Stages of Labour

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There are three stages of labour;

The dilation of the cervix
The movement of the baby down and out of the birth canal
The delivery of the placenta or afterbirth.

As labour starts, the pressure of the baby's head on the cervix and the lower part of the uterus triggers a burst of oxytocin to be released. This prompts your uterus to start contracting. Your waters may break before contractions begin or during the first or second stage. It is important to remember that every birth is different.

If you're induced (when labour's brought on medically), prostaglandins (chemical messengers similar to hormones) are administered in pessary, tablet or gel form into your vagina to stimulate contractions.

The purpose of the contractions is to open your cervix to allow your baby to move down the birth canal (vagina) and be born. At the start of labour your cervix is hardly open, or dilated, sometime in the next 5 to 15 hours or so it dilates completely to 10cm. This may take longer for some women.

STAGE ONE

·                     Baby pushes downwards
·                     Contractions will get closer together and last longer
·                     Each contractions may last around 40-50secs and 10mins apart at the very beginning
·                     Each contraction will last longer than 1min & will be coming every 30sec towards the end
·                     You should try and stay as mobile as possible and try different positions to help baby down and encourage your cervix to dilate

In the first stage of labour, the purpose of contractions is to achieve a fully dilated cervix. Ripening of the cervix, a physical and chemical process that happens before contractions start, prepares the cervix. Ripening makes the tissues softer and thinner, ready to become dilated.

The baby is pushed downwards and almost reaches the end of the birth canal, with the head (usually) to be born first. During this stage, each contraction gets closer to the one before and lasts longer. This means labour gets faster as it progresses: it usually takes more time to go from being 1cm or 2cm dilated to 5cm or 6cm dilated.

A typical pattern is to experience 1 contraction for about 40 to 50 seconds every 10 minutes at the beginning of stage 1, and 1 contraction lasting more than 1 minute and then coming every 30 seconds or so at the end. By this time, the dilated cervix is fully open and wide enough for the birth of your baby's head.

During this stage it helps to stay mobile and to be somewhere you can experiment with different positions, such as leaning against something or getting on all fours.

Grinding to a halt?

Labour isn't always smooth running. It doesn’t always get gradually stronger and stronger. Sometimes, contractions may slow down or stop altogether before you get a fully dilated cervix. If you and your baby are fine, you needn't worry. Just be patient, calm and prepared to walk around or move into a different position while you wait for them to start again.

If contractions slow for a long period of time and it's thought that you and/or your baby might benefit from things being helped along, you may be advised to agree to:

• Stimulation of contractions with a hormone drip (usually a synthetic oxytocin)
• Artificial rupturing of your membranes (ARM), the technical term for breaking the waters around your baby
• Prostaglandins being used to help the cervix ripening and stimulate contractions.

STAGE TWO

·                     Cervix fully dilates (10cms)
·                     You start pushing with the guidance of your midwife
·                     You'll need to listen on when to breathe and when to push to help prevent any tearing
·                     The baby's head is born followed by the rest of the baby
·                     The cord is then clamped & cut
·                     Mother meets her baby and gets her first cuddle – it’s all been worth it!

The birth of your baby is usually a lot shorter than the first stage. However, times do vary, it can be very quick, lasting just a few minutes, or take more than 2 hours. It can be hard work, too, as you're actively pushing the baby out.

The second stage begins when the cervix is fully dilated (10cm) and you feel a very strong urge to push downwards, although if you've had an epidural you might not feel this urge. If this is the case, your midwife will tell you when to push. Pushing might be guided by the midwife, who can see what's happening. She might ask you to withhold some pushes, to coordinate them with your breathing, or to breathe through some of the urges. This can help prevent a tear in your perineum (the muscle and tissue between the vagina and the anus), which might happen if the baby comes out too quickly.

Your baby's head will emerge first, which is known as crowning. A couple more contractions and the head will be born, usually facing towards your back. Your baby's shoulders and head will then turn sideways. The baby is then born 'in full'. The umbilical cord is usually clamped and cut at this stage. All being well, you'll then be given your baby to hold.

STAGE THREE

·                     Delivery of the placenta takes place
·                     You may need an injection of synthetic hormone to help stimulate the uterus to contract
·                     Midwife may also need to help with their hand on your abdomen
·                     The placenta peels away and is delivered The delivery of the placenta takes 15 to 30 minutes.

You may not be very aware of it happening, as most of your attention will be on your baby. As your baby's born, you may be given an injection of a synthetic hormone, usually in your thigh or buttock. The midwife should ask your consent before she does this. It stimulates the uterus to contract, which causes the placenta to come away from the uterus. You might be asked to give a push or two to help it down, and the midwife might help with a process called 'controlled cord traction' - she places one hand on your abdomen, while the other hand keeps the umbilical cord taut. The placenta peels away and the blood vessels on the inside of the uterus close themselves, which stops most of the bleeding (some bleeding is normal).

Some mothers opt for a 'physiological third stage' or a 'natural third stage'. This means the uterus contracts by itself, and expels the placenta and membranes. The cord is normally clamped and cut soon after the delivery of the baby, but sometimes this is left until after the placenta has been delivered as well. If this is what you'd prefer to happen, ensure it's in your notes or is part of your birth plan. There are some situations in which it might not be considered safe, if you're at risk of haemorrhage for instance, or have a problem with blood pressure.

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