Birth is a normal and natural process. About 70%-80% of babies are delivered via normal birth each year. Delivering a baby is a great challenge and yet, most women find the thought scary and intimidating initially.
With better information and preparation, most women find it comforting to know what to expect during labour and delivery. One is likely to look back once it’s done and find nothing but the purest joy of having your baby in your arms.
Most times, the question “Am I in labour?” is what most women are concerned about but are afraid to ask – it is as though we are expected to know this instinctively. Let us reassure you that it is a perfectly normal question and the midwives and obstetricians are most happy to answer all your questions and address your doubts.
Signs which show that you are going into labour include:
> Passing out a mucous plug
Throughout pregnancy, a mucous plug is situated at the opening of the neck of your womb (cervix) to prevent ascending infection. This mucous plug is clear and gelatinous looking.
Before the onset of labour, whereby the cervix begins dilating and effacing, the mucous plug occasionally becomes dislodged and gets passed out. Some women may not even notice the passing of the mucous plug as there is already increased vaginal discharge during pregnancy.
However, it is difficult to predict when the labour is going to start with this sign. It could be in one or two days, or even weeks away as the cervix continues to open up gradually over time.
> Bloody show
Passing of a mucous discharge with pinkish or brown tinge or with blood is a sign of cervical dilatation. It is caused by the rupture of blood vessels at the cervix as it dilates and effaces, preparing for the actual labour, which may take place in one to two days.
You do not need to rush to the hospital with the first sight of show. However, if the bloody show is heavy, bright red and/or associated with severe tummy pain, you should contact your obstetrician immediately as you could be experiencing complications such as placenta praevia or placental abruption.
> Your water breaks (Rupture of membrane)
Some women may experience a sudden loss of pale, clear or straw-coloured fluid, which typically gush out between their legs and soak their pants and clothes. It can also happen when they are lying down in bed.
This is a sign that your water bag has broken.
However, it is sometimes difficult to distinguish that from urine. One of the clues is that the amniotic fluid is odourless. Urine has a smell of ammonia.
Another clue is if you continue leaking the pale coloured fluid despite squeezing your pelvic muscle (Kegel exercises).
Please contact your obstetrician if you experience rupture of membrane. Do not have sexual intercourse or introduce anything into your vagina such as tampon because this may potentially cause infection to your baby.
> Regular contractions
The onset of regular and painful contractions associated with progressive engagement of your baby’s head and dilatation of the cervix is the most significant sign of labour.
These contractions initially feel like menstrual pain or lower backache and can be irregular.
During early labour, these contractions could be as far apart as 20-30 minutes. However, as the labour progresses, the contractions become more regular and intense, happening every 10-15 minutes or less.
When the intervals are consistently five minutes apart, you should call your obstetrician.
First stage of labour
Labour can be divided into three stages. The first stage of labour is defined as the onset of labour until the cervix is fully dilated up to 10cm. This first stage of labour can be further subdivided into the latent phase and active phase.
The latent phase starts from the onset of labour until the cervix is dilated up to 3-4cm. This may take up to a few days. The active phase continues until the cervix is fully dilated (10cm). During the active phase, the cervix usually dilates at the rate of at least 1cm/hour.
During the latent phase labour, the cervix effacement and dilation causes contractions which are usually mild, 10-30 minutes apart and lasting for 20-35 seconds each.
What to do:
- Relax during this phase and there is no need to rush to the hospital or birthing centre immediately.
- Doing simple routines at home and taking short walks are ways to improve the contractions and further enhance the cervical dilatation and effacement.
- You can eat and drink as normal but avoid heavy and oily meals as this may accumulate in your stomach, causing acid reflux.
During the active phase of labour, when the contractions become more regular and intense – happening at shorter intervals (5-10 minutes apart) and lasting more than 40 seconds
What to do:
- You should call your health care provider and get yourself admitted to the birthing centre or hospital.
- You would expect your cervix to then be more than 3-4cm dilated. At this stage of labour, the cervix usually dilates at the rate of at least 1cm/hour.
- When you arrive at the birthing place of your choice, the healthcare provider will examine your blood pressure, pulse rate and also cervical dilation.
Second stage of labour
This is defined as the stage when the cervix is fully dilated up to the delivery of the baby. If childbirth is like running a marathon, then the second stage of labour is equivalent to the last 100m sprint of the run.
You are almost there but not quite yet. Up till now, your cervix and your uterus have done most of the work. Now that the dilatation of the cervix is complete, it is time for you to push!
