Early labour — the first signs
Your baby is starting to flex his head, move deeper into your pelvis, closer to your cervix. That started out firm, like a nose, but by the end, it will become soft and stretchy like lips.
Incredibly, some women don’t notice their early contractions and can be several centimetres dilated before they realise they’re in labour. Most mothers-to-be will, however, notice the physical symptoms.
The “show” Many women experience a “show” — a pinkish-red blob of mucous discharge from the vagina. This mucus plug has sealed your uterus from infection during pregnancy and its appearance is a sign that established labour will probably begin in the next few hours or days.
Lower-back pain This, the need to go to the loo and premenstrual-like cramps are other signs of early labour.
Your waters break This may start with a gush or a trickle, depending on how much amniotic fluid you have. The fluid is almost clear, with a yellow tinge, and may be bloodstained to begin with. Stick on a sanitary napkin, but use a towel if there’s a lot of amniotic fluid. Contact your hospital as soon as your waters break because there is higher chance of getting an infection now.
Contractions start Your contractions can take hours, even days, to build and put pressure your cervix to open up. Since first labours tend to last 12 to 16 hours, you may feel more comfortable staying at home until a little later.
First Stage Labour — leave for the hospital
Your cervix dilates so that your baby can come out. Initially, your contractions are short and infrequent, and feel a bit like period pains. As your cervix widens, the contractions will become stronger and occur closer together in time — by the time contractions are every 10 to 15 minutes, you should be in the hospital.
When you arrive, a nurse will ask whether your waters have broken, how frequently the contractions are coming and whether you’ve had a bowel movement. You may still have hours to wait before you deliver.
You’ll change into loose clothes, after which the nurses will palpate your abdomen to feel where baby is, listen to his heartbeat, as well as take your blood pressure, pulse and temperature. You’ll undergo an internal examination to see how far your cervix has dilated and give a urine sample for protein-testing to ensure that you don’t have pregnancy-induced hypertension. Nurses will use a foetal heart monitor to check baby’s heartbeat.
You are in active labour when your cervix has dilated to 3 to 4cm. As contractions will be strong, medication can offer pain relief. Whether or not to use pain relief is something you should have decided on long before this stage.
You can choose to have pethidine or an epidural — the earlier you are put on these, the more pain you’ll save yourself. If you decide against pain-killing drugs, you can still use a Tens machine (which delivers small electrical pulses to the body), and try breathing exercises and relaxation techniques. Or ask for gas and air or a massage from your husband.
Transition phase — your body is getting ready
During the transitional phase, the cervix dilates to about 8 to 10cm (the length of a mobile phone ― yes, really!). At this stage, contractions are long and powerful and you may feel angry, stressed, weepy, shaky or sick.
Some women feel the urge to push, but you shouldn’t act on it until your gynae has confirmed that your cervix is fully dilated. For many women, the end of this stage is marked by involuntarily grunting ― a sign your baby will be born soon.
Second Stage Labour — time for the push
Your uterine muscles are pushing the baby down the birth canal and her head will soon press on your pelvic floor. There’s often a lull after transition when the contractions stop and you can rest. When they start again, you might feel the pressure of your baby’s head between your legs. You are now 10cm dilated and ready to start pushing.
This stage may last up to 90 minutes if it’s your first baby. Push smoothly and continuously, directing all muscular effort downwards and outwards.
Your baby’s head will move far down your pelvis, stretching the vagina opening. When this happens, you’ll probably feel a hot, stinging sensation and your gynae will tell you that your baby’s head has “crowned”. As the head begins to emerge, he may ask you to stop pushing to reduce the risk of tearing.
Once the baby is born, the pain stops, the umbilical cord will be clamped and cut, and the baby handed to you for some skin-to-skin contact and photo-taking.
Third Stage Labour — the kid’s here, get the placenta out
When your baby is born, the uterus should start contracting immediately in a relatively painless way. Usually, your body expels the placenta within 5 to 10 minutes though a few mothers find that this process takes 15 to 20 minutes. The doctor will check your abdomen to ensure that nothing is left behind.
If the placenta is still not delivered after 20 minutes, you may risk losing large amounts of blood, so, your gynae may consider manually removing it. This requires anaesthesia or the use of the operating theatre.
Now, all you need is to lay back, pat yourself on the back for a job well-done and enjoy some Milo ― on the hospital!