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Labour and delivery: All you need to know

Fadu News 2018-12-07 11:39:01

Each women’s labour is unique in itself. Often it is a test of the mother’s emotional and physical stamina.

Although women experience labour in diverse ways, usually, labour and birth involve the following

  • Opening and softening of the cervix
  • Rupture of the amniotic sac
  • Strong and closer contractions

Occasionally, though, labour and delivery can take unanticipated turns and twists. You may review the need for pain medication or you may even be advised an immediate C-section

Signs of labour

One should be on watch out for little signs, once past the 36th-week mark. Even in signs of preterm labour, one should contact the doctor.

The signs to be on lookout include:

  • Strong contractions at regular short intervals
  • Persistent cramps and low back pain
  • Brown to bloody reddish mucus
  • Water breaks that can be in form of a continuous trickle or a heavy gush

How to discriminate false labour from true labour:

Majority of the women, particularly first-time mothers may mistake they are in labour whilst they are not.  This is known as false labour. In the last weeks of pregnancy, the uterus has Braxton Hicks contractions, which are characterised by tightening or hardening of the uterus. These are usually without pain but are nonetheless very uncomfortable. Occasionally, one may experience pain during the Braxton Hicks contractions.

How to know that one is in true labour?

With the onset of true labour, the contractions are strong, regular and occur more frequently. These can be differentiated from Braxton Hicks contractions by timing the contractions. Braxton Hicks contractions do not follow a regular pattern. In case of any doubt over the contractions, one must contact the doctor.

Stages of labour

Labour occurs in 3 stages:

  • Beginning of regular contractions
  • Baby moves down in the pelvis
  • Cervix opens and thins

The progression and duration of labour vary for every woman.

First Stage:Early Labour

The first phase is the longest phase and could last up to 20 hours.  The first phase of labour begins with the opening of cervix due to contractions.

Signs of early labour

One will encounter contractions which may vary from very minor to moderate in nature and lasting from 30-45 sec. The contractions could be short, irregular or regular. Often there may be a gap in their incidence for more or less 20 minutes. One will be able to notice the contraction only in the last 2-6 hours.

One can experience the following signs in early labour:

  • Cramps
  • Backache
  • Diarrhoea
  • Pressure on the lower abdomen
  • Warm sensation in abdomen
  • Discharges of mucous tinged with blood
  • Amniotic membrane rupture (more likely to happen during active labour)

What to do during early labour?

You many feel the excitement, relief, uncertainty, anxiety or even fear. All of these responses are normal. It's important to try to relax and conserve your strength for later.

Do not be too obsessed about timing your contractions. You may check periodically to see if they occur at intervals of 10 min. Eat light and avoid fats, acidic stuff and drink a lot of water.

Use the bathroom frequently. Keep an eye on the kicks or foetal activity.

In the case of acute bleeding or unusual red discharges seek medical attention immediately.

Second phase: Active Labour

This phase usually lasts 2-3.5 hrs with the cervix dilating to 7 cm. This phase usually occurs in the hospital.

Signs of active labour:

The contractions increase and become intense and can be painful. Active labour is marked by longer, stronger contractions that occur in a definite pattern (may not be regular always).

One can expect:

  • Rise in discomfort and pain during contractions
  • Fatigue
  • Backache
  • Bloody show
  • Water break (may be done by the physician if it doesn’t happen on its own)

The hospital staff will monitor your contractions, do foetal monitoring, and see if you require an epidural anaesthesia. Keep you mouth moist by drinking light and clear beverages. Use the restroom; a full bladder may go unnoticed due to pelvic pressure and hamper the progress. Sometimes, a catheter is placed when an epidural has been given.

Third Phase: Transitional (advanced) labour

This is the most intensive phase of labour. The cervix will dilate to 10 cm from 7 cm. The good thing is that it is the shortest phase (usually 15 min – 1 hr).

Signs of transitional labour

The contractions are now stronger lasting 60-90 sec and are very intense. Often women who had delivered earlier will have many peaks.

In the transitional phase one can experience (if not numbed by pain medication or epidural):

  • Feeling warm, shaky and chilled or sweaty
  • In the perineum or lower back, a strong pressure is felt
  • Pressure on the rectum
  • Exhaustion
  • Legs may tremble with cramps
  • Vomiting or nausea
  • Drowsiness

During the transitional phase, try to breathe slowly rhythmically between the contractions.

One will be shifted to delivery room the moment the cervix is fully dilated to 10 cm. Now you will require pushing from your end. Pushing helps the baby through the birth canal. Delivery usually takes 30 min – 1 hr. Sometimes, it can be lesser, from few minutes to lasting several hours.

When will you know, it’s time to push?

By now one will have regular contractions than the transitional phase, these are a bit apart (2-5 min usually).  These may be very intense or less intense. One will clearly be able to see a regular rest interval between them.

Similar to the second stage (if on epidural nothing may be felt):

  • Possibly less pain during the contractions
  • Increased urge to push
  • Heightened rectal pressure
  • Increased bloody show
  • A surge of new energy or exhaustion
  • Sensations that are wet tingling or stinging at vagina as the baby’s head begins to merge

Pushing Tips

It is now time to get the baby out by pushing. Pushing might appear embarrassing or frustrating if the time taken is too much.

