Labour and Birth
As your pregnancy progresses, it’s quite normal to feel anxious or worried. You might be concerned about the changes you see in your body, whether your baby will be born healthy, how painful labour will be, and how you will cope with the birth. Make sure you are well prepared and you know what to expect as this will put your mind at ease. Also, having someone with you that you trust will help you to relax and improve the experience for you.
Choosing a Birth Companion
Your partner may not necessarily be the best person to accompany you at your baby’s birth, especially if they are likely to become anxious, uncomfortable, or panic. Choose someone who you know will listen to you and who will remain calm. Usually, this will be another woman who you feel comfortable enough with to express yourself.
Research shows that if you have the right support, your labour is likely to be shorter and you will be less likely to need other assistance. Remember, who is around you is up to you. It is essential that you do not feel inhibited when you are giving birth. You do not have to have that person with you the whole time during your labour; you might want them to support you for a while early on, but not when your baby is actually born.
Preparing for Labour
There are things you can do to prepare yourself for your baby’s birth:
Prepare a birth plan
You can make a written note of how you would like your labour to progress and what’s important to you during your baby’s delivery. However, it is important to remember that things can change. You might feel that you do not want any pain relief, but you could feel differently once you experience labour. Or, you might find you cope with contractions much better than you anticipated.
Every woman, labour and birth is different and it is impossible to predict precisely how your labour will go and how you will feel. Your body and your baby will decide when labour starts and it is impossible for you to have total control over how it progresses. This is why you need to be flexible about your birth plan. If you are not flexible, you could be setting yourself up for disappointment.
Stay fit and healthy
Look after yourself as your due date approaches. This includes eating a healthy, balanced diet, doing pelvic floor exercises, practising relaxation techniques, and monitoring your baby’s movements. If you are concerned that your baby is moving around less, get in touch with your doctor or midwife or call the hospital for advice.
Antenatal classes can help prepare you for your baby’s birth, both mentally and physically. You might feel more anxious about labour if you don’t know what to expect, whereas if you have a clear idea of what is likely to happen, you will likely feel calmer. As a result, you will be more relaxed and your labour will progress more smoothly.
Have a list of strategies ready to help you cope with the early stages of labour. These strategies might include relaxation techniques, breathing exercises, or natural methods of pain relief.
Talk to people you trust
Discuss your plans and worries with your doctor and midwife and ask any questions you may have. It can also help to talk to your partner or someone else you trust. Support and reassurance will go a long way to making you feel more positive about your approaching labour.
Braxton Hicks Contractions
Your body will be preparing for labour and birth with practice contractions, called Braxton Hicks. Your body performs Braxton Hicks throughout your pregnancy, but you might not notice them until the second trimester.
Braxton Hicks are often called ‘false labour’ because, although they can be strong and uncomfortable, they are not painful and they do not open or dilate the cervix like contractions in real labour. Many women find Braxton Hicks contractions disappear when they change position or they relax in a warm bath or shower.
The Start of Labour
Exactly what starts labour is a mystery but we do know that changes in your body and hormones must occur for your contractions to be strong enough to push your baby out.
Signs of labour include:
- Period-like pains, tightening or contractions.
- Backache that gets stronger and develops into regular contractions.
- You notice a ‘show’. This often looks like mucous streaked with blood. A show is a sign that the plug at the neck of the cervix has come away as a result of the cervix becoming soft and ripe to allow your baby to be delivered.
Contractions are the muscles of the uterus working to push the baby down and open the cervix. A contraction starts at the top of the uterus and moves downwards towards your pelvis like a wave. Each contraction works to pull up the cervix so that it dilates to 10 cm to allow your baby to travel through during delivery.
When you experience a contraction, you will feel it build up and your uterus will become tight. The contraction will peak for about 15 to 20 seconds, then it will ease off and disappear. There will then be a pain-free period before the next contraction builds up. As labour progresses, contractions become stronger and closer together.
How to Know if You Are in Labour
There are two sure signs that you are in labour: you experience contractions that become longer, stronger and closer together; your waters break (called rupture of the membranes).
Rupturing of the Membranes
‘Waters’ refers to the fluid that surrounds and cushions the baby in your womb. These waters are called the amniotic fluid. When your waters break, you will feel fluid release, either as a trickle which feels like urine, or as a gush.
If this happens to you, put a pad on your underwear and call your doctor or midwife. You will need to check the pad to see what colour the fluid is and whether it smells. If the fluid is greenish brown, it may be because of meconium in the amniotic fluid. Meconium comes from your baby’s bowels and is a sign that your baby may be distressed. If this is the case, your baby will need closer monitoring.
If your waters break, you may be asked to come into hospital.
When to Contact Your Doctor or Midwife
Get in touch with your doctor, midwife or the hospital if:
- Your waters break.
- You notice blood loss that is bright red.
- You are worried about your baby’s movements.
