While it’s nearly impossible to plan for every aspect of your labour and delivery, you will probably appreciate feeling prepared. A few things to think through in advance of your birth:
- Create your birth plan, so that you and your midwife/obstetrician are on the same page as to how you’d ideally like your baby to be born.
- Pack your hospital bag.
- Have a look at a few common labour positions or attend one of the many parent education workshops available.
- Read up on breastfeeding basics, since you’ll most likely be able to give it a go the moment your baby arrives.
- Know the signs of labour so you’ll be aware when baby is almost here!
What happens during labour and birth?
Labour describes the gradual process of the womb contracting that eventually results in the birth of your baby. Every labour is different and its pattern and progress can be difficult to predict. This is a very special and unique time, and here at Saint Mary’s we hope to support you as much as you need through this process.
Please note: Because of the risks of surgery to mum and baby, Saint Mary’s does not offer Caesarean section without medical or obstetric reason.
- The first stage, when your contractions make the neck of the womb (cervix) gradually open up (dilate). This is usually the longest stage. It includes ‘early labour’ (also known as the ‘latent phase’) and ‘established labour’.
- The second stage of labour is when your cervix is fully open and you give birth. This is the part of labour where you help your baby move through the birth canal by pushing with your contractions.
- The third stage of labour is after the birth, when your womb contracts and causes the placenta (or after birth) to deliver. This is usually the quickest stage and takes less than 1 hour.
The first stage of labour
The process of softening can take many hours before you’re in what midwives call ‘established’ or ‘active’ labour. Established labour is when you are having regular contractions and your cervix has dilated to 4cm or more. If you come into Triage or the Midwifery Led Unit before labour is established, you may be advised to go home for a while to wait for your labour to establish. If you go home, you should make sure you eat and drink, and you can always contact your midwife for further guidance.
At night, attempt to get comfortable and relaxed. If you can, try to sleep. A warm bath or shower may help you relax. During the day, keep upright and active. This helps the baby move down into the pelvis and helps the cervix to dilate.
Once labour is established, the midwife will examine you regularly to see how the labour is progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours.
How will I know when my labour starts?
Other signs that labour is beginning include your waters breaking (rupture of the membranes), or strong intermittent backache and contractions that become more regular.
You’re likely to recognise the signs of labour when the time comes, but if you’re in any doubt, don’t hesitate to contact your midwife for advice.
What are contractions like?
When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labour may be starting. As labour gets going, your contractions tend to become longer, stronger and more frequent.
During a contraction, the muscles in your womb contract and the pain increases. If you put your hand on your abdomen, you will 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.
For the majority of women with an uncomplicated pregnancy, studies have shown that the labour will progress better in your own environment at home, therefore your midwife will probably advise you to stay at home until your contractions become and remain frequent.
For first-time mums, it is not uncommon for your contractions to become stronger and regular and then slow down again. This is simply your body preparing for active labour so take the opportunity to rest whilst you can. Remember to eat and drink plenty of water to keep your energy levels up during this period.
When your contractions last 30-60 seconds and occur every five minutes, call your midwife for further guidance.
If you’re planning to have your baby in the Midwifery Led Unit contact the unit directly on (0161) 271 0018.
If you have been recommended by your doctor or midwife to have your baby in the Consultant Led Unit, please contact Triage on (0161) 276 6657.
If your midwife has advised you to come into the hospital, please remember to bring your hand-held notes.
Other common symptoms in labour
Lower backache is very common in labour and is part of the normal processes. You may get backache or the aching, heavy feeling that some women experience with their monthly period.
What is a ‘show’?
It may come away all at once or gradually. It is pink in colour because it’s 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 Triage on (0161) 276 6567 straight away.
A show may indicate that the cervix is starting to open and labour may follow quickly, or it may take several days or even weeks. Some women do not have a show.
What happens when your waters break?
You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out and put a protective 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 begin with. Tell your midwife immediately if the waters are smelly or coloured, or if you are losing blood, as this could mean you and your baby require urgent attention.
If your waters break before labour starts, contact Saint Mary’s hospital on the number you have been given by your midwife. If you can’t find this number, or have not been given it, call Triage on (0161) 276 6657 for advice. Without amniotic fluid your baby is no longer protected and there is a small risk of infection.
