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The stages of labour

Labour is divided into 3 stages. The first stage results in the dilation of the cervix (the neck of the womb) to about 10 centimetres.

The First Stage of labour is also in 3 stages: early, active and transitional phases.

Early Phase (usually known as the latent phase)

The uterus starts to contract or tighten regularly. These contractions are not like the Braxton Hicks contractions which you may have experienced late in the pregnancy. Braxton Hicks contractions are very irregular and are not usually painful - however the early phase contractions will be more uncomfortable and regular. The contractions are softening, shortening and opening the cervix to 3-4cms. This is usually the longest phase of labour and it is not unusual for a latent phase to last 24-48 hours in a first labour.

Every woman is different and some may not even notice that they have gone into labour and everyone will proceed at a different pace. During this stage it is likely that you will be able to potter around the house doing light jobs, watch TV or play a relaxing DVD. The best thing to do at this stage of labour is to rest and relax as much as you can. Eat carbohydrate rich snacks such as pasta, potatoes, rice and bread to give you plenty of energy for the remaining stages of labour and make sure that you get in a really comfortable position while resting. Take a warm aromatic bath if you like, play relaxing music and pamper yourself generally, also now is the time to make use of any relaxation techniques and massage you have learnt during your pregnancy. If labour starts at night then it is recommended that you try to get back to sleep or at least rest, as this stage can take several hours and sometimes a couple of days.

Active Phase

Midwives and doctors indicate that that you are in the active phase when the cervix is dilated to 3-4cms. The contractions will now start to get stronger and last longer. They will eventually start to come every three to four minutes and will last 60 to 90 seconds. The time to go to hospital or call your midwife to attend your planned home birth, is when you and your partner would like the reassurance of a midwife's presence or feel you need additional pain relief. If you are having the baby at home then call your midwife for advice and reassurance. The contractions may well feel like they are coming one on top of another - but just listen to your body's needs. Drink or eat if you need more energy, provided you don't feel sick, and go to the toilet to urinate if possible. Make sure that you keep adapting your body to the most comfortable position. Ask for more information and encouragement from your midwife if you need it.

Again this is a good time to remember and practice all the relaxation techniques you have learnt and your partner should encourage you to remember these and maybe give you a gentle massage. It may be at this stage you may want to try gas and air to make the contractions easier to cope with. At this stage some people like to take a warm bath to help relaxation. You may want to use a birth pool, if this is the type of delivery you have chosen. Sometimes a stage is reached in labour when the dilation of the cervix slows or stops - if this happens just continue to relax as much as you can - go for a short walk perhaps along the corridor. Release all the emotional tension which may be building up. The midwife may suggest breaking your waters to speed things up and be aware if this happens that the contractions could intensify. If you feel that during the Active Phase that the contractions are becoming difficult for you to manage then ask to have the pros and cons of pethidine, meptid or an epidural explained to you

Transition Phase

During this phase the cervix dilates from eight to ten centimetres and the contractions may each last up to one and half minutes and occur every two to three minutes. You may feel strange - perhaps a little shivery, emotional or sick - or perhaps you will not feel like this at all as all women are different. If things become a bit tough then remember that you are nearly there. Make the most of the short periods between contractions to rest and relax and make sure you are in the most comfortable position to cope best with the next contraction. Keep your breathing rhythmical and groan or shout out as much as you can if this helps!!

Second Stage

This is the exciting stage when the baby is born. The uterus pushes the baby down the vagina or birth canal. There may be a lull (latent phase) at the end of the first stage which will give you a chance to recover a bit and relax. When the contractions start again you may feel the pressure of the baby's head moving down between your legs. Don't push until you get an overwhelming urge to do so (unless there is medical need to have the baby born quickly). This way you'll conserve energy for when you really need it, and calm breathing ensures a good oxygen supply for your baby. With every push and contraction he will move further down into the pelvis. He may slip back a bit after each contraction but as long as he continues to move down everything will be going fine.

When the baby's head has moved far down and is stretching the opening of the vagina then you may feel a hot, stinging sensation. The midwife will then tell you that the baby's head is crowning - which means that she will be able to see the baby's head which is a really exciting time and you then know there is not long to go now. At this stage the midwife may ask you to stop pushing so that the baby's head is born gently - she will probably ask you to pant gently when you breathe out. The slow birth of the head should help to prevent you from tearing. If you have had a baby before then this second stage may only take five or ten minutes but could take several hours if this is your first child.

At this stage make yourself as comfortable as you can. It may help to stand, kneel or squat and then gravity will be helping you with the downward movement of the baby. Try not to hold your breath while you are pushing. Push for as long as you want to then push again - you will push several times with each contraction. If you want to lie down to rest then try and lie on your left hand side rather than lying on your back, then this will make more room for the baby in the pelvis. If you have had an epidural, then the midwife will tell you when to push, as you will not have any sensation prompting you to push.

Third Stage

After the baby is born then you will have the third stage when you deliver the placenta which has supplied the baby with nutrients while in the womb and also taken away all waste products. After the birth of the baby there is usually a latent phase of about 10 minutes before the contractions will start again but with a much lesser intensity and these contractions will cause the placenta to come away from the lining of the uterus. The placenta together with the empty membrane of waters will pass down to the bottom of the womb, you may need to give a couple of gentle pushes and then the placenta comes through the birth canal out of the body. This is known as a physiological third stage. The midwife will examine the placenta carefully after delivery to make sure that nothing has been left behind and she will check your tummy to make sure that the uterus is contracting down hard to ensure no heavy loss of blood from where the placenta was attached. You may be offered a "managed" third stage where you are given an injection (to make your uterus contract strongly) in your thigh as soon as the baby is born. This means the baby's cord has to be clamped and cut immediately and the midwife then gently applies traction to the cord to deliver the placenta. This type of management is recommended if there is a known risk factor for heavy bleeding.

It may be that you will not be very aware of this third stage of labour as your attention is likely to be taken up with looking at, enjoying and admiring your new baby!! Indeed handling and offering the baby the breast should cause the uterus to contract down hard.

After the birth you may feel very tired or you may feel very elated - everybody is different! If you are going to breast feed then the midwife will help you to put the baby to the breast. Close body contact, skin to skin, will help you to bond with your baby straight away and helps regulate baby's breathing, keeps him warm and encourages him to start breast feeding. If you are very tired or perhaps dulled by pain relief drugs then do not concern yourself (Your partner can have skin to skin contact with the baby) - just have a rest and you will soon want to get to know your baby after all the hard work!

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