Your Guide to Stages of Labour

Every labour is different so there’s no set rule about when to go to the hospital. Generally it’s best to call your midwife or the hospital first so they can assess whether they think it’s time for you to go in.

If this is your first baby, you should call when your contractions are five minutes apart and lasting around 30 or 40 seconds. They’ll probably tell you to make your way to the hospital very soon.

For second, third or later babies, you should call when your contractions are roughly seven minutes apart. Your LMC will advise you beforehand if they want you to call before you’ve got to the seven minute stage.

Early Signs of Labour

Bloody Show

Your “bloody show” is a plug of mucus that has been blocking the opening of your cervix. It helps to maintain your uterus as a sterile environment for your developing baby by keeping bacteria out. As your cervix begins to soften and dilate, it will often dislodge, either in small or large amounts.  This mucus can be blood stained, pink or clear and can discharge before labour or within a few hours of it starting.

Waters Breaking

The best time for your membranes around your baby to break is at the end of the first stage of labour after your cervix is fully dilated and no longer supporting the sac of amniotic fluid. As your uterus contracts, this will help break the membrane. However, your waters can break days before labour begins, or at the beginning of the first stage too, or they could remain intact right up until the birth of your baby. Sometimes a baby is born still in their sac! (This was traditionally known as a ‘caul’ birth.)

If your waters break, it is time to notify your midwife or doctor, even if you are not in labour. It’s also important to take note of the colour of your amniotic fluid. It should be clear or straw colour. It may also have a pink tinge, so let your LMC know if it is any other colour. If you are unsure that your waters have broken, wear a sanitary pad and check it in a couple of hours. Tell your doctor or midwife even if you are unsure.

Understanding the different stages of your labour can be very beneficial for your overall birth experience – it may help to provide you with a sense of what to expect, and you may also feel more confident in identifying how far along you are when it starts to happen.

Stage One: Latent phase of labour

The first stage of labour is divided into two phases: latent and active. The latent phase takers place before the active stage and may last 6-8 hours or more for many first time mothers.

During this time, your cervix will continue to efface (shorten) and then dilate (open) from 0 to around 4 cm. Early labour feelings in this phase may include cramps or period-like pains, bloating, changes in bowel motions, nausea, and contractions that are perhaps irregular, relatively mild, and short, but are slowly increasing in their strength, length and frequency.

Early labour may also start with getting your “show” or your “waters breaking”, although this is not necessarily the case. During the early stages of labour you may want to eat and drink light meals or snacks and drink plenty of water.

Stage One: Active phase of labour

In active labour, the cervix will become fully effaced and dilate from 4 up to 10cm (full dilatation). This process will usually happen more rapidly than latent labour and will occur alongside rhythmic contractions that have become much stronger, longer and closer together.

Typically during this time your contractions will be so strong that you can not talk through them, and will last around a minute or more, and come every few minutes. The contractions will be in an established and regular pattern. During this time you may want to be actively moving around, sitting in a water pool, or focusing on your breath and relaxation strategies.

Transition

Somewhere around the time where the cervix is 8-10cm dilated (or until expulsive contractions for the second stage are felt by a woman) many women will enter a period called transition. During this time it is very common for women to feel overwhelmed- for example you may want to go home or escape the birthing room, or feel you cannot cope or do it any longer. This may be the time when you may think you need further pain relief because of the normal emotional feelings surrounding this phase.

Somewhere around the time where the cervix is 8-10cm dilated (or until expulsive contractions for the second stage are felt by a woman) many women will enter a period called transition. During this time it is very common for women to feel overwhelmed- for example you may want to go home or escape the birthing room, or feel you cannot cope or do it any longer. This may be the time when you may think you need further pain relief because of the normal emotional feelings surrounding this phase.

This is where having a really good support person can play a vital role in helping you get through to the second stage. This stage is usually lasts about around an hour, and sometimes you can see a lull in the intensity of uterine contractions between the end of the first stage, and the start of the second stage of labour.

The second stage of labour is also known as the “pushing stage”. This is the stage where your baby continues to descend through the birth canal and is finally born!

This stage begins when the cervix is fully dilated. At this point you will often feel an incredible urge to push your baby out. During this time, the contractions often change and are felt to be much stronger. These contractions sometimes begin to space further apart slightly, so for example if they were coming once every two minutes during the first stage, they may come once every three minutes. The urge to push is often so strong; it is as if you can’t help but push along with your uterus that is also contracting to expel your baby. Feeling this urge to push can be affected by your choices of pain relief in labour.

Second Stage of Labour

The second stage of labour can be as short as a few pushes to an hour or longer. Usually, for first time mothers the second stage is longer than if you have previously given birth.

Congratulations! Your new baby is now born! However, you will still need to deliver your placenta and the membrane sack that your baby has lived in for the past nine months.

Third Stage of Labour

This can be done in two ways. The first is the physiological delivery of your placenta (or the natural method), and the second is called active management of your placenta.

In a physiological delivery of your placenta, the umbilical cord is clamped and cut after it has stopped pulsating, and the placenta is delivered by you pushing it out. This is much softer and easier than birthing your baby and your body will continue to have natural contractions to expel the placenta. It may only take several minutes following birth, but can take up to an hour.

The second method, called active management of the placenta, involves having an injection of a hormone into your thigh immediately following the birth of your baby, and once the cord has been clamped and cut. This injection (usually of a drug called syntocinon or syntometrine) helps to separate the placenta from the wall of your uterus. Your midwife or doctor will then pull the placenta out.

It’s good to discuss your choices and care with your midwife or doctor beforehand and include it in your birth plan.

Warning Signs

If any of the following happen, you should get in touch with your health care professional or hospital immediately.

  • If you’re less than 37 weeks pregnant and are feeling contractions
  • If you haven’t felt your baby move normally for them, or there have been less than 10 movements in any 12 hour period. If you are ever concerned about your baby’s movements (if they are absent, reduced or very active!) at any point in your pregnancy you should call your health care professional
  • If your contractions are too strong for you to cope with
  • If your waters break
  • Any vaginal bleeding

If you aren’t able to call, head straight to the hospital so that they can make sure everything is OK and give you the attention you need. Don’t be afraid to call for an ambulance if you’re on your own and unable to get to the hospital yourself.

Refernce: http://www.kariclub.co.nz – some sections have been edited by The Baby View

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