How to cope when labour begins
- Walking and moving can help the labour to progress.
- Drink plenty of clear fluids and you may find isotonic drinks (sports drinks) help keep your energy levels up.
- Have regular snacks, although many women don’t feel very hungry and some feel sick.
- As the contractions get stronger and more painful, you can try relaxation and breathing exercises – your birth partner can help by doing these with you.
- Your birth partner can rub your back as it can help relieve pain.
- You can take paracetamol 1g (2 tablets) every 4-6 hours, up to a maximum of 8 tablets in 24 hours.
- A warm bath or shower may also help.
Monitoring your baby in labour
Your midwife may listen to your baby’s heart intermittently, for at least one minute every 15 minutes when you are in established labour, using a handheld ultrasound monitor. This method means you are free to move around. This is the best method of monitoring for women with healthy pregnancies on the Midwifery Led Units.
Your baby’s heartbeat and your contractions may also be monitored continuously using a machine called a CTG (cardiotocograph). Two monitors will be held onto your abdomen (tummy) using soft belts. You can still get up and move around with a CTG, but how far you can move will depend on the type of machine. On our Consultant Led Unit, we have a wireless CTG monitor which can be used in the birthing pool.
If the midwife cannot get a good trace of your baby’s heart rate through your abdomen, they may recommend putting a clip on the baby’s head to record the heart rate. The clip (called a fetal scalp electrode) is put on during a vaginal examination and your waters will be broken if they have not already done so.
Sometimes it is necessary to find out whether a baby is coping with the contractions and maintaining their oxygen levels. If this happens, the doctor will talk about an extra test on your baby called a fetal blood sample (FBS). This involves taking a small scratch of blood from the baby’s head, and is quick and safe to do. It has been shown to reduce unnecessary interventions during labour.
Speeding up Labour
- Getting up and moving around, drinking more water or isotonic drinks and/or making sure you have emptied your bladder can often encourage your contractions to become frequent again.
- Breaking your waters using a procedure called artificial rupture of membranes, or ARM, is often enough to speed up the labour. During a vaginal examination, the midwife or doctor makes a small break in the membranes around your baby.
- A drip containing a drug called Oxytocin or Syntocinon, which is given into a vein in your arm to encourage contractions. After the drip is attached, your contractions and your baby’s heartbeat should be continuously monitored with a CTG.
The second stage of labour
This includes the ‘pushing’ stage. It begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and guide you when you feel the urge to push.
Finding a position to give birth in
Find the position you prefer and that will make labour easier. You can stand, sit, kneel or squat and an upright position is recommended as this is the easiest and most effective position to help the baby be born. Some positions are more appropriate depending on the position of your baby and your midwife can guide you to choose the best position for both of you.
Pushing the baby out
When your cervix is fully dilated and your baby moves downwards, you will feel a very strong urge to push. The midwife will support you with this. Find out more about what your birth partner can do.
The third stage of labour
This is the name given to the delivery of the placenta. It is recommended that you have an injection in your thigh just as the baby is born, to speed this up and to prevent heavy bleeding. If you would prefer not to have this injection, please discuss this with your midwife.
Soon after your baby is born, your midwife will examine your vagina and perineum for any tears and either your midwife or a doctor will repair these (if needed) to help the healing process.
Encourage your baby to lie skin to skin on your chest after birth – this could also be done by your partner. Skin to skin his has been shown to encourage parent-baby bonding, regulate baby’s temperature and breathing and will encourage you both to recover after birth. It also prepares your baby for their first feed, regardless of feeding method.
It is recommended to let your baby breastfeed as soon after birth as possible. This helps with breastfeeding later on and it also helps your womb contract. Most babies start sucking immediately. However, this sometimes occurs just for a short period of time – they may just like to feel the nipple in their mouth.
Meeting your baby
As long as you haven’t experienced any complications during labour and delivery, you’ll be able to hold your baby — and breastfeed, if you choose — immediately following delivery, often while you’re delivering your placenta and your practitioner is repairing any tears. Take the time for some quality cuddling together — and speak up, since your baby will recognise your voice and your partner’s. You may feel an immediate bond with your baby, or you may feel somewhat detached. Both responses are completely normal. No matter how you feel now, you will come to love your baby intensely. Sometimes it just takes a little time.