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| Labour |
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| What
Happens During Labour? |
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No one will tell you that
giving birth is easy, but if you know what to
expect, you're much less likely to panic and more
likely to feel confident about any choices you
are asked to make. Labour is commonly divided
into three stages. In the first stage, you will
experience shorter, less painful contractions
as your cervix begins to dilate and thin out (called
effacement of the cervix). Later in the first
stage, your contractions will be more frequent
and painful as you reach transition, when your
cervix will be fully dilated. The second stage
involves actually delivering your baby, and the
third stage refers to the delivery of the placenta.
Most women dread the pain of labour more than
they dread the series of sleepless nights that
will follow. Every woman experiences pain during
labour differently, and it is very difficult to
describe the pain of contractions. In early labour
they can feel like menstrual cramps, or can be
confined to your back and feel like a lower backache.
Some describe contractions as waves of tightening
of the stomach and accompanying discomfort. You
can often see your stomach harden with the contraction.
You can't control your contractions, but your
state of mind can greatly affect the amount of
pain you feel. If you are having a hospital birth,
you should thoroughly discuss your pain relief
options in advance when you choose your hospital.
Remember, the medical staff are there to help
you, and there is no "right" or "wrong"
way to give birth. There's nothing wrong with
asking for pain relief if you want it. It is important
to know what all the options are, and to be fully
aware of the implications that your choice will
have.
Labour is usually longest with a first child,
lasting 12-14 hours in most cases. Typically if
you have light contractions, your labour will
be longer. |
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| First
Stage of Labour |
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During the first stage of
labour, your cervix will dilate and thin out to
allow the baby to pass through the birth canal.
Dilatation is measured in centimetres, so when
your midwife or doctor says that you have reached
ten centimetres dilatation, you know that your
baby is ready to be born. The so-called transitional
stage at the end of the first stage of labour
can be difficult, as you may be quite uncomfortable
and yet not be allowed to push. You may shiver
or tremble; some women experience nausea or vomiting.
Try to employ the breathing techniques you have
learned, and try varying your position to make
things a little easier.
If you have asked for an epidural, the anaesthetist
will visit you shortly after your admission to
hospital. Your baby's heart rate will be monitored
by fetoscope, sonicaid, or by a machine. You will
have a number of internal examinations to determine
how dilated you are. If a long period of time
has gone by, or you are experiencing particularly
strong contractions, or you are feeling discouraged,
ask for an exam so you'll know what progress you've
made. |
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| Second
Stage of Labour |
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The average duration of
the second stage of labour for first-time mothers
is about an hour, although it can be as long as
two hours or as short as 15 minutes for some.
You will feel an overwhelming urge to bear down.
When the midwife or doctor tells you, take a deep
breath, bend your knees and push. Pushing is very
hard work, so don't despair if you're feeling
a bit exhausted. It is much easier if you are
in a sitting or squatting position, or on your
knees or all fours. Take your time with pushing
in order to give your tissues and muscles a chance
to stretch and thereby avoid the need for an episiotomy.
Be sure to push during contractions, not between
them. Try to relax your pelvic floor (although
this sounds impossible, it can be done). Don't
worry if you pass a little urine or stool during
pushing. Your midwives and doctors have seen it
all before, and it will be whisked away before
anyone notices. Try to relax gradually after each
push so that the baby maintains some momentum.
When the baby is about to be born, your perineum
and anus will begin to bulge. Your baby's head
will appear more with each contraction, although
it may slip back a little in between contractions.
After the top of the baby's head appears (called
"crowning"), the head will be delivered
in the next couple of contractions. As the baby's
head stretches the end of the birth canal, you
will usually feel a burning or stinging sensation.
This lasts only a short time and is followed by
numbness as the baby's head stretches your tissues
so thin that the nerves are blocked. This creates
a natural anaesthetic. When you feel this burning
sensation, stop pushing and allow your uterus
to push the baby out. This can help prevent tearing
and avoid the need for an episiotomy. If your
doctor or midwife feels that you will need an
episiotomy, it will be performed now.
Once the baby's head has emerged, the midwife
will ensure that the cord is not around the baby's
neck. She will then wipe the baby's eyes, nose
and mouth and remove any fluid from the baby's
nose and airway. The contractions may stop for
a few moments and then restart for the delivery
of the baby's shoulders and body. Sometimes the
entire baby is delivered in just one contraction!
The midwife will probably help with the last part
of the delivery by pulling the baby out and lifting
him up towards you.
Your new arrival will be quite a sight. He will
be bluish in colour, slippery and covered with
blood, amniotic fluid, and vernix, the white greasy
substance that protected his skin from amniotic
fluid in the womb. His head may be pointy or misshapen
from the delivery. He may cry after the delivery
and continue to cry for a short while. If your
baby is breathing normally, you should be able
to hold him and put him to your breast immediately.
Both of you should be kept warm.
The midwife or nurse will assess your baby and
check to make sure breathing is normal. Newborns
are assessed by a series of five tests called
the Apgar score, administered at one minute and
five minutes. Each test is scored with 2,1, or
0. A breakdown of the tests and their scores is
shown below. |
Heart rate
- Above 100 beats per minute – 2
- Below 100 beats per minute – 1
- Absent – 0
| Breathing |
- Regular – 2
- Irregular – 1
- Absent – 0
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| Movements |
- Active – 2
- Some – 1
- Limp – 0
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| Skin Colour |
- Pink – 2
- Bluish extremeties only – 1
- Blue – 0
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| Reflexes |
- Cries – 2
- Whimpers – 1
- Absent – 0
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| Third
Stage of Labour |
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After your baby is born,
the uterus will probably stop contracting for
a few minutes. Eventually it will start up again,
perhaps helped along by an injection in your thigh
of syntometrine or ergometrine, synthetic hormones
which speed up the delivery of the placenta. The
third stage of labour is basically nothing more
than the delivery of the placenta. The placenta
will detach from the uterine wall and be expelled
painlessly by the contractions of the uterus.
The large blood vessels attached to the placenta
will be torn apart and then clamped together by
the tightening of the uterine muscles, Nature's
way of stanching the flow of blood. It is absolutely
essential that the entire placenta be delivered,
otherwise there is a risk of prolonged bleeding
and infection. The midwife will inspect the placenta
after it is delivered to ensure that it is intact.
You can look at it as well if you're interested.
Don't be alarmed if you shake like a leaf after
the delivery of the placenta. The shivering and
shaking should stop after a half an hour or so.
Get your birthing partner to fetch your jumper
or cover you with blankets. A glass of champagne
should help, too, if you feel up to it!
The umbilical cord will be clamped and cut, and
you can put your baby to the breast or simply
cuddle up get to know one another. Newborns are
usually quite alert in that first hour after birth.
You will be washed, stitched if you had an episiotomy,
and asked to urinate to ensure that your plumbing
is functional. Your baby will be wiped down and
weighed, and placed in a cot beside your bed or
in a nursery. |
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