Pregnant woman in delivery roomWe have all seen the movie depictions, where the pregnant heroine, immaculately dressed and presented, suddenly experiences a large gush of waters breaking, immediately followed by contractions that happen every couple of minutes, shortly proceeded by a couple of attempts of pushing, before a surprisingly large and clean baby is placed in her arms. It all seems so simple and straight forward, but as anyone who has experienced labour first hand knows it is far from realistic for the majority of births.

If you are first time mother you probably have lots of questions about labour, and you will want to know what to expect. It’s important to realise that every labour is different, and there is no way of predicting what yours will be like. Your mother may have had a quick, four-hour labour, whilst you might experience a 24-hour labour, or vice versa. You could also have a very detailed birth plan ready that ends up being thrown out once labour begins because of something unexpected.

Some women prefer to remain somewhat ignorant of the process of labour before they go through it, choosing to take a “deal with it when it happens” approach, which is perfectly fine. However, if you do have questions and want to know more, this article should give you a basic idea of what’s involved.

Early Signs Of Labour – The Pre-Labour Stage

Labour has distinctive stages, though there is usually an overlap between the stages and it sometimes difficult to know what stage you are in. Just before labour begins, you will start to experience signs and symptoms that labour is imminent, and this is often referred to as “pre-labour”.

Some of these signs are obvious, whilst others are subtle and you may not realise that what you experienced was a sign until well after the event when you have had a chance to reflect on what has happened. As every labour is different, you may experience some, none, or all of these symptoms during the pre-labour stage:

Loss of Mucus Plug – A “Show”

The mucus plug is a gelatinous lump that acts as a cork to your uterus. Sometimes it comes out all at once; sometimes it comes out in small amounts at a time. This is referred to as a “show.” You may not notice it at all, or you may notice a thick lumpy vaginal discharge when you use the toilet.

Sometimes it appears clear, whereas for other women it can have small amounts of blood mixed in. The mucus plug comes loose as your cervix begins to soften in preparation for labour. It can happen several days or a week before labour starts, but if it is bloody then it is more likely that labour is imminent.

Increase In Energy / “Nesting” Instinct

It may seem like a bit of a cliché, but many women do report a spike in energy and an overwhelming need to clean in the days and hours leading up to labour. You may find yourself scrubbing the bathroom, sorting out the cupboard under the stairs that is used for storing items when you have no idea where else to place them, or dusting every nook and cranny. It’s thought that this behaviour stems from our primal ancestors, where creating a safe space for the forthcoming arrival was essential for survival. If you do find yourself with a sudden need to rearrange the kitchen, make sure you don’t strain yourself too much and avoid any heavy lifting.

Braxton Hicks Contractions

Although usually associated with the latter stages of pregnancy, Braxton Hicks can begin early in the first trimester, but they are not usually felt. Braxton Hicks is the term used to describe a tightening of the uterus muscles. They are thought to be part of the process that readies your body for labour and during the later stages of pregnancy they can become more painful and more frequent.

Unlike the contractions that are part of labour, Braxton Hicks are generally irregular, but in the pre-labour stage they can become more frequent and can easily be confused for contractions. If you are not sure if you are experiencing Braxton Hicks or labour contractions, you will need to be checked by a midwife who will look to see if your cervix has begun to dilate.

Membrane Rupture (Waters Breaking)

For some women, the Hollywood portrayal of labour that begins with the sudden gush of their waters breaking is indeed a reality. Other women may experience something a bit more akin to a slight trickle. This is where the amniotic sack that has kept your baby safe all this time breaks down ready for labour. The amniotic fluid is usually clear, though it can have bloody specks in it, and is often odourless or has a sweet smell.

If you think your waters have broken or are leaking then you need to contact your maternity unit, midwife, or birth centre straight away to be examined, as once this happens there is an increased chance of infection to your baby. For some women, their waters may break a few hours or days before labour begins, for others it may signal the start of labour, whilst other women may ended up needing their waters broken once labour has begun.

Pain In the Lower Back / Abdominal Area

You may experience general pain and cramping in your lower back and abdominal area in the days leading up to labour. This can be caused by the start of contractions and Braxton Hicks, or it could be your baby moving into position. If you are concerned about any pain you experience then seek advice from your midwife.

