The stages of labour
It is the custom to divide labour into three stages:
- the opening-up stage
- the pushing stage
- the afterbirth
First babies take between 6 and 20 hours to be born on average, later babies 3-12 hours.
The opening stage
The womb is an extremely strong organ, the muscles of which
force the baby down the cervical canal into the world. During the first
stage of labour the cervix dilates 10 cm. If this is your first baby, the
contractions first have to open up the cervical canal before they can begin
on the neck of the cervix. This may take anything up to 8-9 hours. The
uterine orifice (the outer opening) then opens up in 1-2 hours. Medication
can be administered to give the contractions greater effect and thus to
speed the process up.
In later births the mouth of the cervix begins dilating even before the
cervical canal is fully dilated. The birth is often very quick once the
cervix has dilated 4-5 cm.
To begin with the contractions come at intervals of about 5 minutes and last
about 30 seconds. As labour progresses, the contractions get longer and more
frequent.
The midwife will check the size of the cervix, the position of the baby in
the cervical canal and your blood pressure every one or two hours. The
baby's heartbeat will be checked more frequently, either through your tummy
or on a device that monitors both the contractions and the baby's heartbeat.
The state of the baby can also be monitored by an ultrasound scan, from
blood specimens, samples of the amniotic fluid, etc., depending on what
equipment the hospital has, and the situation.
The midwife will also check that the bladder does not get too full and
hinder the delivery. She will also check the colour, quantity and smell of
the amniotic fluid, in addition to giving you support and encouragement.
Opening up the cervix is the job of the womb. You can make this process
easier and quicker by relaxing. The worst stage is just before you begin to
push. It is at this stage that many mothers appreciate the presence of their
husband most, giving encouragement and a sense of security, and keeping
calm. This makes the pain easier to bear.
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Pushing stage
Once the cervix is fully dilated, you can begin to push.
Some mothers feel the need to push even before the cervix is fully dilated
and the baby's head has turned into the right position. You should then
avoid pushing, with the help of the midwife, by the shallow breathing
technique you have learnt at the clinic. Pushing too soon may prolong the
delivery as it causes swelling in the opening of the cervix. Many find this
the most painful and trying stage of labour. Luckily it doesn't last long.
The midwife will try to keep the atmosphere in the delivery room calm, out
of respect for the new life about to begin. Too much fuss and bright lights
will if possible be avoided.
When you are given permission to push, you must push 3-5 times during each
contraction, taking a quick breath in between. When the baby's head begins
to press on the muscle between the vagina and the back passage, the midwife
may well do an episiotomy, i.e. make a small cut under a local anaesthetic,
especially if this is your first baby. This prevents the tissue from
tearing. At this stage the midwife may well tell you to stop pushing for a
moment so that she can carefully ease the baby's head out. She will then
ease out each shoulder in turn, with you pushing slightly, and then the rest
of the body.
The pushing stage usually takes 20-30 minutes for first babies but only
about 10 minutes for later ones.
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Afterbirth
As soon as the baby is born, you will be given an injection
to contract the womb. The contractions usually expel the placenta in 5-10
minutes. The midwife will help by pulling gently on the cord or pressing on
the lower abdomen. She will then check the placenta, weigh it and measure
it.
The episiotomy wound and any other tears will be sewn up under a local
anaesthetic. You and your baby will then be kept in the delivery room for
about two hours for observation before being moved to the postnatal ward.
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