Labour

By Sue Dawson - Midwife

Each labour is unique to every woman and therefore it is difficult to summarise and generalise this very varied part of your pregnancy. However, we hope that this section helps to dispel any fears, worries and concerns you may have and that we can offer you as much reassurance as possible for “The Big Day!”

The most frequently asked question has to be “How will I know when labour has started?” You will be offered all manner of suggestions by friends, colleagues and family and will no doubt have to sit through either tales of terror and horror or, alternatively, heart-warming stories of quick, pain free labours!! This is one aspect of our lives which we love to share with other women – so listen to them, smile sweetly then just focus on your and your body!

What are the stages of labour?

There are three parts of your labour:

1^st stage (latent phase)

This is the bit that can give you aches, pains and twinges for any number of days! You may also have a “show” (mucous plug coming away from the cervix) but these do not necessarily mean that labour is imminent. The “Braxton Hicks” tightenings may become more frequent and even give you period like cramps. If you are due to see your midwife – mention this to her if you experience any of the above and she can examine you, if you wish, to give you some idea of whether anything is happening.

If in doubt, and you do not have an antenatal appointment, phone the Labour Ward.

During this first stage, it is important to keep mobile and to eat and drink normally. Be aware of the frequency of contractions but don’t obsess about them as they will be irregular. Once a pattern emerges (ie every 10 minutes or every 7 minutes etc) and they are stopping you in your tracks – then it’s time to phone the Labour Ward.

If your waters break, or you think they have broken, or you are worried about the baby’s movements phone the Labour Ward.

1st Stage Part 2 (established labour)!!

The cervix is closed during pregnancy and starts to open up once labour begins. When it finally reaches 3-4cms and your contractions are strong, painful and regular; CONGRATULATIONS! You are in established labour!

At the maternity unit, you will be welcomed by your named midwife and, following basic checks (blood pressure, temperature, pulse and wee) and a quick check of the baby’s heartbeat, you will be encouraged to remain as mobile as possible. This is the time to discuss your birth plan, if you have one, and let the midwife know of any specific requests (cultural or otherwise). You will be asked about how you wish to deliver your placenta (more of that later!) and whether you and your partner with the baby to have Vitamin K. These are issues which require your consent and so they are discussed whilst you are still in a sane frame of mind!! Pain does peculiar things to us! It is best to have found out about them beforehand so ask your Community midwife for information.

You should have some idea of the pain relief options that are available. It is always useful to have read up on Tens; Water; Gas + Air; Pethidine. Nobody can predict how they will cope with labour pains, so be open-minded and don’t feel bad about changing your mind half way through if you need something.

(We do have a round the clock epidural service as long as the anaesthetist is not in theatre – so this is another option. Our advice to you would be to find out as much as possible about this prior to your labour starting. Once you are in established labour, it is difficult to absorb everything the anaesthetist is telling you)

How things progress from 4cm to 10cm is impossible to predict, but there are lots of tips to help that head come down! The most important one is gravity. Stay upright, rock those hips, do your breathing and relax as much as possible when the contraction goes. A great book to read on this subject is:

Jean Sutton and Pauline Scott’s “Optimal Foetal Positioning”

Or check out http://www.homebirth.org.uk/ofp.htm

Your favourite music, supportive partner and a positive frame of mind are all going to be very helpful during your labour. Bring plenty of water and snacks and we’ll keep your partner topped up with tea!

Your baby’s heartbeat will be checked regularly (with a little listener called a sonic aid) as we prefer you not be strapped to a monitor. (However, there may be occasions when we have no choice but to monitor continuously – this will be discussed and explained at the time if deemed necessary). We’ll also keep an eye on your blood pressure, temperature and pulse but not in an intrusive way.

2nd Stage (Pushing)

Your cervix will be dilating thanks to the force of the contractions pushing the baby’s head on to it and you will eventually reach that magic 10cms. Some women feel an urge to push at this point. Others are given a bit of respite before the contractions become what we call “expulsive”. The urge to push becomes stronger and stronger until it is impossible to resist. The midwife will use her judgement as to whether or not she needs to examine you to make sure that the cervix is fully dilated.

As the baby’s head begins to emerge – your midwife will be encouraging you, reassuring you and urging you to push! Say whatever you want – we’ve heard it all before and don’t take it to heart!! Just remember to listen out for her telling you to stop pushing and to pant – this is a really important bit so that the head comes out nice and slowly. Yes – it hurts and stings but you are in safe hands. Have faith in your body – you can do it.

Your baby will be placed on to your tummy if you wish or, if you prefer, will be wiped down first. You and your partner can check to see what sex your baby is or we can tell you!

3^rd stage (delivery of the placenta)

There are two methods of delivering the placenta:

	Managed - where we give you an injection in the thigh, as the baby is being born, which makes the placenta come out within 5-10 minutes. The injection can occasionally cause side effects such as nausea and vomiting or raise blood pressure.
	Physiological - where we wait for the placenta to come out by itself. This can take from 5 minutes to 1.5 hours.

How you choose to deliver your placenta is entirely up to you – provided that everything is normal. Your partner can cut the cord whichever method you opt for, if he so desires.

Once the baby and placenta are delivered, you will be checked to see if you need stitches, baby will be weighed and you will be given help to put the baby to the breast if you wish to breastfeed. At this point, tea and toast will be provided and you will be left in peace to enjoy the new arrival and make some phone calls!

This is a very brief summary of how a labour can progress to a normal delivery. We are very aware that this is not always the case so please rest assured that we are here to offer you our care, help, reassurance and advice for whatever situation arises.

Remember this:

FOR MOST WOMEN, THE BABY WILL COME OUT THE SAME WAY HE/SHE GOT IN !!

Managed - where we give you an injection in the thigh, as the baby is being born, which makes the placenta come out within 5-10 minutes. The injection can occasionally cause side effects such as nausea and vomiting or raise blood pressure.