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Labour

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.

First Stage of Labour

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.

Second Stage of Labour

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.

  • Above 100 beats per minute – 2
  • Below 100 beats per minute – 1
  • Absent – 0

Breathing

  • Regular – 2
  • Irregular – 1
  • Absent – 0

Movements

  • Active – 2
  • Some – 1
  • Limp – 0

Skin Colour

  • Pink – 2
  • Bluish extremeties only – 1
  • Blue – 0

Reflexes

  • Cries – 2
  • Whimpers – 1
  • Absent – 0

Second Stage of Labour

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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