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Beginning Labour

http://www.nlm.nih.gov/medlineplus/childbirth.html, accessed on 28 Feb 2012

Labour begins when your cervix starts to open, or dilate. The uterus contracts at regular intervals, and the abdomen becomes hard. Between contractions, the uterus relaxes, and the abdomen becomes soft.

How labour begins

It is difficult to define clearly the moment of onset of labour and to predict the exact sequence of events.

There is a period of pre-labour, called lightening, during which the foetus falls lower toward the cervix. Lightening creates pressure on your bladder and makes you need to urinate more often. Pre-labour can last for several days or weeks.

The contractions you experience during the pre-labour phase may make you think that you are in labour. Time the contractions from the beginning of one to the beginning of the next. If they don't change in frequency or length and are not regular, you are probably in "false labour"; if the contractions become more frequent and continue for more than an hour, you are probably in labour. In the early stage of labour, they will probably last for 30 to 60 seconds.

If you are at term and in labour, you will probably also experience

  1. The beginning of the opening of the cervix to allow the passage of the foetus. As the cervix begins to stretch, it may release a plug of bloody mucus that has blocked the cervix during pregnancy.
  2. The rupturing of the amniotic membrane, most commonly after contractions have started. The rupture may come as a gush or as a slight dribble of fluid, but it won't hurt. The membrane may not break until you are in active labour at the hospital – but when it does, it is time to call your health care professional.

Early phase of labour

At home or in the hospital, your doctor will ask you about your labour so far – about your contractions and whether your membrane has broken. You will be asked, too, about bowel movements. If you have not had one recently, you may be given an enema or a suppository. A urine sample will be taken to test for protein and sugar.

During an examination you will be examined to determine the foetus' position and heartbeat; for your blood pressure, pulse, and temperature; and to see how much your cervix has opened. You will have periodic vaginal examinations, and the foetal heart rate will be monitored either periodically or continuously.

In the early stages of labour, if your doctor is not there at all times, he or she will be kept informed of your progress and will be notified of any problems. In the later stages, the primary provider should be present all the time.

During the first stage of labour the foetus drops, usually head downward toward the cervix, stretching it. If the amniotic membrane did not break at the start of labour, it will probably rupture now. The stretching of the cervix causes contractions of the uterus, which in turn push the foetus down and stretch the cervix more. Then the cycle begins again. In the early part of labour, the contractions might occur only once every 30 minutes.

During this stage of labour you will probably be encouraged to relax during contractions, rather than bear down. Bearing down now will not help the progress of delivery.

The length of labour with a first child averages 12 to 14 hours; after the first child, labour averages 7 hours.

If labour needs to be induced

If your health or the health of your child is at risk, your labour may need to be induced (started by the doctor). Induction may be selected for numerous reasons, including the following:

  • Amniotic membrane has ruptured without the onset of labour.
  • Placenta has been delivered before child
  • You have diabetes
  • You are 2 weeks past  your due date

The contractions of induced labour may be more painful, because they start so suddenly. Induced labour may also be more likely to require the use of pain medication.

If induction is needed, your doctor will discuss with you on when you would need to be admitted.

Stage of labour - (How to know when you're in labour)

First stage of labour

Before labour begins: Braxton Hicks contractions

  • These are like practice contractions for your womb, when it tightens and relaxes
  • They're not as strong or painful as contractions in labour and are irregular
  • You might get them for several weeks before labour

Before labour or as labour begins: Your ‘show'

  • The plug of mucus that seals your cervix during pregnancy comes away
  • It's a slightly pink mixture of mucus and blood
  • This can happen anywhere up to two weeks before labour begins, so don't worry if you don't go into labour right away

Signs of false labour

  • Contractions are irregular. It happens every 3 minutes, then every 10 minutes.
  • Contractions don't get stronger over time
  • They ease when you move around
  • They're not accompanied by increased mucus or bloodstained show

Signs of labour

  • Contractions have a regular pattern – for example every 10 minutes
  • They get progressively stronger
  • They don't ease when you move around
  • They may be accompanied by a show or your waters breaking
  • Your cervix is beginning to dilate - determined by vaginal examination.

Contractions start

  • Contractions are a tightening of the muscle. You can feel them in your front or back
  • They usually start slowly and feel like period discomfort
  • They'll feel stronger than Braxton Hicks contractions and are regular and painful
  • They help soften the cervix, which gradually dialtes.
  • This first stage of labour can take many hours, especially with your first child
  • Initially contractions will be more than 5 minutes apart. As labour progresses they'll become closer together and longer


Your waters break

  • The amniotic sac surrounding your child breaks
  • Your waters may suddenly gush out or it may be a very slow trickle throughout labour
  • It can happen before or after your contractions become strong and regular
  • Contact your hospital even if you're not having contractions

When do I go to hospital?

