Understanding the stages of labour and delivery

If you’re nervous about your delivery, you can take comfort in the fact that you’re not the first. Every woman has jittery emotions about childbirth, which can range from mildly apprehensive to downright terrified, no matter the option selected. If you’re undecided as to how you want to give birth, understanding the process of labour and the different delivery methods may help clarify the decision-making process (depending on whether your pregnancy is considered normal and healthy enough for you to make the decision entirely on your preference).

It’s human nature to be a little nervous, even scared. If you have a better idea of what to expect, chances are your levels of anxiety will drop and the process of each stage of labour and delivery can go a lot smoother for you.

Labour and birth by vaginal delivery

There is no perfect script for childbirth. Once labour has been triggered, you can expect to go through 3 stages before you are able to hold your new little human in your arms. Every woman’s delivery experience is going to be unique in its own way. How one woman experiences these stages may be different for another. There’s no way to really expect what exactly you’ll go through and feel until you are well in the moment.

For the majority of first time moms, labour can last anywhere between 12 and 24 hours. Some have shorter labour periods and for others this period can last a little longer.

As labour approaches you may experience the following:

• Your belly may drop a little and you may feel like you are able to breathe a little easier. This is because the baby is beginning their descent into the pelvic area and relieving pressure from the lungs where he or she has been stationed for the duration of your pregnancy.
• You may also feel a strong urge to urinate as the baby begins pressing on your bladder (sometimes this occurs in the weeks leading up to the day of delivery or several hours beforehand).
• During the build-up to labour, you may experience frequent loose stools (diarrhoea). This can sometimes be an indication that labour is imminent.

In general, this is what every new mom can expect to go through during her labour process:

• Stage one – the latent phase: Of all the stages you will go through, this one will be the longest part of your childbirth process and happens in two distinctive parts. Once labour is triggered contractions (uterine muscle spasms) begin. Notify your doctor and birthing team. Contractions will be mild at first and you will feel pressure approximately every 15 to 20 minutes as your cervix begins to open (dilate) and stretch (thin). Opening and stretching of the cervix ends when there is approximately a 3 or 4 centimetre gap (about 1 and a half inches). Many women liken the sensation of contraction pressure to a moderate back ache or menstrual cramps. Contractions may last anywhere between 30 and 70 seconds at a time and become more regular, frequent and intense as labour progresses. As the cervix opens you may notice a pink/red or brown-tinged discharge. Sometimes this can happen as early as a few days before labour, as well as during this initial stage as the body naturally prepares for birth. This discharge is merely the rupturing of the amniotic membranes and is perfectly normal. You may notice the discharge as merely wetness or perhaps feel a ‘gush’ of activity. If you are in reasonably good health and are not considered high-risk for complications, you may be able to remain home at this stage until you begin experiencing contractions around every 5 minutes. Once this happens, notify your doctor and ensure that you make your way safely to your birthing environment. If at any point you notice that you are leaking fluid, even before contractions are 5 minutes apart, it is best to get to a hospital as quickly as possible. During this phase, make yourself as comfortable as you can throughout. If soaking in a warm bath helps or playing music helps, do what you can to ensure you are calm, comfortable and focussed.
• Stage one – the active phase: Still part of the labour phase, this is when contractions begin to get serious. Contractions will be getting more frequent, around 2 or 3 minutes apart and lasting about 45 to 60 seconds at a time or longer, and becoming more intense (painful). During the end of this stage, your cervix will dilate (stretch) a little more rapidly (around 1.2 centimetres an hour). Once dilation reaches between 8 and 10 centimetres (3 to 4 inches), you are moving into a transition stage, and may begin to feel increased pressure, back pain and even nausea. Once you have reached or are set up in your birthing environment, your delivery team will assess your condition (body temperature, pulse and blood pressure). External monitors may be used to assess your contractions and the baby’s heart rate. Your rate of cervix dilation will be assessed and the delivery team (nurses, midwife, doctors etc.) will then begin preparing for the next stage of your labour. You may be offered pain management options (an epidural or anaesthesia). If you’ve planned a fully natural birth with no pain management you can change your mind at this stage and opt for pain assistance, if you are in a medically controlled environment that can provide this for you. At this point you will be rather uncomfortable. You may wish to find some relief by changing positions, such as walking around or getting down on all fours (hands and knees) at this stage. Bouncing on a birthing ball or receiving a massage can help with lower back pain. Deep breathing also provides considerable relief.
• Stage two – the pushing phase: This stage generally lasts between 2 and 3 hours and begins when you reach maximum dilation (10 centimetres / 4 inches) and the baby’s head descends into the birth canal (vaginal / pelvic area). Pressure will build as the baby pushes down on nerves, creating an intense urge to have a bowel movement. Trust your birthing team. They will guide you and tell you when to start pushing. If you do this too early, your cervix can begin to swell. It’s more than likely that you will push in three spurts during each contraction. To ease delivery an episiotomy may be suggested but is not always all that necessary. Your birthing team will measure the baby’s descent through the birth canal in what is called ‘stations’ until he or she crowns (the top of the head becomes visible at the opening of your vagina). With a few final pushes, you will deliver the rest of your baby. The umbilical cord will then be clamped and cut.
• Stage three – the afterbirth: Once the baby is safely delivered, you will need to push out the afterbirth (placenta – a disk or pancake shaped organ that is attached to one side of the uterus and on the other, the baby’s umbilical cord) which has helped to nourish your baby while in the womb. This final stage is the shortest of the three and can last anywhere between a few moments or up to 30 minutes. You will still experience contractions, but this will not be as intense as those experienced during your baby’s birth. It’s hardly likely that you will experience any pain at all. Some women may not even notice that the placenta has passed through. Any tears or incisions that occurred during birth will be stitched up once all the placenta has been removed. It is vitally important that a woman deliver the placenta. Any that is retained can cause serious complications, such as bleeding and infection. The doctor will examine the placenta once delivered to ensure that it is intact and a portion hasn’t been left behind in the uterus. Typically, the maternal side (the side that attaches to the uterus) of the placenta is a dark red colour and the side attached to the baby is almost translucent. Placenta that isn’t delivered entirely is known as ‘retained placenta’ and this can happen because the cervix begins to close and the opening is too small for it to move through, or it is too tightly attached to the uterus, or a portion has broken off during the delivery. A doctor will ensure that all is removed (surgery may be necessary in some instances). This is very important as the uterus must naturally contract and clamp back down following the birth of a baby. This tightening enables the blood vessels inside to stop bleeding. Retained placenta will cause internal bleeding and infection if not removed entirely, which can be dangerous for a new mother.

