The three stages of labour

How to recognise when labour starts Regular contractions Backache A show Waters breaking Nausea or vomiting diarrhoea

Sure signs Regular contractions: These will feel similar to Braxton hicks contractions (when your abdomen gets tight and then relaxes) you may have felt earlier in the pregnancy. They will now be coming regularly and last more than 30 seconds. Gradually they will become stronger, longer and more frequent. Backache: This is similar to the heavy aching feeling that some women get with their monthly period, low down at the bottom part of their backs

A show: Waters breaking: This will be either before labour starts or early in labour. This is where the pug of mucus in the cervix, which has helped seal the womb during pregnancy, comes away and comes out of the vagina. It is a small amount of sticky pink mucus, containing a small amount of blood. If you are loosing a lot of blood, it may be a sign that something is wrong and so contact with hospital or midwife should be made straight away. Waters breaking: This is when the bag of water in which the baby is floating may break before labour starts (you could keep a sanitary pad handy if your going out and put plastic sheets on your bed). If the waters break before labour starts, you will notice either a slow trickle from your vagina or a sudden gush of water that you cant control. Phone the hospital or your midwife, and you will probably be advised to go in at once.

Pain relief in labour Self- help Gas and air TENS (transcutaneuos electrical nerve stimulation) Injections i.e pethidine Epidural anaesthesia

When to go into hospital When your waters have broken you will probably be advised to go straight into hospital. If your contractions start but your waters have not yet broken wait until they are coming regularly, about 5 minutes apart, lasting about 60 seconds and are very painful. If you are at all uncertain about whether or not it is time for you to go into hospital, always phone the hospital or your midwife for advice.

The first stage of labour The dilation of the cervix: Contractions at the start of labour help to soften the cervix The cervix will then gradually open to about 10cm This is wide enough to let the baby out and is called ‘fully dilated’ These stages can take ages and are sometimes referred to by the midwife as ‘established labour’, when your cervix is opened to at least 3cm

Continued… If you go into hospital before labour is established you may be asked if you would prefer to go home, rather than spend extra hours in hospital The time from the start of established labour to full dilation is between 6 to 12 hours Towards the end of the first stage, you may feel that you want to push as each contraction comes, although you should not do this until your cervix is fully dilated and the baby’s head can be seen To help you get over the urge to push, try blowing out slowly, gently or in little puffs At this stage every baby’s heart is monitored throughout labour to check for any change in heart rate in case there are signs of distress and a speedy delivery is needed

Fetal heart monitoring Sonicaid: a hand-held ultrasound monitor. This enables you to move around freely Internal electrode: a tiny electrode is placed through the vagina onto the scalp of the baby (or the bottom if in breech) Continuous Foetal Monitoring: two electrodes are strapped to the mothers abdomen using stretchy bands. This measures the baby’s heat rate. It also measures contractions, how long they are and the gap between them. The mother will have to lie or sit for this type of monitoring Listening: the midwife listens using a foetal stethoscope which looks like a trumpet

Speeding up labour If labour is slow, your doctor may recommend acceleration to get things moving. This will start with you waters being broken (if not already done so) during a vaginal examination. This may be enough to get things moving, but if not, you may be offered a drip containing a hormone which will encourage contractions. This will be fed into a vein in your arm.

Second stages of labour The baby’s birth: This stage begins when the cervix is fully dilated and lass until the birth of the baby. Your body will now tell you to push, and your midwife will guide you through this.

Position Find the position you prefer and which will make labour easier and more comfortable for you You might want to remain in bed with your back propped up with pillows, or stand, sit, kneel or squat If you are very tired you might prefer lying on your side than your back You can also kneel on all fours if you have been suffering from backache

Pushing It is now time to start to push each time you have a contraction. Your body will tell you how naturally, if not take two deep breaths as each contraction starts and push down. After each contraction, rest and build up strength for the next one. This stage may take an hour or more, so ask your midwife what is happening as it helps to know how you’re doing.

The birth… As the baby’s head moves into the vaginal opening, you can put your hand down and feel it When about half the head can be seen, the midwife will tell you to stop pushing, push very gently, or to puff a couple of quick short breaths, blowing out through your mouth This is so your baby’s head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and back passage) time to stretch without tearing Sometimes the skin of the perineum may tear or the baby is getting short of oxygen in which case the midwife or doctor will ask if they can cut the skin to make the opening bigger, this is called an episiotomy Afterwards they will stitch the tear up and it will heal over time

Continued… Once your baby’s head is born, most of the hard work is over It takes one more gentle push for the whole body to be born, and this happens quite quickly and easily The baby can then be lifted straight on to you before the cord is cut, or will be wiped and dried to prevent him or her from becoming cold so you can hold and cuddle your baby properly Your baby may be quite messy, so if you prefer you can ask the midwife to wipe your baby clean and wrap him or her in a blanket before passing them to you Sometimes your baby may have some mucus in their nose or may need some oxygen to to help get their breathing underway, but your baby wont be kept from you any longer than necessary

The third stage of labour The placenta After your bay is born, more contractions will push out the placenta. This can take between 20 minutes and an hour, but you will usually have an injection in your thigh to speed this up. The injection contains a drug called syntometrine or syntocinon, which makes the womb contract and so helps prevent heavy bleeding.

Continued… After the birth of the placenta, a thorough examination takes place. It will be dark red, like liver, weigh about 1lb/470g and be the size of a large dinner plate. It should be intact, as any left inside the mother could cause a serious infection or a haemorrhage. The placenta belongs to the mother and if she wishes to keep it she can. It is most common in this country that the hospital will dispose of the placenta for you.

Afterwards… After the birth and you have had some time with your baby, he or she will need to be examined, weighed and possibly measured. Your baby will then be given a wrist tag with your name on it At this time you will have the opportunity to wash and freshen up before alone time with your baby and your partner If this doesn’t happen you must ask, as it is important bonding time for both parents and the baby

Tasks… Design a poster to show the different ways a baby can be born. Include: Forceps Ventouse extraction Caesarean section (elective and emergency) Induced labour

Homework Carry out a survey to discover: How many fathers were present at the birth What role did the father/partner play during the birth? Ask the mother how the father/partner helped during the birth Your questions may be open or closed, and you must show your results in a table, graph or essay form.