a drip or using a gel to speed up the rate of dilation.
An emergency caesarean will be performed if the health of the mother or the baby is deteriorating.
3) The third stage (also known as afterbirth)
During this stage of labour, the placenta and membranes are delivered. The uterus will contract mildly to loosen the placenta before releasing it. Many hospitals use an injection and tug on the umbilical cord to prompt this final stage of labour, but immediate breastfeeding can stimulate the placenta to detach naturally. The third stage of labour can often go unnoticed for some women.
There will some blood loss, but the doctor or midwife will monitor this to ensure it doesn't lead to postpartum haemorrhaging, and also examine the placenta to check that nothing has been left inside (which can lead to a condition known as retained placenta).
Postpartum haemorrhaging is more likely if a birth has been particularly difficult or if the woman has a condition such as placenta praevia, pre-eclampsia or an operative delivery (with forceps or ventouse). Retained placenta stops the uterus from returning to its usual size and increases the chance of uterine infection, but is rare. Both doctors and midwives are trained to deal with these complications during this third stage of labour and will intervene when necessary.