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Stages of Labour

The First Stage

The first stage is when the cervix opens from 4cm -10cm, with regular contractions.  The contractions will become stronger, longer, and more frequent.  Contractions are usually about every 5 minutes, lasting 40-60 seconds.  Remember, every contraction is doing its job!  You can do it!

The length of the first stage of labour varies between each woman. On average, labour will last about 8 hours for women who are having their first baby and is unlikely to last over 18 hours. For women having their second or subsequent baby, labours on average take 5 hours and are unlikely to last over 12 hours.  We consider it to be perfectly normal for the cervix to dilate approximately half a centimetre an hour, with regular strong contractions.  The position of your baby inside the womb and the positions you adopt during labour can affect the length of your labour.

Remember:  Working with your body and adopting upright positions will encourage effective regular contractions, resulting in a quicker, less painful labour.

Self-help Strategies for the First Stage

  • Remaining upright and active can shorten your labour and mean that less pain relief is required

  • Keep changing positions until you are comfortable

  • Conserve your energy when you can, by finding positions where you can relax fully supported.  Leaning over the back of the bed, or propped up on a chair supported by pillows may help

  • Keep drinking sips of fluids.  Still isotonic drinks can be helpful and give you a boost of energy during labour

  • Remember to keep your bladder empty at least four hourly as a full bladder slows down contractions, and stops baby’s head entering the pelvis effectively

  • Have your birth partners support you with massage and distraction  techniques

  • A shower or bath, or use of the birthing pool will help you stay clam and relaxed.  Remember, your body will produce lots of oxytocin and therefore effective contractions when you are calm and relaxed

  • Eat  small amounts of high energy foods during labour including chocolate, dried fruit, toast, energy bars,  glucose tablets.  Eat little and often
     

The Transitional Stage of Labour

The transitional stage is described as the most painful part of labour, as your body is changing from the cervix opening to the body getting ready for the pushing stage.  Women often experience the transitional stage around 7-10 centimetres dilated. 

During this phase, women often experience physical symptoms such as shaking, nausea and vomiting.  An obvious change in emotional state is witnessed, as many women feel overwhelmed and out of control.  Women often state that they cant cope, want pain relief, and that they have had enough and are going home.

Birth partners note:  Often all the supportive techniques that you have used effectively up to now will be a source of agitation during transition.  Indeed, many women often push birth partners away and focus on themselves.

This phase is only temporary and lasts approximately 10-15 minutes (4 or 5 contractions). Midwives are aware of the signs of transition and will encourage the woman to try and adopt different positions to get through the stage.  It can be distressing for the birth partner to observe the transition stage and the Midwife will encourage them to provide support and encouragement too.

In some women the transition stage may last longer, and the Midwife will support you through this process.

 

Self-help Strategies for the Transitional Stage

Feelings of panic, loss of control and physical side effects are common, and the support of your birth partner is vital at this time.

  • Keep changing positions, it will be difficult to get comfortable

  • Knee chest positions help to ease an early urge to push, and reduces the pressure felt in your bottom

  • Try to concentrate on your breathing, or distraction techniques during your contractions

  • Try to stay focused during your contractions, keep interruptions to a minimum, close your eyes and concentrate

  • Sips of water will help keep you hydrated and reduce the feeling of nausea

  • Reassurance and support will help at this time

 

Remember that every contraction is doing its job, and that labour doesn’t last forever. You can do it!

 

The Second Stage of Labour

The second stage begins when the cervix is 10cm open or fully dilated and ends with the birth of the baby.

The second stage usually takes place within three hours for women having their first babies, and within two hours if you have had a baby before.  The second stage can be divided into two parts:

Passive stage:  fully dilated but no urges to push
Active second stage: when one or more of the following exist:

  • expulsive contractions (making you want to push)  with the finding of full dilatation of the cervix

  • active maternal effort, following confirmation of full dilatation of the cervix in the absence of expulsive contractions

  • external signs of full dilatation

 

Contractions in the second stage are usually shorter than in transition, with a longer space in between them.  Some women experience a temporary lull in contractions, which is nature's way of letting the body recover.  Take this opportunity to rest and build up your energy stores for pushing.

Your body usually knows instinctively when to push, and the urge will be irresistible.  Each push helps guide baby down the birth canal.  Women often experience a sensation of pressure on the bowel and the urge to go to the toilet at this time.  It is perfectly normal to feel this sensation, and try not to be distracted or anxious about it.  These are all positive signs that baby is making its way down the birth canal. 

The more upright you are during the pushing stage makes it easier for you and your baby as gravity will help.

