Advice from Canpol's experienced mothers.

Labour stages


Labour is one of the most important and possibly most beautiful, although difficult moments in the life of every woman. Emotions accompanying the first meeting with your baby are hard to describe. It may look so simple - just go to hospital and give birth to a baby. However, before a little person arrives to this world, the future mum has to go through successive stages of labour.


Remember. Positive approach is a must!

You know it is difficult, especially after listening to horrible stories of friends, aunts, women in a shop, other pregnant women in the doctor's waiting room or reading information on internet forums on pregnancy. Especially that the stories told immediately after childbirth are often exaggerated. For this reason you may be scared of labour, but that fear may be significantly reduced if you know what is there in store for you, what successive stages of labour look like, what are the symptoms and what you should do at each moment. Common sense and positive approach are the most important, as well as confidence in the institution at which you want to give birth.

In normally progressing labour, three stages are distinguished.

The first stage is divided into 3 phases: latent, active and transitional.

During the first latent phase:

- Cervix shortens and dilates to 3 - 4 cm. The latent phase of the first stage means shortening of the vaginal part of the cervix and sometimes it occurs without the conscious participation of the patient. The cervix prepares itself for labour during the final weeks of the pregnancy, and a woman does not have to feel any related discomfort. It is also hard to call "latent" the period of reaching dilation of 3 - 4 cm, as most women remember that stage as the worst. It is the longest stage of labour, afterwards it is downhill all the way

- You may feel mild contractions lasting 30 - 45 seconds, pains in the lower abdomen similar to that during a period, or pushing. Then, you may feel a very strong urge to defecate.

- Dark brown fluid, sometimes tinted slightly red, may flow out of your vagina.

-During this phase the mucus plug may be expelled (According to publications, the plug may be expelled up to 2 weeks before birth, but in reality, the situation varies. Everything depends on the amount and thickness of the plug, which also varies for every woman) . It is a jelly-like discharge, tinted pink or brown (it can also be yellowish, if you used vaginal globules before birth) that acts as a plug stopping the entrance to the uterus during pregnancy. It forms a kind of barrier between the baby and outside world.

- During this phase you can stay comfortably at home, as it may last even several hours. However, if you want to give birth with epidural anaesthesia, you should go to hospital. This anaesthetic is administered at about 3 - 4 cm dilation. When the dilation progresses and reaches 8 cm, it is too late for the anaesthetic.
 

- The best thing for that phase is walking, as it brings relief. I particularly recommend a walk or, possibly, a relaxing bath. It should not be too hot. Do not take a bath if you bleed from the vagina. You can also watch a film or read a book.

You should go to hospital immediately, when:

- You have strong, painful and REGULAR contractions about every 10 minutes for at least half an hour. The contractions every 10 minutes may yet weaken, but at that moment women start to worry that they will not reach a hospital in time (particularly, when it is a consecutive birth). Most women arrive too early, but that is understandable and nobody holds that against them.

- When the waters break, you may feel as if you wetted yourself. Sometimes you may not have any contractions before that. Your waters should be transparent. Any other colour (pink, containing blood) should be diagnosed by a doctor. Green waters signal that a slight anoxia occurred resulting in the baby expelling meconium into the waters. In such case labour should be strictly controlled with CTG. It may also be necessary to monitor the baby's condition continuously or more frequently. This decision will be made by hospital personnel.

During the second, active, phase:

- At that phase the cervix dilates to 7 cm.

- The uterine contractions are more intense, stronger and longer, they last 45 - 60 seconds, and occur every 3-4 minutes. You should remember, however, that each pregnancy should be approached individually, and so that time may be slightly shifted either way.

- At that phase contractions are so strong that you may have a problem with normal conversation while a contraction comes.

- Pain in the tights and sacral area increases, and bloody discharge is expelled from the vagina.

- At that phase you may feel slightly tired, worried or excited with the approaching birth.

- If there are no contraindications, you may drink some water or eat a small light meal, but most doctors forbid eating or drinking. In that case you may wet your mouth with water. Fluids may also be administered intravenously.

- At that phase you may walk around the room or at least around the bed. Change your position frequently, as this facilitates the uterus function.

During the third, transient, phase:

- The final 3 cm to the full dilation do not last that long. Usually the cervix is fully dilated (10 cm) after 15 minutes to 1 hour. There are some women, however, who get stuck at the 7th centimetre for even two hours.

- Contractions are now very frequent and strong. They occur every 1 - 2 minutes and last 60-90 seconds. You may feel as if contractions do not ease at all, only sometimes are weaker and sometimes stronger. Be strong and do not give - You may feel pain in you lower back and in your perineum. You may also feel a strong rectal pressure, resulting in passing urine or stool. For that reason enema and frequent urinating are recommended at the earlier stage. Enema is not obligatory, but it is worth considering - uncontrolled passing of stool in the presence of medical personnel is embarrassing and unpleasant for a woman in labour. Regular emptying of the bladder is necessary for better head engagement in the birth canal, but administered epidural anaesthetic may eliminate a need to urinate. Therefore, if attempts to urinate are unsuccessful, there may be a need to insert a catheter into the urethra of the woman in labour. The full bladder is a significant obstacle during birth.

