The birth

Latent labour

Latent labour refers to the early phase of your labour. It is a good idea to use this time to rest and stay as relaxed as possible if you can. Eat, rest, nourish. Use heat packs, shower and bath to help ease the discomfort. The latent phase can last many hours, sometimes your contractions may be intense enough that you need to concentrate on your breathing, but you should be able to talk through them. 

First stage - dilation and effacement of your cervix

In the early part of the first stage you may have small contractions every 20 minutes or so. Your contractions may be irregular in frequency and strength. As labour progresses, the contractions will get longer, stronger and closer together. Towards the end of the first stage you will have them every three to four minutes. Active labour, is described as strong and frequent contractions, with a dilating cervix.

During the early first stage you may find that going for a gentle walk, having a warm shower or keeping busy by sharing the excitement with your other children or family members. Now is a great time for your support person to make sure everything is ready for the active stages of labour. Natural forms of pain relief - water, massage, heat, acupressure are great tools to help you stay comfortable during the first stage. 

Transition

At the very end of the first stage of labour, as the cervix finishes dilating to 10cm, many women find that labour becomes even harder. You may feel shaky and cold, or even be sick. You may become distressed. This is one of the hardest stages of labour. You may have a small bit of cervix left to dilate but your body wants to push. Your baby may be trying to find the best position to birth. Some women have no contractions during transition and there is a quiet period. Transition is generally the shortest phase of labour and tends to last between 15 - 60 minutes with contractions at their strongest when they come.

How To Cope

For the majority of women this is when they feel they need the support of their birth partner the most. They can massage your shoulders, put pressure on your acupoints and give you lots of encouragement while reminding you that baby will be here soon. Changing positions as your baby descends into the pelvis might help with the discomfort. Transition is a great time to focus on your breathing techniques to get through this phase. 

The second stage and the birth

Once your cervix is dilated to the full 10cm, you can begin to push. This is called the second stage of labour. Some women feel an urge to push earlier and will be assisted by their midwife to try and breathe through until the last part of cervix disappears. They may suggest position changes. They may perform a vaginal exam to confirm the cervix is all gone and again during the second stage to ensure that baby is descending with your pushes. You may find that you are more comfortable in an upright position when pushing, allowing gravity to help your baby descend into the pelvis. Try kneeling with your arms and shoulders resting on either the edge of the birth pool (if you are having a water birth) or on a chair or bed. Some women find that standing with one leg elevated on something can help as well. With every contraction your baby will move lower in your pelvis.

Most women get a strong urge to push with each contraction; your LMC will guide you through the pushing stage if needed. If you have an epidural you may need some guidance from your midwife if you do not feel the pressure of the contractions. Many women poo as they are pushing. Don’t be embarrassed, it is a sign you are pushing well!  As your baby is about to be born, your LMC may tell you not to push, but to pant or breathe. This allows the baby’s head to be born gently. You may feel what some refer to as the ‘ring of fire’ as your baby’s head crowns. Your last pushes will birth your baby’s shoulders and the rest of their body. Your baby will be placed skin to skin on your chest or stomach. 

Third stage - placenta 

The delivery of the placenta is the final stage of labour. 

Physiological - This is where you have no medication and your placenta is left to detach naturally. It can take 30 minutes, sometimes up to an hour. Putting your baby to the breast can help stimulate uterine contractions. Getting into an upright position and emptying your bladder may also help. 

Active Management - You may be given an injection in your thigh just as the baby is born to help deliver the placenta. This helps encourage your uterus to contract and your placenta detach. It is used if there are any concerns about bleeding, your uterus is very tired or you have had interventions in labour such as oxytocin. Your LMC will put her hand on your uterus (on the outside of your stomach) and gently pull on the umbilical cord to guide the placenta and membranes out. This is called controlled cord traction (CCT). It’s important to discuss this with your LMC before the baby is born. You will be given the choice of whether you want to keep the placenta or not. 

Early signs of labour

In The Week Or So Before Labour You May Notice:

• change in vaginal discharge
• the appearance of the ‘show’, the jelly/egg white like plug of mucus that seals the cervix during pregnancy
• a need to get things finished and ready—the so-called nesting instinct 
• feeling quite emotional; crying for no real reason as your hormones get to you
• a sense that you don’t want to be far from home
• loose bowels (diarrhoea). This is nature’s way of clearing out your lower bowel before labour begins
• Braxton Hicks contractions becoming stronger and more painful

Mucus plug (MP)

Your mucus plug is a thick clump of mucus that seals your cervix to protect your growing baby from bacteria or infection entering your uterus through your vagina. As your body prepares for labour you may notice parts of the MP as discharge or it may come out in one go. It is a similar texture to the discharge you may have during ovulation - like an egg white or stretchy jelly. It may have small bits of blood in it too.

This can happen days, or weeks before you labour. Your mucus plug can regenerate itself. 

Monitoring

Your LMC will listen to your baby’s heartbeat at regular intervals during labour, to ensure your baby is well. In a well pregnancy and labour, the LMC will use a hand-held monitor (Doppler) placed against your abdomen, like they did in your antenatal appointments. If there are concerns about your babies heartrate during labour your LMC may recommend the following monitoring. 

Cardio Toco Graph (CTG)

This records your baby’s heartrate and any uterine activity (contractions). You will have straps that go around your stomach, holding the monitors in place. They connect to a machine that prints out a record of your baby’s heartbeat and your contractions. This gives your LMC/Obstetrician and hospital midwives information about how your baby is coping with labour. 

Fetal Scalp Electrodes (FSE) 

A fetal scalp electrode or FSE is a spiral wire that can be placed on the scalp of your baby to monitor their heart rate and ensure their well-being. It is placed via a vaginal exam when it is difficult to monitor your baby through CTG or if your baby is in distress. 

Fetal Blood Sampling (FBS) - Only available in some hospitals

If there are signs that your baby is in distress, doctors may take a small sample of blood from the baby’s scalp, called fetal blood sampling (FBS). The results of this will assist your obstetrician and midwives to decide if your baby needs to be delivered sooner, or if labour can continue. 

Emergencies

Midwives and hospital staff are highly trained to deal with and provide emergency care. It could be scary when the bells/alarms begin to go off and lots of people rush in but they are very well prepared for these situations. 

Post-partum haemorrhage

Some women bleed after the birth. You may require extra medication via an injection in your leg or IV drip to help your uterus stay contracted and reduce bleeding. This bleeding can be caused by a tired uterus, retained tissue or bleeding from tears inside your vagina. It can be sudden and scary, if you are in the hospital your midwife will call for extra help. You will suddenly find there are lots of people in the room, just try to stay calm as they care for you.