Labour - Giving Birth - Knowledge Area

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GIVING BIRTH - LABOUR

There is one certainty about giving birth - it is going to be a different experience for every mother, but here are some of the biological facts about labour.

For more detailed information, talk to your midwife or find out about ante-natal classes.

Your midwife unit/GP surgery may organise free NHS Parentcraft classes, or there are private ones available with organisations & charities such as the NCT - the National Childbirth Trust.

Ante-natal classes are a great way to meet other expecting parents in your area - you may find they become an important part of your support network and even friends for life!

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How Can Labour Start?

When it's time for your baby to be born (usually from 38 weeks) your body will start to get ready. The baby should start to move down, pressing on your pelvis. If your labour appears to be starting much earlier than this, PLEASE CONTACT YOUR MIDWIFE URGENTLY or even dial 999 for an ambulance, just to be safe.

You may experience mood swings but the beginning of labour can start in various different ways (but as soon as you feel it starting, phone your midwife):

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Waters Breaking

The first sign of the onset of labour may be your waters breaking.

What are the waters? This is the amniotic fluid that the baby develops in and they are held together in the amniotic sac.

When it's time for the baby to be born the membrane of the sac breaks and the "water" comes out through your vagina. It is not like the sensation of knowing you're going to pee - it just happens. It might be a trickle or it might be a gush or, like Nikki in our office, the baby might be born still in the sack. As her baby came out there was a pop and water everywhere - and a very clean baby.

You have no control over the flow and the fluid is a pale, straw colour. Your midwife may ask you to try to keep some (perhaps on a sanitary towel) so she can check it is ok. Tell her if it is very smelly or if there is much blood with it as these are possible signs of trouble.

Once the fluid has gone from around the baby it is no longer protected so if this happens prior to labour starting, contact your midwife for advice.

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The Show

What is The Show? When you are pregnant the entrance (or exit!) to the womb, the cervix, is "plugged" with mucus, also called the operculum. Before labour starts, or in early labour, the "plug" comes away and out of your vagina.

It may come away in one blob or in several pieces. It's sticky, like jelly and, because it's blood-stained, is pink, but you don't lose a lot of blood. If there is more than a small amount of blood then contact your midwife.

If the show appears before labour has started you know everything will start happening soon, but it may take a few days, or just a few hours.

Don't worry if you don't notice the show - this is normal, too.

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Contractions

You may have been experiencing Braxton Hicks contractions (but not everyone does), which is your body practising for the real thing. You should be able to tell the difference between these false contractions and the real thing - time them and if they are getting more frequent and stronger they are likely to be real contractions. Don't worry if you can't tell - call your midwife/maternity unit for advice.

What is a contraction? The dictionary definition is "The shortening and thickening of functioning muscle or muscle fibre". Some midwives refer to it as a "surge".

In labour, the powerful muscles at the top of your uterus tighten, causing the cervix to dilate (translation - the muscles at the top of your womb are tightening, to push your baby down, and the opening to your vagina at the bottom of your womb is getting bigger) getting your body ready to deliver the baby.

As the muscles relax the pain fades away. Early contractions often feel like period pains, are usually short, lasting 30-40 seconds and are as much as 30 minutes apart. Try to stay relaxed - let your birth partner rush around getting ready - and stay comfortable.

When your contractions last 30-60 seconds and are 3-5 minutes apart call your midwife. If you are planning on having your baby in a maternity unit or hospital, now is the time to get going.

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The Three Stages of Labour & Childbirth

The First Stage

The baby is pushed down to the end of the birth canal, ready to be born...

The First Stage will usually take from 5 to 15 hours - this is different for everyone but second time around is usually quicker than your first baby.
Contractions will get stronger, closer together, and last longer - to more than a minute at a time, every 30 seconds or so - but don't worry if they slow down or even stop for a while - move around a bit or ask your birth partner to give you a massage.
You will be monitored and if you need assistance the midwife will discuss this with you.
Your body is getting your cervix softened and wide enough (dilated) from 1 or 2cm to fully dilated at 10cm.
The midwife will examine you internally to see how dilated you are.
Try to keep upright - gravity helps the baby to press against the cervix which encourages it to open.
Experiment with different positions to get comfortable - lean against the wall or bed, sit on a beanbag or birthing ball, or go on all fours on the bed, or have your partner support you from behind.
Try to stay relaxed between contractions, and use breathing exercises and relaxation techniques or have a warm bath - maybe use some pain relief: Gas & Air or a TENS machine.
If the pain is getting too much to cope with, ask about stronger pain relief, such as pethidine or an epidural.
When labour is established your baby's heartbeat will be regularly monitored by the midwife.
At the end of stage one your cervix will be nearly fully dilated and ready for the baby's head to come through.

Transition

The transition is moving from the First into the Second stage...

