Stages of labour
First stage of labour
The first stage of labour is defined as the period when regular contractions begin until the cervix is 10 cms dilated.
During early labour some women find a warm bath helpful. Listening to soft music or going for a walk can also help. Simple, over-the-counter drugs like paracetamol can be taken, particularly if you have backache. Walking and using upright positions can improve your comfort too. In the early part of labour, your body so you will need food to maintain energy levels, eat small meals. It is also important not to get dehydrated during labour. While at home, keep a bottle of water near you and keep sipping it.
The length of the first stage of labour can be different for every woman. If it is your first labour, the time from the start of labour to full dilation of the cervix (10 cm) is usually 6 – 12 hours. If it’s not your first labour, the time is usually shorter. The midwife will monitor the progress of your labour by continuously assessing the frequency, strength and length of your contractions. They will check every few hours to see how your cervix is dilating, what way the baby is presenting and how the baby is moving down through the pelvis.
Generally, as labour progresses, your contractions will become gradually stronger and more painful and come closer together. The bag of water (liquor) may still be present or may break at any time during this period.
Throughout your labour, the midwife provides emotional support, including reassurance and encouragement. They will tell you what is happening and help you to communicate your needs to other members of the team and help you to make choices that work for you. If you need any medical help to ensure your own safety and your baby’s safety, the midwife will explain the reasons for it.
Towards the end of the first stage of labour, you may feel like pushing during the contractions. The midwife will let you know when the cervix is fully dilated and when it is safe to push.
Second stage of labour
The second stage of labour starts when your cervix is 10 cm dilated and ends with the delivery of your baby. Getting familiar with pushing may take some time, especially if it is your first baby. If you don’t have an epidural, find a position that is comfortable and effective for you. You may wish to stay on the bed supported with pillows or to kneel, squat, stand or sit. These positions can be adopted on the bed or on the floor.
As the baby’s head descends further through the birth canal, the contractions get stronger and so does the urge to push. The urge to push is caused by the pressure of your baby’s head on your back passage. Sometimes, this feeling of pressure can make the bowels open. If you have an epidural, you may not be aware of these sensations. This stage is hard work and it is important to rest and relax between the contractions. After each contraction the midwife will listen to your baby’s heart rate and will keep you informed of your progress. Your birth partner will also encourage you and may offer you sips of water and help support you in your chosen position.
As your baby’s head moves down to the vaginal opening, the baby’s head will become visible. At a certain stage, the midwife will tell you to either stop pushing, to push very gently or to pant (blow in an out quickly through your mouth). This is important so that your baby’s head can be born slowly, giving the skin and muscles of the perineum time to stretch without tearing. (The perineum is the area between the vagina and the back passage.) Sometimes the skin won’t stretch enough and may tear or it may be necessary to perform an episiotomy, which is a cut in the skin to widen the opening. The perineum is numbed with a local anaesthetic before an episiotomy is done (unless you have an epidural).
After your baby’s head is born, the hard work is over. With one more contraction, your baby’s body will be born and your baby will be placed onto your tummy, so that you can feel and be close to each other immediately and you can start getting to know your son or daughter.
Soon afterwards, the umbilical cord is clamped and cut and the baby is dried. Sometimes, some mucous needs to be cleared from the baby’s mouth and nose. If your baby needs oxygen or any other care immediately after birth, they will be placed on a radiant warmer, which is like an open cot with a heater overhead, in the birth room. Your baby won’t be kept away from you any longer than is necessary. As soon as possible, your baby will be returned to your arms for another cuddle.
Third stage of labour
The third stage of labour starts after the birth of your baby and ends once the placenta (afterbirth) is delivered and the bleeding is controlled. At the Rotunda, we recommend using an injection to help complete the third stage. The injection makes the womb contract which helps to separate the placenta. This reduces the risk of excessive bleeding.
Some women choose to deliver the placenta without the use of drugs. We can help you to do this if you:
- are not at risk of any complications of bleeding;
- had no drugs administered during labour;
- have discussed this option with your doctor or midwife during your pregnancy and in early labour.
Once the placenta is delivered, the womb normally stays contracted, which helps reduce the blood loss. On average, women will lose 100 – 200 mls of blood at birth. Your body has been preparing for this and you should not feel any side effects.
Sometimes, a detailed laboratory investigation on the placenta is recommended. This may identify certain factors that may relate to your pregnancy or the wellbeing of your baby. If your placenta is sent to the laboratory, the hospital will dispose of it once any tests are completed. If you have any specific requests relating to the placenta, please discuss them with your midwife or doctor.
Pain Management
There are several ways of helping you cope with pain in labour.
Relaxation, breathing techniques and mobilising are some of the ways we recommend. Some women find gentle massage, using warm water in the shower or bath helpful. It is difficult to know before labour what will work best for you.
The midwife will be able to provide you with additional information to help you choose what suits you. Here are some facts about the main methods of pain management available in the Rotunda Hospital.
Natural methods of pain relief
- Water
- Anti-burst gym ball
- Massage
- Breathing techniques
- Music
- TENS machine
- Warm or cold pack
- Aromatherapy
Analgesia in labour
- Gas and air (entonox)
- Pethidine
- Epidural
More on pain management
There are several ways of helping you cope with pain in labour. Relaxation, breathing techniques and mobilising are some of the ways we recommend. Some women find gentle massage, using warm water in the shower or bath helpful. It is difficult to know before labour what will work best for you. The midwife will be able to provide you with additional information to help you choose what suits you. Here are some facts about the main methods of pain management available in the Rotunda.