No More Heartburn

Your baby will drop down into your pelvic area in preparation of labour. This will take pressure off your stomach, therefore stopping stomach acid being forced back up your oesophagus, which is what causes heartburn. You may even see that your bump has visibly “dropped down” and that breathing has become easier as the baby is no longer pressing on your lungs. This can happen a few days or weeks before labour begins.

Diarrhoea / Vomiting

As the muscles around your uterus start contracting in preparation for labour, they may have an effect on your bowel and stomach, resulting in diarrhoea, vomiting, or both. This is fairly common and many experts consider it to be your body’s way of having a bit of a clear out before birth. It can also happen during labour itself. Make sure you stay hydrated by regularly taking sips of water.

Labour – The Stages

The First Stage –Cervix Dilation

Husband & wife delivery roomYou are considered to be in the first stage of labour once your cervix has dilated, or opened up to 3cm, in preparation for the birth of your baby. During the labour process, your cervix will open up to around 10cm to allow your baby to be born, and it is this dilation that results in the contractions. You may have experienced contractions during the pre-labour stage, but during the first stage of labour they will become more regular, usually starting at around 20-minute intervals and gradually increasing in frequency until they come every minute or more.

Timing your contractions will allow you to see how often they are taking place. Once you feel they have established a regular pattern then it’s time to call your midwife or maternity unit. Every woman experiences contractions differently, though they can typically be described as intense cramping in the lower abdomen and back that lasts for a few seconds to begin with, gradually increasing in intensity and length of time.

Your midwife will check you initially to see how far your cervix has dilated. If you haven’t yet reached 3cm, then your midwife may suggest you return home for a few hours. Once you are in established or active labour (when your cervix reaches 3cm dilation) your midwife will monitor you and your baby for any signs of distress or complications. They will offer you pain relief (see section below on the pain relief that is available), and will probably encourage you to move around. You may be offered the use of a birthing pool or birthing balls to help you to feel more comfortable.

Typically, this stage of labour takes around 6 to 12 hours, although this of course varies from woman to woman. If you are experiencing a very long labour then you may be offered additional treatment to help speed things up. It’s important to keep hydrated during this time and it’s a good idea to pack some cartons of juice with straws so that your partner can help you to drink if necessary. If you feel hungry, then you could snack on carbohydrates that will help you to maintain your energy levels.

The Transition Period

Towards the end of the first stage, when your cervix is around 8cm, you will enter what’s known as the “Transition Period”, where you move from the first stage of labour to the second stage of labour. At this point, your contractions are likely to be very painful and intense, and for many women this is the most difficult time of labour.

Transition is typically characterised by a feeling of not wanting to go on, to give up all together. Rest assured that this is all perfectly normal and natural. Some women report becoming abusive towards their midwife and birth partner at this point, whereas others may retreat into themselves as talking becomes increasingly difficult. You may also vomit and have a bowel movement during transition.

The Second Stage – Pushing and Birth

Once your cervix has dilated to around 10cm, you will probably feel the need to begin pushing. Have a think about what type of position you want to be in when you give birth. For example, women with Symphysis Pubis Dysfunction (SPD, or pelvic pain) during pregnancy may find it more comfortable to give birth on their hands and knees, whilst other women may prefer to give birth in the more traditional position on the bed. You may also be required to adopt a certain position for medical reasons.

When it is time to start pushing you will need to push on each contraction, and relax in between. Your midwife will give your guidance and encouragement throughout, advising when to push and when to stop. For most women, this stage of labour lasts up to two hours. Your baby’s head will appear first, and once the head is out the body follows very quickly after. Some women do suffer a tearing of the perineum (the skin between your vagina and anus) and you will be given stitches for this. After the baby is born, the umbilical cord that connects your baby to the placenta needs to be cut, and some maternity units will ask if your birth partner would like to do this. He or she can refuse if they prefer.

The Third Stage – Placenta Delivery, Skin To Skin, and Recovery

Once the hard work is over and your baby is born, the next stage will be to deliver your placenta. Thankfully, after the experience of birthing a baby this will feel somewhat of a breeze! Your midwife will probably offer you an injection to make this process happen faster, and this drug, syntocinon, will also reduce your chances of experience heavy bleeding. Some women prefer to avoid this drug, giving birth to the placenta more naturally. This can take up to about an hour, and the contractions associated with it can be painful, but you are likely to be distracted by your new-born.

