Labour: what to expect

Signs of labour

In the couple of weeks before you give birth you may notice certain physical signs that your baby is on the way.

•  Engagement

This is when the baby’s head drops down into the pelvis. It is also described as a ‘lightening’ as carrying the baby now feels different. For some people it’s actually more comfortable than before. However, your baby’s position now may mean that there is more pressure on your bladder, so loo breaks may become more frequent.

•  A ‘show’

This is when the ‘plug’ of mucous that blocked the cervical canal has comes away. It might look rather like slightly bloody jelly. Other women might not see this, but may notice a change to their vaginal secretions.

•  Braxton Hicks

Some women get false contractions known as Braxton Hicks for as much as six weeks before their due date, others barely notice these. However as the birth approaches, these tummy squeezes may well feel noticeably stronger. In some women they are so strong that they believe they are already in labour.

First stage

The first part of labour is when you will feel contractions. This is a series of short bursts of pain around your tummy as the uterine muscle tightens for a few seconds and then relaxes again. At the end of this part of labour the cervix (the opening of the womb) is fully dilated.

•  Contractions

These can vary in intensity, but as a rule, they will get stronger and become more frequent as labour progresses, with possible occasional easing off. If the contractions are mild for some hours, you may be able to take your mind off them by cooking, ironing or soothing the pain with a bath. As they intensify you may find that back massage from your birth partner really helps. The painful burst of a contraction may last only half a minute at first but eventually will last for longer than a minute, with the gaps inbetween each contraction becoming shorter and shorter.

•  Rupture of membranes

This is what is described as your ‘waters breaking’ and it can happen before contractions begin, during the hours of labour or even as late as the moment you give birth. For some people this is just a trickle of amniotic fluid, for others a gush. If it happens before you are at hospital, call your midwife to let her know as soon as you can.

•  Dilation

In order for your baby to pass out of the entrance to the womb and into the birth canal, the opening in your cervix has to open to a width of 10cm. This gradually happens during the first stage of labour and the rate at which it opens up is one of key ways your midwife can observe how labour is progressing.

Transitional stage

After several hours of discomfort with contractions a woman can feel exhausted, sometimes demoralised or frustrated that she is tired and yet she still has the birth to come.

This can be the point at which you opt for pain relief to help you keep going or, if the labour has already been long, that you might be offered some kind of pain relief in order to give you a rest. A sympathetic and soothing birth partner is a great help at this stage.

•  Breathing

After hours of regular breathing to get through contraction pain, this is the point at which you might begin to feel the desire to bear down (or push). However, your midwife will tell you if it is too soon to push. Instead you will need to take shorter breaths and blow out to help deal with your pain.

Second stage

This is usually much shorter than the first stage, taking up to a couple of hours at most and often less than an hour. This is the point at which your baby is going to pass down from your uterus, into the birth canal, ready to be born.

•  Bearing down

Your body will instinctively want to push, taking deep breaths in order to allow your body to do so. Go with your contractions to maximise the effect of each push.

•  Pushing too hard

Your midwife will guide you if she feels you are pushing too hard too soon, as this can cause physical damage to your muscles and vagina. Relaxing inbetween pushes is important, but also your midwife will not want you to stall for too long during this phase as it can slow down the birth.

•  Birth positions

Pushing is much easier to do if you are having an ‘active’ birth – on all fours, squatting or in a more upright position. These positions allow gravity to help you as well opening up your pelvic frame.

•  Birth

Your baby’s head will come out first. This is the toughest push in many ways because the vagina has to stretch open to allow the skull to pass through. The midwife will then guide the baby out, one shoulder at a time before the rest of the body follows easily.

Third stage

The third stage of birth is when the placenta follows the baby out through the vagina. During the birth of your baby, the midwife will give you an injection in your thigh which encourages the contraction of the uterus. This is to ensure there is no excessive bleeding after the birth.

•  Placenta

The midwife will examine the placenta to make sure it has come out complete and that no debris remains inside.

•  Cutting the cord

The umbilical cord is clamped once it has stopped pulsating. (In some cases the cord gets stuck around the neck of the baby, but usually a midwife is able to unhook this and the birth proceeds as normal.)

After the birth

Usually, you will be allowed to have instant contact with your baby. If there has been any concern during the labour and birth – concern your baby’s heart rate or the duration of the birth was particularly long, for example – then you will most likely to be advised that immediate checks will be required. However routine checks can almost always be carried out alongside you in the labour room, so you will not usually be parted from your new child.

More and more women value the benefits of immediate skin to skin contact with their baby, and as the rest of the team begin to clear up after the birth, you and your partner should enjoy this time.

Feed your baby if you want to, now. And do not feel hurried into bathing your baby – the blood and tissue will act as insulation from this big new world outside your womb.