  • Phone your hospital or birthing unit and describe your symptoms
  • They'll help you decide when you need to come in
  • If you're experiencing any of the following, call the hospital immediately:
    • You're bleeding
    • Your waters break
    • You're in pain
    • You're not feeling your child move as much as normal

Labour slowing down

  • If labour slows down, your maternity team may suggest breaking your waters
  • This sometimes helps speed things up
  • If it doesn't work, you may be offered a hormone called Oxytocin, via a drip in your arm

Monitoring your child's heartbeat

  • Your doctor will monitor your child's heart on admission, intermittently during labour or continuously
  • They may use a hand-held monitor. Or one that's strapped to your tummy
  • If it's strapped to your tummy, it'll also monitor contractions

Second stage of labour

This is the stage when your child is born.

  • This begins when your cervix is fully dilated to 10 cm
  • You'll now feel you want to push
  • Your body will probably do this naturally. But don't worry if this doesn't happen: your doctor will guide you
  • If this is your first child, this part of labour can last an hour or more. If it's your second or more, it may be much shorter

Tearing and episiotomy

  • When your child comes out, it may tear the perineum (the area between your vagina and your anus)
  • To minimise tearing, your doctor will guide you as child's head is born and ask you to breathe instead of pushing
  • An episiotomy will only be performed if necessary
  • This is where they anesthetize and cut the skin to make the opening bigger
  • It's repaired straight after the birth

Forceps and Ventouse (Instrumental Delivery)

Sometimes the child needs some help coming out, for example if they are in an awkward position or you're exhausted. In this case, a doctor might use:

  • Forceps. These are placed on either side of the child's head. The doctor gently pulls on them when you push, to help your child out
  • A Ventouse. This is attached to your child's head using suction. The doctor gently pulls when you push to help your child out
  • An episiotomy is usually necessary if forceps or Ventouse are used

Don't worry if this leaves a red mark on your child's head. This is common and it won't last long.

Emergency caesarean

  • If there are problems and the child has to be delivered quickly, you'll be offered an emergency caesarean

Third stage of labour

This involves delivering the placenta (afterbirth). A Syntometerine injection as your child is being delivered can be given to you to help the third stage speed up. This will be given via an IV (intravenous) drip containing the hormone syntocinon. This is an option to be discussed with your doctor. You'll have more contractions as your womb shrinks, and it can take up to an hour. The good thing is it shouldn't be painful.

Going with the flow

Adjusting to events as they unfold.

  • Every mum-to-be has ideas of how they want their labour to be
  • Once labour has started, all you can do is adjust to things as they unfold. Take your birth plan with you and discuss it with your doctor
  • For example, you may be very keen on having a ‘natural birth' with as little medical intervention as possible. But sometimes events take over and you may want strong pain relief
  • It's important to ask your partner to remind you of your birth plan. But also to support you in whatever decision you need to make at the time
  • Listen to your doctor. They'll guide you and try to accommodate your needs

Pain relief in labour

There is a range of effective pain-relief options for you to choose from in labour. Write your choices into your birth plan and make sure your birth partner knows what you plan to use.

Natural techniques

  • Massage, breathing exercises and staying mobile can all help you to cope with the pain of contractions during labour
  • Having a supportive birth partner helps too
  • Some women find labouring in water helps to ease the pain of contractions
  • Others find that giving birth in familiar surroundings at home helps them to stay relaxed and so cope with the pain better

TENS (Transcutaneous Electrical Nerve Stimulation)

  • This is a device that emits small electrical pulses via electrodes stuck to your back
  • These pulses block pain signals to your brain and encourage your body to release natural pain killers called endorphins
  • TENS is only effective in early labour
  • It has no harmful side effects for you or your child

Nitrous oxide and oxygen (Entonox)

  • This is a mixture of oxygen and nitrous oxide gas breathed in through a mouthpiece or mask
  • It helps to reduce pain almost straight away
  • You control how much you have
  • Some women complain it makes them feel sick or lightheaded
  • Enotonox has no harmful side effects for you and your child

Pethidine

  • Pethidine is an injected pain reliever
  • It works by relaxing you and so eases pain
  • Doctors sometimes use a drug called diamorphine instead
  • The effects last for up to four hours
  • Some women find pethidine make them feel dizzy, which can make it difficult to push
  • Pethidine can't be used if you are labouring in water
  • If it's given too close to delivery it may affect your child's breathing and ability to feed

Epidural

  • A pain-relieving drug is injected into the space around your spinal cord using a fine, flexible tube
  • An epidural usually gives excellent pain relief
  • It can take a while to administer and take effect
  • You'll also need to have a catheter inserted into your bladder to help you wee
  • Your child's heart beat will need constant monitoring
  • Epidurals can't be administered at home
  • An epidural may make it harder to push because you lose sensation below your waist

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