It is the custom to divide labour into three stages:
- the opening-up stage
- the pushing stage
- the afterbirth
First babies take between 6 and 20 hours to be born on average, later babies 3-12 hours.
The opening stage
The womb is an extremely strong organ, the muscles of which force the baby down the cervical canal into the world. During the first stage of labour the cervix dilates 10 cm. If this is your first baby, the contractions first have to open up the cervical canal before they can begin on the neck of the cervix. This may take anything up to 8-9 hours. The uterine orifice (the outer opening) then opens up in 1-2 hours. Medication can be administered to give the contractions greater effect and thus to speed the process up.
In later births the mouth of the cervix begins dilating even before the cervical canal is fully dilated. The birth is often very quick once the cervix has dilated 4-5 cm.
To begin with the contractions come at intervals of about 5 minutes and last about 30 seconds. As labour progresses, the contractions get longer and more frequent.
The midwife will check the size of the cervix, the position of the baby in the cervical canal and your blood pressure every one or two hours. The baby’s heartbeat will be checked more frequently, either through your tummy or on a device that monitors both the contractions and the baby’s heartbeat. The state of the baby can also be monitored by an ultrasound scan, from blood specimens, samples of the amniotic fluid, etc., depending on what equipment the hospital has, and the situation.
The midwife will also check that the bladder does not get too full and hinder the delivery. She will also check the colour, quantity and smell of the amniotic fluid, in addition to giving you support and encouragement.
Opening up the cervix is the job of the womb. You can make this process easier and quicker by relaxing. The worst stage is just before you begin to push. It is at this stage that many mothers appreciate the presence of their husband most, giving encouragement and a sense of security, and keeping calm. This makes the pain easier to bear.
Once the cervix is fully dilated, you can begin to push. Some mothers feel the need to push even before the cervix is fully dilated and the baby’s head has turned into the right position. You should then avoid pushing, with the help of the midwife, by the shallow breathing technique you have learnt at the clinic. Pushing too soon may prolong the delivery as it causes swelling in the opening of the cervix. Many find this the most painful and trying stage of labour. Luckily it doesn’t last long.
The midwife will try to keep the atmosphere in the delivery room calm, out of respect for the new life about to begin. Too much fuss and bright lights will if possible be avoided.
When you are given permission to push, you must push 3-5 times during each contraction, taking a quick breath in between. When the baby’s head begins to press on the muscle between the vagina and the back passage, the midwife may well do an episiotomy, i.e. make a small cut under a local anaesthetic, especially if this is your first baby. This prevents the tissue from tearing. At this stage the midwife may well tell you to stop pushing for a moment so that she can carefully ease the baby’s head out. She will then ease out each shoulder in turn, with you pushing slightly, and then the rest of the body.
The pushing stage usually takes 20-30 minutes for first babies but only about 10 minutes for later ones.
As soon as the baby is born, you will be given an injection to contract the womb. The contractions usually expel the placenta in 5-10 minutes. The midwife will help by pulling gently on the cord or pressing on the lower abdomen. She will then check the placenta, weigh it and measure it.
The episiotomy wound and any other tears will be sewn up under a local anaesthetic. You and your baby will then be kept in the delivery room for about two hours for observation before being moved to the postnatal ward.