What will your labour be like? All labours follow the same stages – but yours will also be unique in many ways.

By Teresa Pitman

By the end of your pregnancy, your uterus has expanded from a small organ about the size of a pear to a large sac of muscle that extends from just below your ribs to your pubic bone. Now that uterus is preparing for its most important task: pushing your baby out into the world.

Until now, the baby has been well-protected and comfortable inside the bag of water (called the amniotic sac) within the uterus. The bottom of the uterus (called the cervix) protrudes slightly into the vagina and is like a thick donut with a very small hole in the middle. It’s this hole that needs to be gradually opened up during labour to allow the baby to be born.

ADVANCE PREPARATIONS: PRE-LABOUR

Before labour actually begins, a number of “advance preparations” take place. For some time now, you have probably been feeling your uterus tighten painlessly now and then; these are called Braxton-Hicks contractions and they help the uterus prepare for the harder work of labour. As the “birth day” draws near, you may even have some false labour – a series of contractions that peter out and don’t result in the arrival of the baby. The cervix will become softer in preparation for the stretching process that will happen during labour. You may also notice that walking is more difficult than usual. This is caused by a loosening and softening of the cartilage between the bones of your pelvis to make it easier for the baby to pass through.

If this is your first birth the baby will probably move down into your pelvis a few weeks before labour starts. This is described as the baby being engaged or dropping. You will notice that your breathing is a little easier and that pressure on your bladder increases.

One of the ways that the baby is protected inside the uterus is by a plug of thick mucus in the opening of the cervix. As the cervix softens and begins to open up, that mucus comes out ( usually mixed with a bit of blood. You may notice the pink or red-tinged mucus on your underwear or when you wipe yourself after going to the bathroom) this is often called a bloody show and may appear either during labour or a few days before.

Women also frequently experience loose bowel movements just before or during the early hours of labour. This is the body’s way of making more room for the baby to emerge.

LABOUR BEGINS

No matter how many children you have already had, or how many birth stories you have heard from others, each labour and birth is unique. What happens will be affected by the position of your baby, your physical health and condition, and other factors (like the birth environment and your feelings) that we don’t fully understand. While it is a good idea to prepare for labour and make some decisions about what you would like to happen, it’s also important to keep an open mind and realize that things may be different from what you expect.

When does labour really begin? It’s hard to say. Some women will experience contractions over a period of hours or days, and then feel discouraged because their caregiver reports no dilation of the cervix. But these contractions are not wasted (they are softening and thinning the cervix so it is ready to open. If this ripening of the cervix has, instead, happened gradually in the days or weeks prior to labour, then you may go right into active labour, with no doubt about it!

The earliest contractions may feel like strong menstrual cramps or like an intermittent backache. At first, contractions may be fairly short ( perhaps 30 to 40 seconds long ( with 15 or 20 minutes in between. You can walk and talk through contractions, and may be wondering if you are in labour or not. If it is night, you should rest as much as possible in preparation for the hard work ahead of you. These early contractions are softening the cervix, thinning it out and beginning to pull it open.

THE PACE PICKS UP: ACTIVE LABOUR

As labour continues, the contractions generally become stronger, more intense, longer, and closer together. The cervix is definitely dilating now. If the baby is in a posterior position (with the back of his head against your back), which happens in about one out of four births, you may feel pain or intense pressure in your back, and this may not disappear entirely between contractions.

As the cervix opens further, you will see more mucus and some blood. You will need to stop walking during these contractions, and may need to lean on a wall or your partner for support. Or you might prefer to be sitting or kneeling.

THE HOME STRETCH: TRANSITION

By now, you may have been labouring for many hours. You’re tired and may be fed up with the whole thing. You are moving into the most intense stage of labour, as the contractions pull the cervix the rest of the way open to allow the baby to be born.

Contractions in the transition stage may be right on top of each other, with little time to rest or relax in between. Because the baby is beginning to move down into the pelvis, positions that were comfortable earlier in labour may not work any more. You may feel nauseated or vomit, experience shaking or trembling (especially in your legs), feel flushed and hot, feel scared, panicky and overwhelmed. While this can be a tough stage, all these are positive signs ( you are getting close to the birth of your baby.