- Your contractions are five minutes apart.
- You want to come into hospital as you are no longer comfortable at home.
Arriving at Hospital for Your Baby's Birth
Your doctor or midwife will:
- Go through your medical and pregnancy history with you.
- Check your pulse and blood pressure.
- Test your urine.
- Determine whether your waters have broken.
- Check whether you have any bleeding.
- Listen to your baby’s heartbeat and monitor your contractions.
He or she will also feel your abdomen with their hands to determine your baby’s position. This will tell them how far along your labour is, how your baby is coping with the labour, and how prepared your baby is for the birth.
The Three Stages of Labour
During the early stages of labour, relaxation techniques, massage, heat and water can help you to cope with the pain. As your labour progresses, you may need medication. Every woman is different and it is essential that you communicate with your doctor or midwife to let them know how you are coping.
The First Stage of Labour
The first stage of labour usually lasts about 12 hours for a first-time mother and eight hours for women who have given birth before. However, nobody knows for sure and the best thing you can do is to try to relax and not to worry about how things will progress. Focus on one minute at a time and try to keep your mind busy by timing your contractions.
Your contractions will likely begin slowly, then build up in strength and frequency as labour progresses. When a contraction passes, the pain will ease. Try to rest between contractions and remember that your body is doing exactly what it has prepared to do, which is work to shorten and open your cervix in preparation for your baby’s delivery.
The Second Stage of Labour
Your doctor or midwife will need to examine you internally to determine whether your cervix is fully dilated. When your cervix is 10 cm dilated, the second stage of labour begins and you are ready to push your baby out.
Your contractions will be longer and further apart and you may feel the urge to push. If this is your first labour, progress might seem slow. When you experience a contraction, your baby moves forward and as the contraction eases, your baby withdraws slightly. Listen to your doctor or midwife as they will give you instructions to help you deliver your baby.
Third Stage of Labour
After your baby has been born, your doctor or midwife will clamp and cut the umbilical cord and place your baby on your chest. You will then need to deliver the placenta. This is the third stage of labour.
Usually, you will be given an injection to help the placenta to come away from your uterus and to reduce any bleeding. Although you will still feel contractions as your body pushes the placenta out of your uterus, the contractions won’t be as strong as those you felt during the second stage of your labour.
Your doctor or midwife will deliver the placenta and feel your abdomen to check your uterus. They will also assess whether you need any stitches and check your pulse and blood pressure. As long as everything is ok with you and your baby, you will be able to enjoy some quiet time to bond. Skin to skin contact will keep your baby warm and encourage him or her to have their first feed. Your midwife will be close by to make sure everything is well.
Your doctor or midwife will be alert to fetal distress throughout your labour. Signs of fetal distress include the presence of meconium in the amniotic fluid or any changes in the baby's heart rate, including a pronounced slowing. If your baby shows signs of distress, they will be monitored more closely and there may be a need to intervene or deliver your baby more quickly. If there is an emergency situation, your healthcare professional will do all they can to discuss with you the options that are available.
In an assisted birth, your doctor or midwife will use forceps or a ventouse suction cup to help deliver your baby. Forceps are instruments that fit around your baby’s head. A ventouse or vacuum cup is an instrument that fits onto your baby’s head by suction. You might need an instrumental birth if your doctor or midwife is concerned about your baby’s heart rate, your baby is in an awkward position, or if you are too exhausted to push your baby out without help.
A caesarean section is an operation to deliver your baby through a cut in your abdomen. The operation can be scheduled in advance, called an elective caesarean, or it might be required as an emergency. An emergency caesarean takes place if a baby needs to be delivered quickly but a vaginal birth is risky or not possible.
Most babies move into delivery position, head close to the birth canal, a few weeks before their birth. Breech position is when the baby’s feet or buttocks are at the opening of the birth canal. If your baby is in breech position, your healthcare provider will discuss your options with you.
Usually, labour starts of its own accord between 37 and 42 weeks. Sometimes, if you or your baby are at risk, your healthcare professional may need to start your labour off artificially; this is called induction of labour. You might need to be induced if you have a health condition such as diabetes or high blood pressure, or your baby is not thriving or is showing signs of distress.
You may also need to be induced if your pregnancy goes beyond 41 weeks or if your waters break but your contractions don’t start.
Augmentation to Help Labour Progress
If your labour starts naturally but your contractions are not regular or strong enough to dilate the cervix, you may need augmentation.
- You may need to have your waters broken by your doctor or midwife.
- You may need an artificial hormone to increase your contractions. This is administered by a drip.
It is perfectly normal to worry about labour and the birth of your baby. However, remember that a woman’s body is designed to stretch and give birth and that your body has prepared itself for this event. A normal labour lasts no longer than a day and there are lots of things you can do to prepare yourself physically and mentally for a positive experience. Ask questions, ensure you understand the answers, and communicate with your healthcare professional.