Natural methods of pain relief
Labour Pool
In the Rotunda Hospital, we have one bespoke birthing room which accommodates a large pool for use during labour. Learn more about the labour pool here.
Anti-burst gym ball
Sitting on a gym ball encourages a natural swaying and rotating motion of the pelvis and can help to move the baby down through the birth canal. Sitting on the ball can help to take pressure off your bottom. The way you sit on the ball is similar to a squat, which helps to open the pelvis and speeds up labour. Gentle moving on the ball reduces the pain of the contractions and it also means your partner can rub your back if you would like it massaged. If you are considering using a gym ball, please purchase an anti-burst one and make sure that it is inflated to the recommended level.
Massage
The sense of touch has been associated with the power of healing since the beginning of time. Touch has the power to soothe pain. Some women like a light, stroking massage or a long stroke massage, while others like firm, circular massage particularly if they are tense or are having back pain. Massage oils can be used and we recommend you talk about and practice the different types of massage with your birth partner before labour.
Breathing techniques
These relaxation techniques work by making you aware of your breathing patterns. Focusing on how you are breathing helps you to breathe slowly and deeply. It helps you to avoid holding your breath – holding your breath tenses up your muscles and reduces the level of oxygen. Some women develop techniques to help them concentrate on their breathing such as chanting a word or poem, or focusing on just one element of the breathing cycle.
Imagery
Thinking about or imagining something pleasant can encourage relaxation and help women manage their pain in labour.
Aromatherapy
Aromatherapy is a way of accessing and applying the therapeutic benefits of plants by using oils called ‘essential oils’, which are extracted from plants, usually by distillation. They can be used in baths, compress, vaporisation, showers, inhalation and massage with specified essential oils and carrier oils such as sunflower.
Warm or cold pack
Warm or cold packs are simple ways of easing pain and helping you to relax in labour. You can buy heat and cold packs in your local pharmacy. An ice pack or heat pack on the lower back can help to ease backache.
Music
Music can help you to relax and reduce stress and tension. It might also help you to focus on your breathing and take your mind off the contractions.
TENS machine
TENS stands for ‘transcutaneous electrical nerve stimulation’. Four electrodes are placed on your back, which are connected to a small hand-held device that is battery operated. TENS has been used for back pain for many years. It works by stimulating the nerve near your womb and your body responds by producing natural ‘morphine like’ substances called endorphins. These are the body’s natural painkillers. The TENS machine helps to ease the pain for some women. There are no known side effects for either you or your baby and you can continue to move around while using it.
It is recommended that you start using the TENS machine as soon as your contractions become regular. As this often happens when you are at home, you may consider renting or buying one. If you start to use it at home, you can continue to use it throughout your labour. Some TENS machines are also available in the delivery suite.
Analgesia in labour
Gas and air (entonox)
This is a mixture of oxygen and another gas called nitrous oxide. You breathe it in through a mouthpiece when you have a contraction. It acts quickly and wears off quickly once you stop using it. While it won’t take the pain away completely, it makes the contractions easier to cope with. It doesn’t cause any harm to the baby and it can be used at any time during labour. It can also be used with the TENS machine.
Pethidine
Pethidine is a drug that is injected into the muscle in your buttock (bottom). A second drug is given at the same time to stop you feeling sick. It takes about 20 minutes to work and the effects last between two and four hours. It works by easing the pain and it helps you to relax. Pethidine can make some women feel a bit light-headed and forgetful. The drug passes through the placenta to the baby so if it is given too close to birth, it may temporarily affect your baby’s breathing at birth and the initiation of breastfeeding. If this happens your baby may require a drug to undo the effects of the pethidine.
Epidural
An epidural is generally the most effective form of pain relief during labour. The word ‘epidural’ refers to a space in your back where pain messages from your womb and birth canal pass to the brain. An epidural involves injecting local anaesthetic and pain relieving drugs into this space to block the sensation of pain. If you decide you want an epidural, the anaesthetist will tell you how the procedure works and explain the advantages and possible side effects.
It takes about 20 minutes to set up the epidural. You will need a drip in your arm to give you extra fluids so that your blood pressure does not fall. The midwife will help you into a sitting position or you can lie on your side. This makes it easier to get the epidural tube inserted. You will be asked to stay very still while the tube is being inserted.
The epidural can be very helpful for women who are having a long and painful labour. It takes the pain away for most women. Some of the disadvantages of having an epidural include having difficulty passing urine so a catheter (tube) is placed into your bladder to keep it empty. Your legs may feel heavy so you must stay in bed. Your baby’s heartbeat will be monitored continuously.
Some of the known side effects of an epidural are:
- the second stage of your labour may take longer;
- you are more likely to have an assisted birth with forceps or vacuum (but it doesn’t increase the chance of needing a caesarean section);
- you might have some backache for a few days after an epidural. (Long-term back pain after birth can happen with or without an epidural.);
- 1 in 100 people can develop severe headaches in the days following birth. This can be treated but it involves having another epidural procedure.
The risk of injury to the nerves in the epidural space is very small. This side effect is thought to occur 1 in 10,000 times. Numbness, tingling, or weakness in one or other leg can also rarely occur (1 in 2,000 times) following births where epidurals have not been used. For further information on anaesthesia please follow this link to the Obstetric Anaesthetists’ Association website www.oaa-anaes.ac.uk.