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Stages of Labour

First Stage of Labour

During early labour some women find a warm bath helpful.woman in first stages of labour Listening to soft music or going for a walk can also help. Simple, over-the-counter drugs like paracetamol can be taken, particularly if you have backache. Walking and using upright positions can improve your comfort too. In the early part of labour, you may have some light food.

Signs of true labour include:

  • contractions occurring regularly;
  • contractions getting longer, stronger and closer together;
  • walking around or changing position does not make your contractions go away.

The length of the first stage of labour can be different for every woman. If it is your first labour, the time from the start of labour to full dilation of the cervix (10 cm) is usually 6 – 12 hours. If it’s not your first labour, the time is usually shorter. The midwife will monitor the progress of your labour by continuously assessing the frequency, strength and length of your contractions. They will check every few hours to see how your cervix is dilating, what way the baby is presenting and how the baby is moving down through the pelvis. 

Generally, as labour progresses, your contractions will become gradually stronger and more painful and come closer together. The bag of water (liquor) may still be present or may break at any time during this period.

Throughout your labour, the midwife provides emotional support, including reassurance and encouragement. They will tell you what is happening and help you to communicate your needs to other members of the team and help you to make choices that work for you. If you need any medical help to ensure your own safety and your baby’s safety, the midwife will explain the reasons for it.

 Woman in first stage of labour

Towards the end of the first stage of labour, you may feel like pushing during the contractions. The midwife will let you know when the cervix is fully dilated and when it is safe to push.

Second Stage of Labour

The second stage of labour starts when your cervix is 10 cm dilated. This will be confirmed by an internal (vaginal) examination. Up to an hour may pass before you will be asked to start active pushing. During this time, the baby’s head will come down through the birth canal. The urge to push is caused by the pressure of your baby’s head on your back passage. Sometimes, this feeling of pressure can make the bowels open.

Getting familiar with pushing may take some time, especially if it is your first baby. If you don’t have an epidural, find a position that is comfortable and effective for you. You may wish to stay on the bed supported with pillows or to kneel, squat, stand or sit. These positions can be adopted on the bed or on the floor.

woman in second stage of labour

As the baby’s head descends further through the birth canal, the contractions get stronger and so does the urge to push. If you have an epidural, you won’t really be aware of these sensations. During each contraction, the midwife will tell you how and when to push. This stage is hard work and it is important to rest and relax between the contractions. After each contraction the midwife will listen to your baby’s heart rate and will keep you informed of your progress. Your birth partner will also encourage you and may offer you sips of water and help support you in your chosen position.

As your baby’s head moves down to the vaginal opening, the baby’s head will become visible. At a certain stage, the midwife will tell you to either stop pushing, to push very gently or to pant (blow in an out quickly through your mouth). This is important so that your baby’s head can be born slowly, giving the skin and muscles of the perineum time to stretch without tearing. (The perineum is the area between the vagina and the back passage.) Sometimes the skin won’t stretch enough and may tear or it may be necessary to perform an episiotomy, which is a cut in the skin to widen the opening. The perineum is numbed with a local anaesthetic before an episiotomy is done (unless you have an epidural).

After your baby’s head is born, the hard work is over. With one more contraction, your baby’s body will be born and your baby will be placed onto your tummy, so that you can feel and be close to each other immediately and you can start getting to know your son or daughter.

Soon afterwards, the umbilical cord is clamped and cut and the baby is dried. Sometimes, some mucous needs to be cleared from the baby’s mouth and nose. If your baby needs oxygen or any other care immediately after birth, they will be placed on a radiant warmer, which is like an open cot with a heater overhead, in the birth room. Your baby won’t be kept away from you any longer than is necessary. As soon as possible, your baby will be returned to your arms for another cuddle.

Caesarean section

A caesarean section is an operation to allow the baby to be born without going through the birth canal. A caesarean section canCaesarean section be planned (elective) or unplanned (emergency). As a caesarean section is considered to be major surgery, it is only performed if there is a clinical need, following discussion between you and the obstetrician. The baby is born through an incision or opening in your tummy just below the bikini line. The midwife will come with you to theatre and will care for your baby when it is born.

Sometimes it is possible for your birth partner to come with you to the theatre for the birth. This will depend on how urgent your caesarean section is. Also, the obstetrician and anaesthetist must agree that it’s ok. If your partner can’t come with you, the midwife will stay with you throughout the operation; your birth partner will wait outside the theatre and will see your baby as soon as possible after birth.

If possible, the operation is performed under epidural or spinal anaesthetic. (A spinal anaesthetic is like an epidural but the drugs are injected into the fluid surrounding the lower spinal cord). A general anaesthetic (which puts you to sleep) is sometimes necessary in emergency situations when the baby needs to be delivered very quickly and an epidural tube is not in place. If you have the caesarean section under epidural or spinal, you will be awake throughout the operation. You won’t feel any pain but you may feel some tugging as your baby is born. The operation takes about 30 - 40 minutes but the baby is usually born within the first ten minutes. A curtain or divider will prevent you and your partner from seeing the operation being performed. Once the baby is born and providing you and your baby are both well, the baby can be placed directly on your chest for skin to skin contact. If you are unable for skin to skin contact at this time, your partner will be given your baby to hold skin to skin.

baby being checked after a caesarean

Assisted vaginal delivery (ventouse or forceps delivery)

Some women need help to deliver their baby vaginally. This may be due to exhaustion and not being able to push the baby out. Also, the baby can show signs of becoming distressed during birth and the safest thing is to deliver the baby quickly. The midwife and doctor will explain the process to you. A ventouse (vacuum) is a shallow suction cup placed on the baby’s head. This suction helps to get the baby out quickly. Forceps are metal instruments, which look like a tongs. One part of the forceps is gently placed on each side of the baby’s head. You will be told to continue pushing during contractions while the doctor helps you using the ventouse or forceps. An episiotomy is more likely to be performed if you need an assisted vaginal delivery.

Third Stage of Labour

The third stage of labour starts after the birth of your baby and ends once the placenta (afterbirth) is delivered and the bleeding is controlled. At the Rotunda, we recommend using an injection to help complete the third stage. The injection makes the womb contract which helps to separate the placenta. This reduces the risk of excessive bleeding.

Some women choose to deliver the placenta without the use of drugs. We can help you to do this if you:

  •  are not at risk of any complications of bleeding;
  •  had no drugs administered during labour; 
  •  have discussed this option with your doctor or midwife during your pregnancy and in early labour.

Once the placenta is delivered, the womb normally stays contracted, which helps reduce the blood loss. On average, women will lose 100 – 200 mls of blood at birth. Your body has been preparing for this and you should not feel any side effects.

Sometimes, a detailed laboratory investigation on the placenta is recommended. This may identify certain factors that may relate to your pregnancy or the wellbeing of your baby. If your placenta is sent to the laboratory, the hospital will dispose of it once any tests are completed. If you have any specific requests relating to the placenta, please discuss them with your midwife or doctor.

lady with newborn baby and her partner

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