Drugs in labour and birth
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Alison Ross
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Registered Midwife, DipHe, BSc (Hons) Was a midwife at Kingston Hospital and Specialist Midwife in Perinatal Mental Health.
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Birth and Labour

What are the stages of labour?

Every woman's experience of labour will be different but overall there are three stages of labour.
In Short
Engagement - when your baby's head drops down into the lowest part of the pelvis, or 'engages'.

First stage - latent labour - mild, irregular contractions, and the cervix dilates to around 3-4 cm.

First stage - active labour and transition - frequent, strong contractions. At around 7-9 cm of the cervix dilating, the active phase moves into 'transition', when contractions become more intense and you'll feel the urge to push.

Second stage - starts when the cervix is fully dilated and ends with the birth of your baby.

Third stage - the delivery of the placenta and membranes after the birth of the baby.

Engagement

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 (or pre-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.
  • 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. Even though this is a sign that some changes are occurring – a show is not necessarily a true indication of the onset of labour and that it might be days or perhaps longer before true labour begins.
  • 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. If you think your waters have broken it is advised that you inform your local hospital or homebirth team. They will advise on whether you need further assessment. Generally, if you know your waters have gone and its clear fluid leaking, with no other symptoms such as signs of infection, you will be advised to stay at home and await events. If after 24 hours there is no sign of labour or delivery not imminent you will be advised to come to hospital and have your labour started and also start iv antibiotcs to help reduce the risk of infection to your baby.
  • 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.

Note
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). 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.

It is better for you to remain at home and active during the latent phase of labour. If you are worried in any way you can always call the labour ward/delivery suite or your community midwife and they will assess your situation.

First stage – Second Part – Active Labour and Transition

The first stage of labour is considered to be from when the contractions become more regular and intense and the cervix (neck of womb) begins to open or dilate. The cervix needs to open to around 10cm(4in) so that it is big enough for your baby to pass through. This softening and dilation of the cervix can take many hours, particularly for a first baby. Your midwife may occasionally check your progress by carrying out vaginal examinations to see how much the cervix has opened and also will check the position of your baby by feeling his fontanelles (the soft areas on a baby’s head). Towards the end of the first stage the contractions will be stronger, longer and more frequent (every two to three minutes). You may also begin to feel a strong desire to poo and this is because your baby is making his way down your birth canal and pressing on your bowel. Your midwife may advise you to hold off pushing for a little while as your cervix may not be fully dilated yet.

  • Contractions intensity are closer together and longer.
  • Your baby begins to drop into position in your pelvis.
  • 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.
  • You may become sensitive and tearful as you go deeper into birthing mode.
  • You may have an increase in energy, hunger or unsettledness.
  • Your waters may break if they have not done so already.
Transition

This is a time between first and second stages of labour when you may have a strong desire to push but may be advised not to do so because your cervix is not fully dilated. During the transition, you may begin to feel more unsettled and distressed as you prepare to begin pushing your baby out. This is often the time when you feel like you can’t go on any longer but you are now so close to baby being born.

Second Stage

The second stage of labour starts when your cervix is fully dilated and you can begin to go with your body’s strong desire to push and ends with the birth of your baby. This phase includes:

  • Strong urge to push and bear down.
  • Powerful contractions pushing your baby against your pelvic floor and bowel.
  • You may find you are making deep grunting sounds which are a normal part of the birth process
  • You may worry that you are pooing – almost all women poo at this stage and your midwife will very discreetly clear this up so try not to worry about it.
  • Your midwife will guide you to and encourage you to work with your body to push with the contractions.
  • As your baby’s head begins to appear at the entrance to your vagina your midwife may suggest that you stop pushing so forcefully and breathe or pant your baby out to reduce the risk of tears. Your midwife may explain that you “push the baby down but blow the baby out”.
  • Once your baby’s head is out the hard work is done as the rest of baby will slip out more easily.
  • Your midwife will check around baby’s neck to make sure the cord is not too tight and will cut this if required
  • Once your baby’s body is born your midwife should hand baby straight to you, gently drying him or her and you can both then enjoy skin to skin contact together whilst the midwife delivers your placenta and checks for any bruising or tears.
Third Stage

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. However, if there are no complications such as bleeding you can opt for a natural third stage allowing the placenta to separate by itself. Having a baby in skin contact and allowing them to lick and nuzzle at your breast can help the separation. Sometimes the drug used to ‘manage’ the third stage can cause you to feel sick so it can be worth considering all options.

This stage usually takes around 5-30 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).
  • If you notice that you are having contractions that are feeling stronger, lasting longer and coming more frequently.
At what point in a normal labour should I go to the hospital?

It does depend on your personal preferences – i.e. 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…

  • Once you are certain that your contractions are definitely stronger. Longer and more regular, or you feel you need pain relief.
  • Take your notes with you and your packed hospital bag.
  • 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 – e.g. Group B strep (where you might need to go in a bit earlier to start an antibiotic drip).
  • If your first labour was super fast (i.e. 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 – call an ambulance or 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). This is a sign a baby may be distressed and increases the risk of infection.
  • Vomiting for long periods.
  • Blurred vision or dizziness.
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DISCLAIMER
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.