- This stage of labour usually lasts anywhere between 20 minutes to two hours, depending on the number of deliveries you had before and whether you have an epidural for pain relief.
- The second stage of labour is usually longer if you are having your baby for the first time.
- If you have an epidural for pain relief, your attending obstetrician may even allow your second stage of labour to last up to two or three hours.
- During the second stage of labour, you would notice that the contractions are more frequent and lasting longer (about 45-90 seconds).
- You may feel a strong urge to push. However, if you have an epidural for pain relief, you may not be able to feel the urge to push.
Apart from the urge to push, you may also feel strong pressure at your back passage (rectum), which may be associated with slight bowel movement or urinary accident. Some women also notice an increase in the bloody show.
The baby’s head will eventually become visible at this stage (crowning). You may feel a stretching, burning or stinging sensation at your birth canal (vagina) as your baby’s head emerges. Your birth attendant will instruct you as what to do at this stage.
Easing the pushing
It is time to get the baby out – but what to expect when you are pushing? Getting into a good pushing position may ease the process. This will depend on the birthing bed or chair, or your practitioner’s preference.
Most importantly, the position should be what is most comfortable and effective for you. A semi-sitting or semi-squatting position may be ideal as these positions utilise gravity to your advantage.
Once you have the urge to push, give it all you got. The more effective you push, the sooner the whole ordeal will be over and the more quickly you will meet your baby. However, one must not panic as disorganised pushing will waste your energy and accomplish little.
The following tips may be helpful to ease your pushing:
- Relax your body, pelvic floor and back passage (anal area)
- Focus your energy on your vagina and rectum, not your upper body or face. Arching your body will not help, it will result in back pain after delivery. The same goes to straining with your face – this will cause you to have bloodshot eyes and do nothing to help you to get your baby out;
- Rest between contractions – this helps to save your energy and gets you ready for effective pushing when the contractions starts;
- You could use a mirror to look at the progress of your pushing once the baby’s head becomes more visible. This gives you more motivation to push when the pushing gets tough. Seeing your baby’s head crown can be very encouraging.
What can your birthing partner do to help:
- Help the expecting mother to relax by keeping her as comfortable as possible. Giving her sips of water or ice cubes can be very welcoming. Labour is hard work and requires a marathon runner’s stamina and hydration. You can also support her in her position which she prefers.
- Encourage her with positive phrases, praise her when she is doing the right thing.
- Guide her through her contractions as she may not feel the contractions if she has an epidural for pain relief. You could guide her by placing your hand on her tummy and feeling for contractions.
- Do not become upset if the expecting mother becomes angry and vents her emotions at you.
- Staying cool and calm will help to calm down the expecting mother.
Don’t be too shocked when you first meet your baby – he or she won’t look cute and cuddly immediately upon arrival.
Take note that your baby has just been through a challenging journey after being soaked in a sac of amniotic fluid for nine months and then pushed through a narrow birth canal. How would you look after a similar experience?
Sometimes, after extensive pushing, you may find the baby’s head is in a funny cone-shaped form. This is perfectly normal and you need not worry about it. Your baby’s head will return to its normal shape in a matter of days.
Your baby may also be covered by vernix, which is a cheesy substance that coats the baby in your womb. This can be wiped away easily. Further, there may be fine lanugo hair which covers the shoulder, back and forehead plus puffy eyes.
Third stage of labour
Defined as the time following the delivery of the baby to the expulsion of the after-birth (placenta), this process is anywhere from between five to 30 minutes.
After the delivery of your baby, the umbilical cord will be cut by your healthcare provider. Your birthing partner may be given the chance to do this at your request if you have discussed this in advance with your healthcare provider.
The baby may be handed to you immediately after a quick cleaning for skin-to-skin care to promote bonding with you. While you and your partner are enjoying your baby, your healthcare provider will be waiting for small contractions to begin. This is a sign that the placenta is separating from your womb (uterus).
Sometimes, you may experience a small gush of blood. Your healthcare provider may facilitate the process by placing a hand on your womb while pulling on the umbilical cord. This will result in the delivery of your placenta. After this, your healthcare provider will stitch up the episiotomy wound if you had required an episiotomy for the delivery.
During the third stage of labour, your healthcare provider may be able to help you to collect some blood from the umbilical cord for storage as new evidence has shown that stem cells from the cord may have some potential medical use in the future.
You have now completed the whole process of labour and your healthcare provider will monitor you for the next few hours to ensure that your womb gets well contracted and there is no excessive bleeding.
You and your partner can now enjoy your little bundle of joy! Congratulations!