You will be encouraged to have lots of skin to skin contact with your baby on your chest immediately after birth. This is incredibly calming to both you and the baby, helps with the bonding process, and stimulates the hormones that are needed to produce breast milk. Both parents can use skin-to-skin contact as a way of settling your baby in the days and weeks that follow. It is likely that your midwife will leave you and your birth partner alone at this point to have some special quiet time together.

Your baby will be given a health check and you will have the opportunity to have a wash. Depending on how your birth was and the policy of your maternity unit, you may be able to go home a few hours after giving birth, or you may need to stay in a post-natal unit for a while. Once you have returned home, you will remain in the care of the Community Midwife Team for approximately 10 days before they refer your baby to the Child Health Visiting Team who will provide on-going support and advice for your child in their early years.

What Pain Relief Is Available During Labour

You may have already decided to forego all pain relief in favour of keeping things natural, or you might be a “I’ll have three of everything please” type, or somewhere in between. Whatever you choose, your choice of pain relief is yours and yours alone, and you shouldn’t feel judged or derided over the choices you make. After all, it is you and you alone who understands the pain thresholds of your body. As all the pain relieving methods available to you have both pros and cons, being aware of what is available in advance will help you to make an informed decision.

Epidurals

EpiduralOffering complete pain relief, epidurals are exclusively available in maternity units that have a qualified anaesthetist available. Therefore, epidurals are not available at home and at many midwife led birthing units. If you choose to have an epidural then an anaesthetic will be injected into your back. This will numb the nerves that lead from your lower back, abdomen and birth canal, essentially rendering you unable to feel pain in those areas. You may or may not be able to move your legs once you have received an epidural, depending on the type of anaesthetic used.

Of course, the main benefit to an epidural is the almost complete removal of pain, and this is particularly useful if your labour is prolonged. However, there are some downsides. You may not feel contractions at all so will need a lot more guidance from your midwife as to when to push. This could result in a prolonged labour during the second stage and sometimes forceps may be required to assist your baby out of the birthing canal.

Medication – Pethidine & Diamorphine

If you decide not to have an epidural, you might decide to choose an injection of a pain relieving drug. Typically this will be either Pethidine or Diamorphine, depending on your maternity unit. The drug is injected into your thigh and whilst it does not completely remove the pain it does lessen it significantly. It also has a relaxing effect. Furthermore, they can be administered by a midwife and in some areas they may be available for home births, depending on the policy of the local NHS trust.

The drugs do have some side effects, including a feeling of being drowsy, so you might not be able to then use a birthing pool if you experience this. The effects of the drug last about four hours and they also pass to your baby. Therefore, if you give birth whilst still under the effects of the drug your baby maybe slower to begin breathing and may not be willing to feed due to drowsiness. In some areas, the drugs will not be given to women who are thought to be too close to giving birth for these reasons.

Gas And Air (Entonox)

A favourite of many labouring women, Entonox is a breathable mixture of 50% oxygen and 50% nitrous oxide. You are in complete control of how you use it as you are given the mouthpiece and you can take it away as you please. As you feel a contraction start you can breathe in the Entonox and this has a strong pain relieving effect on your body. The effect wears off within seconds and has no effect on your baby. It can be used both at home and at a maternity unit throughout your labour.

Entonox may make you feel light-headed, and some women are sick during the first few uses, though many will then be able to use it without any further problems. In addition, it can cause a feeling of dry mouth, so it’s a good idea to have plenty of fluids available.

Birthing Pools

In the same way that a bath can help you relax and soothe aches and pains, a birthing pool can help relieve the stress and tension of labour and make the pain of contractions more bearable. The water is kept at body temperature throughout and your baby can be born into the pool if you wish.

It’s thought that this is less stressful for the baby as they move from one watery environment to another, rather than immediately being pushed out into open air. You can also use Entonox whilst in the birthing pool for additional pain relief. If you can, arrange for a tour of your local maternity unit to get an idea of the facilities there. It’s worth remembering that you may not have access to the birthing pool if your unit is dealing with a high number of births.