This phase can feel very intense and you may have strong emotional feelings - you may come out with language you didn't know you knew!
Your cervix will fully dilate from about 8cm to 10cm.
The contractions will be at their most intense and powerful - try to rest in between.
You may feel that you want to push and that you want to open your bowels. Don't worry about this, it is quite natural and the midwife will be used to dealing with a bit of poo.

The Second Stage

This is when the pushing happens...

This stage is usually quicker than the First Stage but times will vary from a few minutes to over 2 hours
As your uterus (womb) muscles push your baby down you'll feel an overwhelming urge to push down, but if you've had an epidural you won't feel this - a monitor will show when you are having contractions.
Your midwife will guide you as to when to push, as she can see what is happening. Use a handheld mirror if you want to see what's happening down there.
She may ask you to breathe through some urges to coordinate your pushes with your breathing which can help prevent tears in your perineum (the area between your vagina and bottom).
It may take just a few pushes for the baby's head to reach the opening of your vagina, or up to 2 hours.

The Delivery

The baby comes out...

The widest part of the baby's head shows first - 'crowning' - and your midwife will ask you to stop pushing to try to prevent the tears in your perineum. You may need an episiotomy (the midwife cuts the perineum to avoid tearing).
After a couple more contractions the baby's head will appear, usually facing towards your back.
The baby's head and shoulders will then turn sideways, and the next push will deliver the baby fully.
The umbilical cord is usually clamped and cut at this stage - you partner may be asked if he wants to cut the cord.
You are now a mother! Congratulations!!
The midwife will check over the baby, weigh it, maybe give it a quick clean up and then hand your child to you - your first contact should ideally be skin to skin (your baby's bare skin touching your bare skin) but this depends on how you are feeling.

The Third Stage

Delivery of the placenta...

This stage usually takes 5-15 minutes but can take up to an hour.
You may be offered syntocinon to speed up the delivery of the placenta and to help stop any bleeding, which the midwife can administer via intravenous drip or via injection, or you may opt to deliver it naturally, but this will depend on the situation as well.
There will be one last contraction which is needed to expel the placenta - after what you've just been through you may hardly notice this, especially as you'll be concentrating on the new life you've just produced!
Seeing your baby and offering him or her your breast for a first feedl can help to stimulate hormones that separate the placenta from the womb wall.
How big is the placenta? It is about 15-23cm across and about 2.5cm thick and is dark red in colour. Placenta is Greek for cake.
The placenta can sometimes get stuck to the wall of the womb in which case you'll be taken to an operating theatre and - under spinal or general anaesthetic, depending on the situation - it will be removed.
Once the placenta has come away the blood vessels where it was attached will heal to stop bleeding, although there will be some bleeding.
The midwife will take a look at the placenta to ensure it is complete and no remnants have been left behind.

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What Next?

How you are feeling now will vary greatly. You will be tired and emotional and may not immediately want to see the baby, or you may be feeling elated and overjoyed at the arrival - at last! - of your baby.

Even if you're not planning to breastfeed, try to give the baby his first feed which is the ultra-healthy colostrum specially formulated in your breasts just for him. This may not happen easily the first time, but the midwife can help you. Your baby will instinctively try to search for your nipple for that first feed.

Research has shown that 60% of mums don't feel an instant bond with their baby and need time to get to know them, so don't worry if this is how you feel. The birth process can be a shock, physically and emotionally, and you may not have been able to spend time together straight away if you had a general anaesthetic or if there were other complications.

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Personal Experiences

Please do let us know about your childbirth experiences. Here are a couple from the Naturebotts office...

Jess - Although I felt that labour was 44 hours (from waters breaking, which happened first to ending in a Caesarean), apparently established labour was short which has always confused me but doesn't stop me from telling people about my 44 hour labour!
I was worried at first about pooing when pushing, and it really wasn't a big deal - the midwife sorted me out. As I had an epidural when this happened I didn't have much control over it (although I was glad that my husband was out of the room!).
When I first saw my first son I immediately thought "Oh, it's YOU!" as I really felt I already knew him. With my second son I thought how beautiful he was (seeing pictures now, 3 years on, of a pink scrawny thing, I realise that how I felt can be described as "love is blind"!!!).

Nikki - My first labour was apparently text book - 13 hours from start to finish. When I finally got to hospital I insisted on an internal. I didn't want to think I got that far only being 1cm but I was already 6cm! The internal on both my labours (that I insisted they did, as one of my midwifes seemed reluctant at first) definitely, as far as I am concerned, sped up the labour for both babies.
I gave birth to both of them in the upright position, on my knees leaning onto a beanbag on the bed.
My second baby was back to back for the last month of my labour. I was told that this meant a longer labour, perhaps with intervention, which I was dreading it as my first labour went very smoothly but she came out in 1 1/2 hours! I was also told that quite often the babies naturally turn whilst you are in labour, which she did - and boy did I feel it, very weird feeling.

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