Signs and Stages of Labour

Signs of labour

It is unlikely that you will mistake the signs of labour when the time comes, but if at the time you have any doubt do not hesitate to contact your midwife.
 
The main signs of labour starting are strong, regular contractions, and a ‘show’. A show is when the plug of mucus from your cervix comes away however this is not always the same for every woman. Other signs of labour could be your waters breaking (rupture of membranes), backache and a need to go to the toilet due to the baby causing pressure on your bowel.

 

Regular Contractions
 

When you are having a contraction, your womb (uterus) gets tight and then relaxes. During your pregnancy you may have felt contractions and particularly towards the end of pregnancy, these painless tightenings are called Braxton Hicks contractions.
 
When you start to have regular, more painful contractions that feel stronger and last more than 30 seconds, you may be in labour, As your progress more in labour (gets established) your contractions tend to become stronger and happen more frequently.

During a contraction, the muscles in your womb contract and the pain increases.  If you put your hand on your abdomen, you can feel it getting harder. When the muscles relax, the pain fades and your hand will feel the hardness ease. The contractions are pushing your baby down and opening your cervix (entrance to the womb) ready for your baby to go through
 
Your Midwife will probably advise you to stay at home until your contractions are frequent. When you are having contractions that last around 30-60 seconds and are happening every 5 minutes call your midwife for advice. If you are having your baby in the hospital phone the labour ward: Pinderfields: 01924 541 661
Dwsbury: 01924 816 050
Midwife led unit, Dewsbury: 01977 747 432
 

You may or may not have the following signs:
 

Backache

Some women experience back ache or the aching, heavy feel some women get with their monthly period.

A ‘show’

While you are pregnant, a plug of mucus is present in your cervix. Just before your labour starts or in early labour, the plug comes away and you may pass this out of your vagina. This small amount of sticky, jelly-like pink mucus is called a show.
It may come away in one blob, or in several pieces. It is pink in colour because it is blood stained, and it’s normal to lose a small amount of blood mixed with mucus. If you’re losing more blood, it may be a sign that something is wrong, so telephone your hospital or midwife straight away.

A show indicates the cervix is starting to open, labour may follow quickly, or it may take a few days. Some women do not have a show.

Your waters breaking

Most women’s waters break during labour, but it can also happen before labour starts. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it’s time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.
 
You may feel a slow trickle or a sudden gush of water that you can not control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out, and put a plastic sheet on your bed.
 
Amniotic fluid is clear and a pale straw colour. Sometimes it’s difficult to tell amniotic fluid from urine. When your waters break, the water may be a little blood stained to start with. Tell your midwife at once if the waters are smelly or coloured or if you are loosing blood, as this could mean your baby needs urgent attention.
 
If your waters break before your labour starts, phone your midwife or the hospital for advice. Without amniotic fluid your baby is not protected and there is a risk of infection.

 

Stages of labour

There are three stages of labour:
 

  • The first stage, when the cervix gradually opens (dilates)
  • The second stage, when the baby is pushed down the vagina and is born (this is sometimes separated in to two phases- the passive or descent phase with no pushing, and or active or pushing phase)
  • The third stage, when the placenta comes away from the wall of the womb and is also pushed out of the vagina 


Coping at the beginning of labour
 

 At the beginning of labour

  • You can be up and moving about if you feel like it.
  • You can drink fluids and may find isotonic drinks (sports drinks) help keep your energy levels up.
  • You can also snack, although many women don’t feel very hungry and some can feel sick.
  • As the contractions get stronger and more painful, you can try relaxation and breathing exercises- your birth partner can help by doing them with you.
  • Your birth partner can rub your back as it may help relieve the pain.
 

The first stage of labour – dilation

 
The cervix needs to open about 10cm for a baby to pass through. This is called ‘fully dilated’. Contractions at the start of labour help soften the cervix so that is gradually opens. Sometimes the process of softening can take many hours before you are in what Midwives call ‘established labour’. Established labour is when your cervix has dilated more than 3cm.
 
If you decide to go in to your hospital or midwifery unit, as you believe you are in established labour, when you get there a Midwife will examine you to find out how far and how you are progressing in labour. If you are not in established labour the Midwife may ask you if you would prefer to go home as you may be more comfortable in your own surroundings rather than spending extra hours in the hospital or midwifery unit. If you decide to go home, you should make sure you eat and drink to keep your energy levels up.
 
At night try to get comfortable and if possible try to get some sleep. A warm bath or shower may help you relax. During the day stay as active and as upright as you can this will help your baby to move down into your pelvis and your cervix to dilate.
 
Once labour is established, the Midwife will check you from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker for subsequent pregnancies.
  

Speeding up Labour
 

Your labour may be slower than expected if your contractions are not frequent or strong enough or because your baby is in an awkward position. If this is the case, your doctor or midwife will explain why they think labour should be sped up and may recommend the following techniques to get things moving.
  • Breaking your waters (if this has not already happened) during a vaginal examination- this is often enough to get things moving.
  • If this doesn’t work, you may be offered a drip containing a drug (syntocinon), which is fed into the vein in your arm to encourage contraction- you may want some pain relief before this drip is started.
  • After the drip is attached, your contractions and your baby’s heartbeat should be continuously monitored with a cardiotocograph (CTG)
 

The second stage of labour

 
This stage begins when the cervix is full dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push.
 

