Towards the end of your pregnancy, your baby’s head will drop down into the lowest part of your pelvis – this is called “engaging” – and is the preparation for labour and delivery. This process can start several weeks before labour in some pregnancies (usually first pregnancies) to just as labour starts in later pregnancies.
First stage – First part – Latent labour
There are two parts to the first phase. Latent labour is the first one.
During latent labour you may experience some or all of the following:
- Persistent lower back or abdominal pain along with cramps and a pre-menstrual feeling.
- Mild contractions – these lengthen over time so you’ll know they’re real. These help your cervix prepare before it starts to dilate.
- Your waters may break; this can also happen before labour starts or later. Your membranes may break with a gush or trickle of amniotic fluid. To prepare for this, you could keep a sanitary towel (not a tampon) handy if you are going out, and put a plastic sheet on your bed.
- A small amount of sticky pink, brown or blood-tinged mucus – the “show” – coming out of your vagina. This is the plug of mucus in the cervix that helped to seal the uterus during pregnancy. It usually comes away before or in early labour as the cervix starts to open and ‘efface’. There should only be a little blood mixed in with the mucus. If you are losing more blood, red and like a period, it may be a sign that something is wrong, so phone your midwife or hospital straight away.
- An upset stomach or diarrhoea.
- Feelings of high emotion or moodiness, usually more so with your first baby.
- Difficulty sleeping.
This phase can last from several hours to a few days in a first labour. It is often much shorter in subsequent labours.
What does a contraction feel like?
During a contraction, your abdomen will feel hard as the muscles of your womb tense up and work to gradually open your cervix making it wider and thinner (efface). Your contractions are not under your mental control. As your labour progresses, the contractions will become more intense and closer together, and, as your muscles relax after each one, the pain will fade.
First stage – Second Part – Active Labour and Transition
- Contractions intensity are closer together and longer.
- Your baby begins to drop into position in your pelvis.
- Your appetite may increase.
- Your breathing becomes deeper.
- Walking can be a struggle.
- You need to pee more often.
- Vaginal discharge will increase as more of the ‘plug” comes away.
- Mood swings.
- You may have an increase in energy.
- Your waters may break if they have not done so already.
How much does the cervix need to dilate?
The cervix needs to open about 10 cm (4 in) for a baby to pass through. This is what’s called being “fully dilated”. In stage 1, your cervix will dilate from around 3 to 9 cm. In stage 2, you will be fully dilated. Contractions at the start of labour help to soften the cervix so that it gradually opens. The process of softening can take many hours. If you are labouring at night, attempt to get comfortable and relaxed. If you can, try to get some sleep. A warm bath or shower may help you relax. During the day, keep upright and gently active. This helps the baby move down into the pelvis and helps the cervix to dilate.
The second stage of labour starts when your cervix is fully dilated and ends with the birth of your baby. This phase includes:
- Strong urge to push and bear down.
- Strong contractions pushing your baby against your pelvis floor.
- Your midwife will guide you – encouraging you to push with the contractions.
The third stage of labour is the delivery of the placenta and membranes, after the birth of your baby. This final stage can be “actively managed” by your birth team – including giving you an injection of synthetic oxytocin to speed up the delivery.
This stage usually takes around 5-15 minutes. You may need to push again to deliver the placenta.
How will I know when I’m in labour?
This is a common question and not as obvious as it sounds. Midwives frequently receive calls from women who are uncertain if they’re in early labour or active labour, and who need advice. Hospitals frequently have women turning up expectantly only to find out they’re not yet in labour and need to go home again.
When should I call the midwife?
The midwife will want to know how close together your contractions are, so it’s good if you’ve timed this before calling. The midwife can usually tell by asking you some questions and by the tone of your voice whether you need to go into hospital. The process of softening the cervix can take many hours before you’re in what midwives describe as ‘established labour’ – when your cervix has dilated to more than 3 cm (1 in).
Call the midwife or labour ward:
- Straightaway if your waters break (even if you haven’t noticed any contractions) as it means the sac around the baby has broken and there’s a risk of infection.
- If your baby is moving much less than usual contact your midwife urgently and count the number of movements you can feel when lying down quietly over a ten-minute period.
- If you notice vaginal bleeding – unless it’s the tiny little bit associated with the show.
- If you have a fever, changes in vision, severe headaches, along with abdominal pain (or if you monitor your blood pressure at home and it goes up).
At what point in a normal labour should I go to the hospital?
It does depend on your personal preferences – ie whether you’re super laid back and it’s your third or fourth baby and you’re happy to wait until the last minute…. Or whether you’re super anxious and you’d like to get there early… but (depending on how far you live from the hospital…) as a general rule of thumb…
- Wait until your contractions are around 5 minutes apart.
- Take your notes with you.
- If you can, give them a call to let them know you’re on your way – they may ask you some questions to check if they agree it’s the right time to come in.
If you experience any labour symptoms and:
- You are carrying twins or multiples.
- You have any medical problems – eg Group B strep.
- If your first labour was super fast (ie around 2-3 hours).
- If you are less than 38 weeks pregnant.
- If you live miles away from the hospital.
- Your baby is breech or sideways.
….. then you should set off for the hospital straight away.
If any of the following occur – also go straight away:
- If your baby stops moving.
- If you feel a strong urge to push.
- If there is bleeding because this can mean your placenta is low and being pushed, or has separated early.
- If your waters have broken.
- Unbearable pain that stays all the time rather than going in waves.
- If your waters or mucus plug are tinged with yellow, green, or dark brown, because this may indicate the presence of meconium (the baby’s first poo), which increases the risk of infection.
- Vomiting for long periods.
- Blurred vision or dizziness.
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here