Every labour is different and individual for each woman. For first time mothers, labour takes approximately 12 to 24 hours while women who are having their second or subsequent baby can expect labour to last approximately seven hours. Labour can be broken down into three stages.
The first stage of labour is generally the longest, taking an average of 8 to 16 hours for a first baby and 3 to 10 hours for a second or subsequent baby.
Labour contractions are responsible for the softening and thinning of the cervix and its dilation to around 10cm. There are three phases in first stage of labour and they include:
•The latent or early phase—generally, this stage is the longest and can be the least painful part of labour. The cervix may take weeks, days or hours to thin out and may come with mild contractions. The contractions may be regularly or irregularly spaced, or else you might not even notice them at all. Labour is said to be 'established' when the cervix is 4 cm dilated and contractions are regular and strong.
•The active phase—or established labour is marked by strong, painful contractions that tend to occur around three or four minutes apart and last up to a minute or so. This phase continues until the cervix dilates to approximately 7 cm, usually at the rate of 1 cm per hour in the presence of strong contractions.
•The transition phase—the contractions become more intense, painful and frequent. You may feel like the contractions are no longer separate but are running into each other. Or you might feel none of these things. Others find that their contractions are lasting one to one-and-a-half minutes and occur every two to three minutes. You might feel shaky, shivery and sick. The cervix may still take around 1 cm per hour to dilate the final 3 cm.
•It is not unusual to feel a strong urge to go to the toilet as your baby’s head pushes against the rectum. The midwife may check your cervix to ensure it is fully dilated before you start to push. You may feel a strong urges to push at this time.
The muscles at the top of your uterus are pressing down on your baby’s bottom and their head is pressing against your cervix. As the baby’s head descends, it exerts pressure on the cervix, assisting further dilation. Dilatation of the cervix may not occur at a constant rate and usually, the dilatation from 1 to 5cm takes much longer than from 5 to 10 cm. Generally, the stronger and longer the contractions, the more responsive the cervix will be in dilating.
If your labour is slow, your obstetrician or midwife may recommend further treatment to help labour progress. You will be given a clear explanation of why this is proposed, what is involved with augmentation of labour and your informed consent will be obtained.
Your waters may be broken during a vaginal examination if this has not already happened. This is often enough to get things moving. If not, you may be offered a drip in your arm containing a hormone called Syntocinon which will encourage contractions. The Syntocinon is increased every 30 minutes until your contractions are effective.
When the cervix is 10 cm or ‘fully dilated’ the second stage begins.
This stage begins when the cervix is fully dilated and lasts until the birth of your baby. Most women feel a strong urge to push. Your midwife or obstetrician will guide you if needed.
Find a position that you find comfortable and which will make labour or pushing easier for you. You might want to be in bed with your back propped up with pillows, or stand, sit, kneel or squat. Squatting will take practice if you are not used to it. If you are very tired, you might be more comfortable lying on your side rather than sitting up. If you have experienced backache in labour, kneeling on all fours might be helpful. It’s up to you. Try out some of these positions at antenatal classes or at home to find out which are the most comfortable for you. Your midwife will help you.
You will probably now feel like pushing each time you have a contraction. Your body will most likely tell you how. This stage is hard work but your midwife will help you by making suggestions and encouraging you. Your partner can also give you lots of support. Your midwife will keep you informed as to what is happening. This stage can take up to two hours, so it helps to know how you’re doing.
As the baby’s head moves closer, you can put your hand down to feel it, or look at it in a mirror. When the baby’s head is nearly born, your obstetrician or midwife will may ask you to stop pushing, to push very gently, or to puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby’s head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and anus) time to stretch without tearing. There will be a burning sensation as the skin is stretching. Sometimes the skin of the perineum won’t stretch enough and may tear, or there may be a need for the baby to be born sooner, in which case, the midwife or doctor will then ask your permission to give you a local anaesthetic and cut the skin to make the opening bigger. This is called an episiotomy. Afterwards the cut or tear is stitched up again and heals quickly.
Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. Your baby will usually be lifted straight on to your tummy before the cord is cut so that you can feel and be close to each other immediately. Your baby will be covered with a warm towel and you will be able to hold and cuddle your baby properly. Skin to skin contact is encouraged for all babies.
Your baby may be born with some of your blood and perhaps some of the white, greasy vernix which acts as a protection in the uterus still on the skin. Sometimes some mucus has to be cleared out of a baby’s nose and mouth or some oxygen given to encourage your baby to breathe effectively. If your baby requires more assistance, your baby will not be kept away from you any longer than necessary.
After your baby is born, more contractions will push out the placenta. This stage usually takes about 10 minutes but can take up to an hour. After discussion with you, your midwife may give you an injection in your thigh, just as the baby is born, or very soon after birth—this is called active third stage.
The injection makes the uterus contract and therefore helps to prevent a postpartum haemorrhage which is very heavy bleeding. You may prefer not to have the injection at first, but to wait and see if it is necessary. You should discuss this in advance with your obstetrician or midwife and make a note on your birth plan.