The neck of the womb, or cervix, needs to open fully to about 10cm for a baby to pass through.  This is what’s called being ‘fully dilated’.  Contractions in early labour help to soften the cervix, so that it gradually opens.

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.

The main signs of labour starting are strong, long, regular contractions and a ‘show’. A show is when the plug of mucus from your cervix comes away. However, it is not unusual to ‘have a show’ several days or weeks before your labour begins and unless it is heavily blood stained, this is nothing to worry about.

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.

When you have a contraction, your womb (uterus) tightens and then relaxes, like a stronger version of period pains. You may have had contractions throughout your pregnancy, particularly towards the end. During pregnancy, these painless tightenings are called Braxton Hicks contractions.

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.

Backache

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.

While you are pregnant, a plug of mucus is present in your cervix. Just before labour starts, or in early labour, the plug comes away and you may pass this into your underwear. This small amount of sticky, jelly-like pink mucus is called 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.

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. This is your waters breaking.

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.

At the beginning of labour:

• 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.

Once your labour has established, your baby’s heart rate will be monitored throughout.  There are different ways of monitoring the baby’s heartbeat and these will be discussed by your midwife:

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.

If your contractions are not frequent or strong enough or if your baby is in an awkward position, your doctor or midwife will discuss speeding up the labour.  The following techniques may be suggested:

• 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.