Labour And Delivery
What is labour?
You are in labour when the muscles of your uterus contract so that your baby can be born. During labour, the uterine muscles tighten and the opening of the uterus (the cervix) thins and opens. The baby moves down the birth canal and is born. After delivery of the baby, the placenta (afterbirth) also comes out of the uterus. This is the last part of labour.
Every labour is different. How long it lasts and how it moves forward varies from woman to woman and from birth to birth. There are, however, general guidelines for labour that a primary care provider uses to decide whether it is progressing normally. If it is not progressing normally, you may need medicines to help it along or surgery (a cesarean section, or c-section).
If you have signs of labour before 37 weeks of pregnancy, the labour is considered preterm. You should see your primary care provider right away if you have any signs or symptoms of labour before 37 weeks.
How does labour start?
No one knows exactly what starts labour. We do know that certain hormones, such as oxytocin and prostaglandin, cause uterine contractions and the thinning (effacement) of the cervix. Perhaps hormones from the baby trigger labour by causing the mother to make more hormones.
Labour starts when uterine contractions are strong and frequent enough to make the cervix open and thin. Signs that your body is getting ready for labour are:
· Passage of a small amount of blood-tinged mucus from the birth canal (vagina). This discharge is called “show” or the mucus plug. It may occur 1 day to several weeks before labour actually starts or it may happen after a vaginal exam.
· A trickle or gush of water from the birth canal. This is caused by a breaking of the amniotic sac, also called the bag of water. The amniotic sac surrounds the baby. If your bag of waters breaks, see your primary care provider right away and go to the hospital.
While the 2 signs above are clear warning signs that labour is about to start, the sign that labour has begun is regular, strong contractions that:
· Are 2 to 3 minutes apart.
· Last 30 seconds or longer.
· Make the cervix to start to thin and open.
Sometimes it’s hard to know when labour has started. You may be admitted to the hospital and then sent home if your labour does not progress–that is, if your cervix does not thin or dilate (open).
What happens during labour?
The 3 stages of labour are:
· First stage: The cervix opens and thins to full dilation.
· Second stage: The baby moves through the birth canal and is born.
· Third stage: The placenta (afterbirth) passes through the birth canal and is delivered.
By the end of the first stage, the cervix has dilated fully to 10 centimeters (cm), or about 4 inches. The cervix needs to open this much for the baby to be able to pass through the birth canal. The first stage of labour is divided into early and active phases and usually lasts several hours.
Early labour, or prelabour, is when your cervix is 0 to 3 cm dilated. The contractions are irregular and mild.
Active labour begins when the cervix is 3 to 4 cm dilated. During active labour the contractions usually get stronger and more regular. The cervix dilates faster. If this is your first labour, you will likely dilate about 1 cm per hour. If you have had a baby before, the cervix usually dilates faster. During this time the contractions are usually more painful.
The baby is born during the second stage of labour. This is when you push the baby down the birth canal. This stage of labour usually lasts 15 minutes to a little over an hour, but may last as long as 2 or 3 hours. How long it takes depends on if you have had previous births, the position of the baby’s head, the size of the baby, and the size of the birth canal. Sometimes medicine for pain, such as an epidural anesthetic, may slow labor.
During the third stage of labour you deliver the placenta. This usually happens within 30 minutes after the baby is born.
The first few hours after delivery are called postpartum recovery. During this time, you will keep having contractions as the uterus goes back to its normal, smaller size. Oxytocin is usually given intravenously (IV) to help keep the uterus contracted and to keep you from bleeding too much. You will have a small amount of bleeding for the next couple of days.
How are problems in labour found?
Ensuring that your labour is normal as possible requires skill, experience, and careful checking by your primary care provider. Your vital signs, your contractions, and your baby’s heart rate must be checked throughout labour. These checks can be done manually or with an electronic monitor. They help your primary care provider find problems and take any necessary action.
During prenatal visits you and your partner should talk with your primary care provider about any questions you have about labour. Discuss how you will manage pain. You should also talk about procedures that may become necessary during labour and delivery, such as electronic monitoring, forceps, vacuum extraction, or C-section.
It is very helpful and important for you and your partner to take prenatal classes to learn more about labor, delivery, and postpartum care.
IWK Health Centre: http://www.iwk.nshealth.ca/corporate-home