  • To begin with, get into a position that suits you or follow the doctor present there. Start pushing at regular intervals normally three times in every contraction or as your urges prompt.
  • Push as if you have a bowel movement. Push with maximal force and do not worry about urinating or passing bowels.
  • Ensure on putting your chin to the chest while pushing. This will help you focus on the pushes.
  • Use all your energy and avoid pushing frantically. One may change positions. Also, ensure that you do not push from the upper body, which can lead to straining of the face.
  • Breathe in deeply when the contractions build up and prepare for pushing.
  • When the contraction is at peak, with a deep breath push with all your strength.
  • Trust your instincts and push when you get the urge and the baby will be delivered.
  • Seek help from the support or medical staff present.
  • The physician might also ask you to pause the pushing to prevent the baby being born very rapidly or to give you some rest.

Occasionally, an episiotomy (surgical cut in the vagina) or rarely forceps or vacuum extraction (assisted delivery) may be performed.

The moment the baby’s head is out; they will guide the baby out with your small push. Once the baby is born, the umbilical cord is cut. The placenta is the last thing to be pushed out.

What to expect post delivery:

Apgar score: Immediately after the baby is born, Apgar test is done within 1 to 5 minutes of birth to assess the baby’s health. The breathing, heart rate, reflexes, muscle tone, and skin colour are scored with a 0, 1 or 2. The scores are added to get a maximum score of 10.

The normal Apgar score is from 7 to 9, indicating the baby is in good health. Any score less than 7 indicates that the new-born requires medical attention to adjust outside the womb.

A low score at 1 minute often comes to near normal by minute 5. Apgar score is not intended to forecast the future health of the baby.

Placenta delivery

One will experience contractions which are mild and last for a minute each. The doctor might try to hasten the process by giving you an injection (oxytocin) to promote contractions of the uterus. They will examine the placenta to ensure the whole of it has come. Bloody vaginal discharge (lochia) is noticed after delivery.

Now it’s time to congratulate yourself and bond with the baby.

Managing labour pain

Nearly, all women worry about labour pain. Labour pain can be managed naturally or with medical help or a combination of both might be required.

Natural pain management

The following may ease the pain:

  • Breathing and relaxation exercises
  • Warm baths or showers
  • Listening to music
  • Massages

Medical pain management

  • Opioids may be injected or given through spinal or epidural blocks
  • Spinal or epidural blocks allow women to be alert and awake during the delivery. These involve injecting small doses of medicine in the spine.
  • Pudendal block involves injecting the pain medicine via the vagina near the pudendal nerve.

What to expect in the delivery room?

Let’s now have a sneak preview of the delivery room, where you will be spending the time during your labour in the hospital. The majority of labour rooms have a homely atmosphere with snug pillows and stuff. Along with them, you will find a lot of instruments and machines which are meant to assist you to deliver a healthy baby. Do remember, these machines have been used innumerable times before by the medical staff there.

One can expect to hear of the following instruments or machines that may be used in one’s delivery:

  • Scissors: These are used for cutting the umbilical cord and for surgically widening the vagina (episiotomy).
  • Speculum: This instrument is normally used in regular check-ups. It is used to check the dilation of the cervix
  • Amniotic hook: It’s a long crochet like needle made of plastic. In cases where the amniotic sac does not break open on its own, it will be used to break the water. The procedure is completely pain-free.
  • Forceps: This may be used instead of a vacuum extractor to coax the baby out during the delivery.
  • Umbilical clamp: It is a plastic clamp used for clamping the umbilical cord. Neither you or the baby will experience any pain during the umbilical cord cutting.
  • Vacuum extractor: A cup of plastic or metal is secured around the baby’s head and suction used to guide the baby out through the birth canal (assisted vaginal delivery).
  • Foetal Monitor: During labour, a strap will be attached to the stomach of the mother to an external foetal monitor which screens the baby’s heart rate and tracks the contractions.

Breathing techniques during labour

Breathing rhythmically during your labour will boost the oxygen levels for you and your baby. Breathing techniques could also help in coping with contractions as well. The techniques of relaxation and breathing have been shown to reduce the risk of assisted birth.

When one is alarmed and tensed, the breathing is fast and shallow in nature. This panic breathing cuts down the oxygen levels for the body and the baby. Further, the state of panic breathing will lead to exhaustion.  While in labour, one has to conserve one’s energy and give more oxygen to the baby to cope up with labour.

Techniques to try

  • Close the eyes and try to focus on the breathing and check its rhythmicity. Ideally, your in-breath and out-breath depth and length match and have a pause before one draws in the next breathe.
  • Count the breathing: Slowly count 1 to 3 or 4 when you breathe in or any number as per your comfort level. When you breathe out, count the numbers. Ideally, it is more convenient to breathe in a count of 3 and breathe out to count of 4.
  • Breath in via the nose and breath out through the mouth. You can sip water between your contractions to prevent the mouth from drying.

Types of delivery

  • Normal Vaginal Delivery It is the most common and safest way of childbirth.
  • Assisted Delivery Sometimes, assisted vaginal delivery is done using a suction cup on the baby’s head to pull the baby gently from the birth canal. The common procedures in assisted delivery include episiotomy, breaking the water (amniotomy) and use of forceps for delivery.
  • Caesarian delivery(C-section) Occasionally, normal delivery may not be feasible. C-section is a surgery to deliver the baby. C-section could be performed for the safety of the mother and the baby especially in scenario of:
    • When the baby is not in head-down position
    • Baby is too large to pass within the pelvis
    • Issues with placenta and umbilical cord
    • The baby’s heart rate is slow
    • Mother has unsafe levels of high blood pressure

Many women, fearing pain during childbirth, opt for C-section.