- You may experience vertigo, nausea or even vomiting. That is very common in women at that stage of labour. Vomiting is very onerous for women in labour but it signals labour progress. However, not all women vomit during labour.

- During the transition phase you may have spells of shivering and feeling cold alternately with hot flushes and sweating. These signs are completely normal. There is no need to worry.

- At this phase of labour you may already feel exhausted and discouraged with long toil. This is a very difficult moment for a woman in labour, as it is difficult to concentrate and relax during painful contractions.

- The transient phase is the most exhausting and the hardest, thus it is good to have someone close beside you, who will assist and support you in critical moments. It can be your husband or best friend. It is important for the decision about a birth partner to be thought over and agreed together, and not spontaneous or forced by fashion. It must be a person whom you can fully trust and not be ashamed of your pain - with strong nerves, who will support you instead of panicking.

- Try to relax during breaks between contractions. If it is possible, breathe slowly and as regularly as you can. You can use breathing techniques learnt at antenatal classes. You can also ask a midwife for assistance.

- Remember that you should not start to push before the cervix is fully dilated as that may cause swelling and prolong the whole labour. You can start pushing only on a signal from the midwife.

The second stage of labour may last only a few minutes, but it should not exceed 2 hours (The Polish Gynaecological Society recommendations)

- Contractions in the second stage occur every 2 - 5 minutes and last 60 - 90 seconds. They are still very strong, but less painful, and you can feel when one ends and the next begins.

- Rectal pressure is particularly strong. You may feel urgency to defecate. Inform the midwife about the urgency to defecate. Never go to a toilet without informing the midwife if you do not want to give birth in the bathroom.

- When the baby's head moves along the birth canal, you may feel pins and needles, itching, stinging or even stabbing pain.

- During pushing you may pass stool or urinate. It is completely natural. Do not worry about that. (In such case everything is cleaned immediately, to prevent discomfort for a woman in labour)

- You should find a position comfortable for you, e.g., half-sitting. You can also squat. Everything depends, of course, on your mood and strength.

- At that stage you should listen to the midwife and the obstetrician's commands. The correct breathing, helping to get through labour and good for the baby, is important.

- You should rest during breaks between contractions. This is a moment to relax your facial muscles, control your breath. As the contraction increases, your breath should be quicker, until you feel a strong urge to push. At that moment, keep the air in your lungs and push your diaphragm towards the pubic symphysis. When the contraction eases, again you have time to relax and control your breath. If scream brings you relief, you can scream at the end of pushing and during the break between contractions. Screaming at the beginning or during pushing may result in exhaling all air required for pushing, and pushing is ineffective. A woman is tired, and a baby is stuck in the perineum.

- The midwife may ask you to refrain from pushing in a given moment. It is usually related to prevention of perineal lacerations.

- During successive contractions a moment arrives when the baby's head is pushed out, and this is a breakthrough in the second stage of labour. If necessary, at that moment the midwife, using special scissors, performs the episiotomy to protect skin against tearing.

- The head is followed by shoulders, tummy and legs and the newborn arrives to the world. Then you hear its first scream. The midwife will put the baby on your belly and cut the umbilical cord (you may ask the midwife to allow your partner to cut it). Then the baby is weighted, measured and assessed according to the ten-point Apgar score.

At that moment you pass to the third stage of labour.

The third stage of labour lasts from few minutes to about half an hour.

- At that stage the uterus contracts expelling placenta.

- Contractions are significantly shorter, weaker and less painful than before. You may not even feel them at all, being absorbed with your new-born baby.

- The midwife will take your temperature, blood pressure, and obstetrician will check condition of your perineum, vagina and uterus, as well as of the placenta. Sometimes it is partly damaged and curettage is necessary. It is very important that the whole placenta is removed from the body, as its remainders may cause infections and haemorrhages. In some hospitals stiching of the perineum is also performed by midwifes and a doctor is called only for difficult cases. This solution will be also in force from April this year.

- If the epistomy was carried out or perineal lacerations occurred, the perineum is stitched under local anaesthesia.

- When all examinations are completed, you will stay in the delivery room for 1 - 2 hours for observations. After that time you will be transferred to the postnatal room. If there are no contraindication, after 2 - 3 days you will be discharged home with your baby.

Stasia

Mum of 9 year old Karolinka and 1,5 year old Adaś, 14 years of professional experience

Marta Piątkowska

Midwife
- consulting

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