Stages of Labour

abour begins as a hormonal response, probably to triggers which come from the baby's adrenal gland.

09:12 09 June 2009

Everyone's idea of 'going into' labour is that your waters break, your contractions start, you make a mad dash to the hospital and ta-da! " your baby is born. This is not always the case. This article also appears on www.bbc.co.uk/parenting/having_a_baby

Three steps to heaven?

Labour begins as a hormonal response, probably to triggers which come from the baby's adrenal gland. Under this response, your uterus starts contracting. Remember that not all births are the same. Your 'waters' could break before the contractions start or afterwards. And in some cases, not until the baby has been delivered.

Hormonal stimulation is how labour is brought on medically. When you're induced, hormones are introduced into your bloodstream, either as a drip or in a pessary inserted into your vagina, and they stimulate the start of contractions. These open your cervix, to allow the baby to come downwards, and then out.

At the start of labour your cervix is barely open (dilated); over the next 5 to 15 hours or so it dilates completely.

Stage one

The baby is pushed downwards and almost reaches the end of the birth canal (vagina), with the head (usually) about to be born first.

"...every contraction does a job..."

During the first stage of labour, your contractions will get closer together and last longer each time. Labour gets faster as it progresses " it usually takes longer to go from being one to two cms dilated and five to six cms dilated, than between being five to six cms and 10 cms (or fully dilated).

A typical pattern is to go from experiencing one contraction of about 40 or 50 seconds every 10 minutes. By the end they will be coming thick and fast " each one might last over a minute, and there may be no more than half a minute to a minute between each one.

By this time, the cervix is fully open, and wide enough for the final descent and birth of your baby's head.

It helps to stay moving, and to be somewhere you can experiment with different positions, such as leaning against something, or on all fours, or moving around.

Grinding to a halt...?

Info Box

Contractions help you on your way to the birth of your baby. Every contraction does a job " your uterus pushes the baby downwards and your cervix opens that little bit more with each one.

Labour isn't always smooth and progressively intense " at times, contractions may slow down, or even cease. If you and your baby are fine you needn't worry. Just be patient, calm, and prepared to walk around, or move into a different position, and wait for them to start again. If contractions really do slow for a long period of time, and it's thought you and/or your baby might benefit from things being helped along, you may be advised to agree to:

• have your contractions stimulated with a hormone drip (usually a synthetic oxytocin called syntocinon)
• have your membranes ruptures artificially, or ARM, which is the technical term for breaking the waters which surround your baby.

The drawback of both of these interventions is they can bring on your contractions very strongly, and this can be difficult to cope with.

Stage two

This is the actual birth of your baby, and it's usually a lot shorter than the first stage. It can be very quick " lasting just a few minutes " or take up to two hours, and sometimes much longer. It can be hard work, as you are actively pushing the baby out. It begins when the cervix is fully dilated (10 cms), and when you feel a very strong urge to push downwards. An epidural might mean you don't feel this urge " if this is the case your midwife will tell you when to push.

Pushing might be guided by the midwife, who can see what's happening as the baby comes out. She might ask you to withhold some pushes, or to co-ordinate them with your breathing, or to breathe through some of the urges to push. This can help prevent a tear in your perineum, which might happen if the baby comes out too fast.

The first part of your baby to be born is the top of his head " this is known as 'crowning'.

A couple more contractions and the head will emerge, usually facing towards your back. Your baby's shoulders and head will then turn sideways. The baby then emerges 'in full'. The umbilical cord is usually clamped and then cut at this stage. All being well, you will be given your baby to hold.

Stage three

This is the delivery of the placenta, and it takes from 15 minutes to about half an hour. You may not be very aware of it happening, as most of your attention will be on your baby! As your baby is born, you may be given an injection of a synthetic hormone, usually in your thigh or buttock. The midwife should ask your consent before she does it.

This stimulates the uterus to contract, which causes the placenta to come away from the uterus. You might be asked to give a push or two to help it down, and the midwife might help by a process called 'controlled cord traction' " she places one hand on your abdomen, and the other hand keeps the umbilical cord taut.

The placenta peels away, and the blood vessels on the inside of the uterus close themselves which stops most of the bleeding (some bleeding is normal).

"Info: Some mothers opt for a 'physiological third stage' or a 'natural third stage'. This means the uterus contracts by itself, and expels the placenta and membranes. The cord is clamped and then cut when it stops pulsating, after the placenta is delivered."

If this is what you would prefer to happen, then you should make sure it's in your notes, or part of your birth plan (see our feature on Making a birth plan). There are some situations where it might not be considered safe " if you are at risk of haemorrhage, for instance, or have a problem with blood pressure.

"I had my birth all planned out, but when it actually happened lots of things were not like I imagined it " it was good to have thought it through beforehand, even so."

"I thought I would want to get on the bed to actually give birth, but the second stage happened so quick, I didn't have time to think about moving... so I just stayed where I was, leaning against the beanbags I'd piled up."

"I didn't want an epidural, but when the contractions were very strong, I was glad it was an option."