Find a position

 
Find the position that you prefer and which will make labour easier for you. You might want to stand, sit, kneel, squat or sit in a bed with your back propped up with pillows, or you may have opted for a water birth. 
 
If you are very tired, you might be more comfortable lying on your side rather than propped up with pillows. If you’ve had backache in labour, kneeling on all fours might be helpful. It’s up to you. It can help if you have tried out some of these positions beforehand.
 

Pushing

 
When your cervix is fully dilated you can start to push when you feel you need to during contractions.
  • Take two deep breaths as the contraction starts, and push down
  • Taken another deep breath when you need to.
  • Give several pushes until the contraction ends
  • After each contraction, rest and get your strength up for the next one.
 
This stage of labour is hard work, but your midwife will help encourage you all the time. Your birth partner can also give you lots of support. This stage may take an hour or more, so it helps to know how you are doing.
 

The Birth

 
During the second stage, the baby’s head moves down the vagina until it can be seen, this is called crowning.  The skin of the perineum  (the area between your vagina and anus) usually stretches well, but it may tear. Sometimes to avoid a tear or to speed up the delivery, the midwife or doctor will suggest making a cut - this is called an episiotomy, you may be offered a local anaesthetic first but it's not always necessary.   Afterwards the cut or tear may be stitched to help healing.
  
Once as 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. You can have your baby lifted straight on to you before the cord is cut by your midwife or birth partner.
 

Skin to skin contact

 
Skin-to-skin contact really helps bonding, so it is a good idea to have your baby lifted onto you before the cord is cut so that you can feel and be close to each other straight away.
 
The cord is clamped and cut, the baby is dried to prevent him or her from getting cold, and you’ll be able to hold and cuddle your baby.  If you prefer to delay clamping the cord, let your midwife know during labour and put this in your birth plan so everyone is aware of your plans.  Your baby might be quite messy, with some of your blood and perhaps vernix on their skin. If you prefer, you can ask your midwife to wipe and wrap them in a blanket before you cuddle.
 
Sometimes mucus has to be cleared out of the baby’s nose and mouth. Some babies need additional help to establish breathing and may be taken to a special area in the room to be given oxygen. Your baby will not be kept away from you any longer than necessary.
 
 

The third stage of labour - placenta

 
After your baby is born, more contractions will push out the placenta. Your midwife will offer you an injection in your thigh just as the baby is born, which will speed up the delivery of the placenta. The injection contains a drug called syntocinon, which make the womb contract and helps to prevent heavy bleeding (postpartum haemorrhage).  If you prefer to deliver the placenta naturally, you will be supported to do this. 
 
Let your baby breastfeed as soon after birth as possible. It helps with breastfeeding later on and it also helps your womb contract. Babies start sucking immediately, although maybe just for a short time. They may just like the feel of your nipple in their mouth.
 

After the birth
 

Your baby will like being close to you after. The time alone with your partner and your baby is very special. Your baby will be examined by a midwife or paediatrician and then weighed, and possibly measured.
 

Vitamin K

 
You’ll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you before hand. If you prefer that your baby doesn’t have an injection, oral doses of vitamin K are available. Further doses will be necessary.
 

Stitches

 
Small tears and grazes are often left to heal without stitches because they often heal better this way. If you need stitches or other treatments, it should be possible to continue cuddling your baby. Your midwife will help you with this a much as she can.
 
If you have had a large tear or an episiotomy, you will probably need stitches. If you have already had an epidural, it can be topped up. If you haven’t, you should be offered a local anaesthetic injection.
 
The midwife or maternity support worker will help you to wash and freshen up before leaving the labour ward to go home or to the postnatal area.  If you have chosen to birth at home, you can relax with your family. 
 

Postpartum haemorrhage

 
Postpartum haemorrhage (PPH) is a complication that can occur during the third stage of labour, after a baby is born. PPH is uncommon. Losing blood during childbirth is considered normal. PPH is excessive bleeding from the vagina after birth.
 
There are two types of PPH, depending on when the bleeding takes place:
  • Primary or intermediate – bleeding that occurs within 24 hours of the baby’s birth
  • Secondary or delayed – bleeding that occurs after the first 24 hours, up to six weeks after birth.
 
Depending on the type of PPH, the causes include:
  • Poor contraction of the womb after the baby is born (uterine atony)
  • Part of the placenta being left in the womb (known as the retained placenta or retained products of conception)
  • Infection of the membrane lining of the womb (endomtritis)
 
To help prevent PPH, you will be offered an injection of syntocinon as your baby is being born, which stimulates contractions and helps to push the placenta out.
 
 
 
 
 
 
 








Click on the link below to see the leaflet from Mid Yorkshire Hospitals on different position for labour:

Positions in labour 
 
 

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