The first stage – when the cervix gradually opens up (dilates)
The cervix needs to open about 10cm for a baby to pass through. This is called ‘fully dilated’. Contractions at the start of labour help to soften the cervix so that it gradually opens.
Sometimes the process of softening can take many hours before you’re in what midwives call ‘established labour’. Established labour is when your cervix has dilated to at least 4cm. If you go into hospital or the midwifery unit before labour is established, you may be asked if you would prefer to go home again for a while rather than spending many extra hours in the maternity unit. If you go home, you should make sure you eat and drink, as you will need the energy.
At night, try to get comfortable and relaxed. If you can, try to sleep. A warm bath or shower may help you to relax. During the day, keep upright and gently active. This helps the baby to move down into the pelvis and helps the cervix to dilate.
Once labour is established, the midwife will check you to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker for subsequent pregnancies.
Your midwife will tell you to try not to push until your cervix is fully open and the baby’s head can be seen.
To help you get over the urge to push, try blowing out slowly and gently or, if the urge is too strong, in little puffs. Some people find this easier lying on their side, or on their knees and elbows, to reduce the pressure of the baby’s head on the cervix.
The second stage – when the baby is pushed down the vagina and is born
This stage begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push.
Find a position
It will be a balance of which position you prefer and which will make labour easier for you. Gravity can be very helpful in labour and being upright can help speed labour along and relieve back pain. You might want to stand, sit on a birth stool or ball, kneel or squat (although squatting may feel difficult if you are not used to it).
If you are very tired, you might be more comfortable lying on your side rather than propped up with pillows. This is also a better position for your baby. If you have had backache in labour, kneeling on all fours might be helpful. It can help if you have tried out some of these positions beforehand.
You may be able to find some examples of comfortable positions here.
The third stage – when the placenta comes out
This stage of labour begins when the baby is born and lasts until the placenta comes out through your vagina.
There are 2 ways of managing this stage of labour – active and physiological.
What is active management?
Your midwife will give you on injection of oxytocin in your thigh shortly after birth. This will make your womb contract.
Evidence suggests that it is better not to cut the cord straight away, so your midwife will wait to do this between one and five minutes after birth. This may need to be done sooner if there are concerns about either you or your baby – for example if the cord is atightly around your baby’s neck.
After the placenta has come away from the womb, your midwife will put some gentle pressure on your abdomen and pull the cord. As the cord is attached to the placenta, this will pull the placenta out of your vagina. This usually happens within 30 minutes of your baby being born.
Active management can speed up delivery of the placenta, and can lower the risk of you bleeding heavily, but can increase the chance of you feeling nauseous and vomiting. It can also make afterpains – contraction like pains – worse.
What is physiological management?
No oxytocin injection is given, and the third stage happens naturally.
The cord isn’t cut until it has stopped pulsating, so blood can still pass from the placenta to your baby.
Once the placenta has come away from the wall of your womb, you should feel some pressure in your bottom and contractions.You will then need to push the placenta out. It can take up to an hour for the placenta to come away, however, only a few minutes to push it out.
If the placenta doesn’t come out naturally or you begin to bleed heavily, you will be advised by the midwife or doctor to switch to active management. You can also choose to do this at any time during the third stage of labour.
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