Labour Process

For weeks you have been waddling around uncomfortably. Every few hours you have Braxton-Hicks contractions that can be quite uncomfortable and sometimes wake you at night, but they always fade away. Your back aches, and you are going to the toilet every hour because your bladder has nowhere to expand. The long awaited date is due, and still nothing dramatic has occurred.

Suddenly you notice that you have lost some bloodstained fluid through the vagina, and the contractions are worse than usual. You have passed the mucus plug that seals the cervix during pregnancy, and if a lot of fluid is lost, you may have ruptured the membranes around the baby as well. Labour should start very soon after this “show”.

Shortly afterwards you can feel the first contraction. It passes quickly, but every ten to fifteen minutes more contractions occur. Most are mild, but some make you stop in your tracks for a few seconds. When you find that two contractions have occurred only five to seven minutes apart, it is time to be taken to hospital or the birthing centre.

You are now in the first of the three stages of labour. This stage will last for about 12 hours with a first pregnancy, but will be much shorter (4 to 8 hours) with subsequent pregnancies. These times can vary significantly from one woman to another.

The hospital nurses fuss over you as you change into a nightie and answer questions. Soon afterwards, you may be given an enema. By the time the obstetrician calls in to see how you are progressing, the contractions are occurring every three or four minutes. The obstetrician examines you internally to check how far the cervix (the opening into the womb) has opened. This check will be performed several times during labour, and leads may be attached through the vagina to the baby’s head to monitor its heart and general condition. The cervix steadily opens until it merges with the walls of the uterus. A fully dilated cervix is about 10 cm in diameter, and you may hear the doctors and nurses discussing the cervix dilation and measurement.

As the labour progresses, you are moved into the delivery room. In a typical hospital delivery room, white drapes hide bulky pieces of equipment, there are large lights on the ceiling, shiny sinks on one wall, and often a cheerful baby poster above them. The contractions become steadily more intense. If the pain in your abdomen doesn’t attack you, the backache does, and your partner (who has hopefully attended one or two of your antenatal classes) massages your back between pains. You begin to wonder when it will all end. The breathing exercises you were taught at the antenatal classes should prove remarkably effective in helping you with the more severe contractions. Even so, the combined backache and sharp stabs of pain may need to be relieved by an injection offered by the nurse. Breathing nitrous oxide gas on a mask when the contractions start can also make them more bearable.

If you experience severe pain or require some intervention (eg. forceps), an epidural or spinal anaesthetic is given. This involves an injection into the spine, which numbs the body from the waist down. You feel nothing but remain quite conscious and alert, and you can assist in the birth process. Even a Caesarean section can be performed using this type of anaesthetic.

Eventually you develop an irresistible desire to start pushing with all your might. Your cervix will be fully dilated by this stage, and you are now entering the second stage of labour, which will last from only a few minutes to 60 minutes or more.

Suddenly there is action around you. The obstetrician has returned and is dressed in gown, gloves and mask. You are being urged to push, and even though it hurts, it doesn’t seem to matter any more, and you labour with all your might to force the head of the baby out of your body. The contractions are much more intense than before, but you should push only at the time of a contraction, as pushing at other times is wasted effort.

Another push, and another, and another, and then a sudden sweeping, elating relief, followed by a healthy cry from your new baby.

Immediately after the delivery, you are given an injection to help contract the uterus. A minute or so after the baby is born the umbilical cord, which has been the lifeline between you and the baby for the last nine months, is clamped and cut. A small sample of cord blood is often taken from the cord to check for any problems in the baby.

About five minutes after the baby is born, the doctor will urge you to push again and help to expel the placenta (afterbirth). This is the third stage of labour.

If you have had an episiotomy (cut) to help open your passage for the baby’s head, or if there has been a tear, the doctor will now repair this with a few sutures.

You should be allowed to nurse the baby for a while (on the breast if you wish) after the birth. Then both you and the baby will be washed and cleaned, and taken back to the ward for a good rest.

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