Transition, while intense, is usually the shortest part of labour.

THE PUSHING STAGE: YOUR BABY’S BIRTH

When those transition contractions have done their job and opened the cervix all the way, most women feel a strong urge to bear down and push the baby out. It is very much like the feeling you have when you need to have a bowel movement (the baby is pressing on many of the same nerves). Sometimes this pushing urge is almost impossible to resist, coming in several surges through each contraction; in other cases the feeling is less clear and you may need some direction and encouragement from your birth attendants. You will be helped to find a comfortable position: perhaps squatting, semi-sitting with legs supported, or side-lying with the top leg supported.

Pushing a first baby through the cervix, into the vagina and then into the outside world is usually a slow process: each push moves the baby a little bit forward, but when the contraction ends the baby slides back. Contractions are further apart than they were during transition, and this stage may take a couple of hours. Second and subsequent babies may come much faster.

Eventually, you will feel a burning sensation at the entrance to the vagina as the baby’s head crowns and stretches the skin. If you can, you may want to pant or blow rather than push during the next contractions, to allow your tissues to stretch more gently. Another contraction or two and the baby’s head emerges, normally facing towards the mother’s back. After a moment or two, the head begins to turn to allow the shoulders to be born. Once the shoulders are delivered, the rest of the baby usually slips quickly out, still attached to the mother by the umbilical cord. Your baby is here!

FINAL CONTRACTIONS

Your baby is born, but your labour isn’t quite over. The cord will be clamped and cut, and then (while you admire your new son or daughter) your attendants await the arrival of the placenta. After nine months of nourishing your baby, this organ is no longer needed, and you will experience a few more mild contractions as it is expelled.

While all labours will follow these stages to a certain extent, yours will be unique in many ways. You may have a very short early labour and a longer-than-usual transition stage. Your contractions may never get close together ( you might just give birth with contractions ten minutes apart. Your labour might be very quick but intense, or last for several days. It may be nothing at all like your last birth.

Being prepared for labour means staying flexible: no one can really predict what your experience will be like. But you can also await the birth of your baby with confidence that your body has been beautifully designed to give birth and to work through the stages of labour.

Tips for Labour Pain Relief

• Preparation is important, since most people fear the unknown. Understanding what happens in labour and why can make the labouring woman feel more confident.
• Each woman and her partner need to discover what helps her relax before labour starts.
• Breathing patterns can provide something to focus on, but generally slow, relaxing breathing is the most effective.
• Listen to music; if you’re giving birth in hospital, bring your own tape and player along.
• Try water therapy ( many hospitals now make showers and whirlpool tubs available to labouring women.
• Gentle massage can be very relaxing, although some women don’t like to be touched at all.
• Walking and moving around in labour is very helpful. It not only shortens labour but makes it more comfortable. When contractions are too strong to walk through, you can lean on your partner or against a wall.
• If you decide to sit in bed, you should change positions frequently. You may want to lie on one side, sit propped up, squat or kneel.
• For back labour, many women find that kneeling on all fours, leaning on a counter or table, lying on one side, or straddling a chair or toilet seat backwards helps. Gentle massaging of the lower back, counterpressure, or applying either ice or a heating pad can also help.
• Although food is not well digested during labour, you can eat whatever you feel like and should at least take sips of juice or ginger ale to stay hydrated. (In hospital, you may be restricted to fluids only.)
• Emptying the bladder frequently is important, even though you may not feel the need to go to the toilet.
• Many women find imagery helpful (they imagine themselves in a peaceful setting, or they focus on ‘opening’ images (such as a flower blooming) as the contractions open the cervix.
• Low moaning noises are often a good way to release tension and promote relaxation.
• The presence and encouragement of a constant companion are extremely valuable. If labour is long, having more than one person available to provide support is a good idea.

– from midwife Jennifer Ristok

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