As you continue to push or bear down, try not to hold your breath.  Instead, take a big breath in and slowly exhale as you push – it may help if you focus on pushing your baby down and out while you are doing this.  After you have fully exhaled, take a couple of shallower breaths and then another deep inhalation as the urge to push begins again.  Continue breathing like this through the contraction.  If you hold your breath while you push, this can make your baby tired or distressed due to a lack of oxygen supply to the baby.  Do not worry - your Midwife and birth partner will help guide and support you through the pushing phase.

Follow your body: it instinctively knows what to do!

As you push, the baby has to negotiate the pelvis and pelvic floor in order to be born in the right position. The sensation of baby’s head touching the pelvic floor gives a surge of oxytocin, which makes the contractions more expulsive.  This is nature's way of giving you a helping hand. 

For those women who have had an epidural (which anesthetises or numbs the pelvic floor), this process is not as effective and that is why the second stage with an epidural is usually longer.  There is also an increased chance that we may have to help you give birth to your baby with the use of forceps or ventouse as a result.

It can be helpful at this stage to imagine that baby is going round a ‘u-bend’, with every contraction gently guiding baby a little bit further.  You may feel the sensation of baby’s head moving forwards and backwards with each push.  This is perfectly normal, as baby has to stretch the vaginal tissues. Once baby gets round the “bend”, baby will stop slipping backwards.  As the head presses on the vaginal tissues and stretches the perineum, you will feel a burning and stinging sensation.  Again this is normal and sends a sudden surge of oxytocin to the brain.  As the skin stretches as baby’s head starts to crown, this burning sensation is the signal to push gently and slowly to allow baby’s head to be born slowly and gently.  The Midwife may ask you just to breath or “pant” at this phase. 

Once baby’s head is born, it usually turns to one side to line up its shoulders.  The Midwife will help you birth the shoulders and the body will slip out.  The Midwife will dry the baby and allow the placenta to give them a surge of blood and oxygen through the cord for roughly a minute before placing baby in skin contact.  This is because baby needs to be positioned below the level of the placenta for this to be most effective.  We would then recommend placing baby in skin contact and allow you have time together with your new baby.

Self-help Strategies for the Second Stage

  • Sips of water will stop you mouth getting dry

  • Remember not to hold your breath while you push

  • Keep as upright as possible.  All fours position or kneeling upright means that you are pushing down hill.

  • Your Midwife and birth partner will give you support and encouragement

  • Focus on your pushing, and concentrate on bearing down. 

  • Try to keep your pelvic floor relaxed while you push

  • Remember the burning sensation as the head stretches the perineum is a reminder to push gently and slowly or just “breath or pant” as baby’s head is born.

 

The Third stage

Once the baby is born, the cord usually stops pulsating after several minutes, after which it may be clamped and cut.  After your baby is born, more contractions will make the womb contract and push out the placenta. This usually takes between 10 minutes and 60 minutes depending on how you choose to deliver the placenta. The process is helped by the baby sucking and nuzzling at the breast, as this gives the body another surge of oxytocin which helps contract the womb and reduces the amount of blood loss. 

You should be offered a choice of:

An Active Third Stage...

A drug called syntometrine or syntocinon is given by injection into your leg to help the uterus contract. The contractions will help to separate the placenta from the wall of the uterus. The Midwife will clamp and cut the baby’s umbilical cord and gently pull the cord to help deliver the placenta.

Advantages:

  • The injection can help prevent heavy bleeding initially which some women may experience without it.

  • It will shorten the time taken to deliver the placenta

Disadvantages:

  • It can make you feel sick, vomit and have a headache.

 

It is recommended that you have an active third stage if you have had any problems during labour, any history of bleeding in this or previous pregnancies, any problems with delivering the placenta in previous labour or you are having more than one baby in this pregnancy.

 

A Physiological Third Stage...

This is when the placenta is delivered naturally by the uterus contracting
without the injection. The Midwife will not cut the cord until it has stopped pulsating and you will need to give a few gentle pushes to help push the placenta out.  It can take approximately an hour for this stage, but skin contact and the baby nuzzling at the breast will help this process, as will the use of gravity in an upright position.  Often women find sitting on a bedpan helps. 

Advantages:

  • It is not painful

  • This is a natural way to deliver the placenta

  • You won’t experience any side effects such as nausea from the injection

 

Disadvantages:

  • It may take longer to deliver the placenta

  • There is an increased risk of bleeding.  If this occurred, we would recommend the administration of an oxytocic drug and continue with active management of the third stage.

 

 

 

Once the placenta is delivered, the Midwife will check to ensure that the placenta and membranes are complete.

The Midwife will also inspect the perineum to check for tears or grazes.

 

Self-help Strategies for the Third Stage

  • Initiate skin contact soon after birth

  • Touch and hold your baby as this will trigger a surge of oxytocin, which will keep your womb contracted, resulting in less blood loss

  • Encourage the baby to suckle at the breast

  • Sit upright while you are waiting for the placenta to come, as gravity will help

 

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