Labour and birth by C-section

If you and your doctor have opted for a C-section delivery, your birth method experience will be explained in detail to prepare you for the big day. Being a surgical procedure, all operation processes and risks will be discussed with you. Your doctor will give you a complete outline about what to expect and what he or she will be preparing for in the event of a complication (such as blood for a blood transfusion), as well as a recommend set of instructions to assist with lowering any foreseeable risk factors as well.

You will also need to prepare for recovery time (at least 3 or 4 days in hospital and up to 8 weeks recovery at home) following the procedure, which is longer than that of a vaginal birth.

In a nutshell, how will the procedure be performed?

• Before the procedure: You will be asked to shave your pubic area the day before the procedure (or the nursing staff will do it for you prior to it). Your bowel will need to be cleaned out prior to surgery (usually via an enema) and IV (intravenous) fluids administered. A catheter may also be put in to help empty your bladder ahead of surgery.
• Preparing for surgery: You may be given one of three types of anaesthetic – a spinal block (injected in the sac that surrounds the spinal cord and numbs the lower portions of your body), an epidural (injected into the lower back outside of the spinal cord sac) or a general anaesthetic (reserved for emergency scenarios where a mother will need to be completely unconscious).
• During the procedure: A horizontal incision will be made just above your pubic hairline, across the pelvis. The doctor will then make an incision into the uterus. Unless birth is happening as an emergency, surgical incisions will not be visible to you, even though you will be conscious. Once the incision into the uterus is made, the baby will be removed and his or her nose and mouth cleared of any fluids. The umbilical cord will then be clamped and snipped, and prepared for that first moment in your arms. The doctor will physically remove the placenta from the uterus. From there your uterus and abdomen will be repaired and stitched (usually with dissolvable stitches). Your doctor will also likely massage the top of your uterus to encourage the natural contraction (shrinking) process. If the uterus does not firm up, medication may be given to help things along or you may be asked to try and breast feed your baby (this can also help the uterus to contract).
• After the procedure: A hospital stay of at least 3 or 4 days will be required for both you and your baby. Medical staff will keep you on an IV and adjust the levels of pain medications administered into your bloodstream while the anaesthetic wears down in the body. You will be encouraged to move (walk around) to help prevent constipation and blood clots. Medical staff will also be on hand to assist you with the most comfortable positions so that you can move about and breast feed without causing yourself injury (to the incision area). You will also be well prepared with instructions for the most comfortable home care as you recuperate and begin being a new mom. Home care will involve rest, the correct posture and support for your body post-op, plenty of fluids, and medications (for pain and discomfort, as well as for infection prevention).