Labour - South Shore Women's and Children's Hospital


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Perhaps there is no other event in a woman’s life that is regarded with equal parts of dread and excitement as labour and delivery. Dread because of the expectation of long hours of pain and the possibility of injury, but excitement at the fact that it will culminate in the delivery of the long awaited baby, and mark the end of a stressful period.

Before the day arrives, you would have discussed extensively with your doctor and made a decision about what mode of delivery is best for you – depending on your previous history, the present condition of both you and your baby, and your personal preferences. If the plan is for you to have a spontaneous labour and delivery, make sure you have your bag packed, ready with the items on the list given to you during your antenatal visits.

You should also have a good plan of how you will get to the hospital from wherever you might be when labour starts. Another important thing that will be discussed is pain management – you will be offered an epidural, which is a type of pain relief given during labour to make the whole process easier to bear. The decision on whether or not to have an epidural rests with you, unless there are medical contraindications like a bleeding disorder or an abnormally low blood pressure.

Be sure to ask questions, clarify any reservations you might have, and get sufficient information on what to expect with an epidural.
You might experience a ‘show’ – This happens when the mucus plug that covered the cervix comes off and is passed out through the vagina. You will notice a thick mucoid discharge, which may be blood streaked.

While this is one of the signs that labour is about to happen, it doesn’t happen obviously to everyone, and even when it does happen, it can still take some days before labour starts.
A more certain sign that labour has started is the beginning of contractions. Labour contractions are different from Braxton Hicks contractions in a number of ways. They are regular and painful, and usually get increasingly stronger and more consistent with time. Also, the contractions do not stop when you change position, and each one may last for about 30 to 60 seconds.
Sometimes, the sac containing the baby might rupture, and the water surrounding the baby (amniotic fluid) begins to leak out; this is called your water breaking.

You might feel a gush of some fluid between your legs. If this happens, or if you suspect that your water has broken but you aren’t absolutely sure, it is important for you to contact your doctor immediately and get to the hospital as soon as possible. Active labour should start soon after your water breaks, in order to reduce the risk of an infection getting to the baby. If your water breaks and labour hasn’t started actively, you might need to have an induction of labour.
Labour is divided into three stages, as follows:

First stage of labour
This is the time from the onset of regular painful contractions till the cervix is fully dilated to 10cm. It lasts on the average for about 10 to 12 hours in first time pregnancies, and subsequently becomes shorter. Once you have been admitted for labour and delivery, you will be placed on a machine called a CTG (cardiotocograph), which functions to assess the baby’s heart rate and the intensity, frequency and duration of your contractions.

You will also have a vaginal examination done by your doctor to measure the dilatation of the cervix and monitor the descent of the baby; this will be repeated at 3hourly intervals.
There is an initial phase of the first stage called the early phase, when the contractions are milder, and might be irregular or have an inconsistent pattern.

The contractions last for about 30 to 45 seconds each, and are 5 to 20 minutes apart. You might be able to walk around, or take some light fluids in this phase. As labour progresses, you will notice that the contractions get stronger, more painful, and closer together.
The second phase of the first stage is the called the active phase, and by this time, your cervix will have dilated up to about 4cm. The contractions now last longer, for about 45 to 90 seconds, and are 3 to 5 minutes apart.

You might feel worsened back ache and an intense pressure at your lower abdomen and vagina as the baby descends. If your water hasn’t broken, it will do so during this time, or your doctor will rupture the amniotic sac, and this usually helps the contractions. There might be an urge to push, but it is important that you do not do so until you are asked to, as pushing before the cervix is fully dilated and the baby is ready to be born can delay your delivery or harm the baby. You can ask for medications to relieve the pain if it becomes unbearable (especially if you are not having an epidural).

Second stage of labour

The second stage begins when the cervix is fully dilated to 10cm and ends when the baby is delivered. This can last from about 10 minutes to 2 hours. It is longer when it’s’ a first pregnancy, but can last for just a few minutes in subsequent deliveries. By now the contractions and the pressure are strongest, and you will be asked to ‘bear down’, or ‘push’, with each contraction. Concentrate on putting pressure down below (just like you are trying to pass stool), and not on your face or upper body. Do this only for as long as you are asked to, so that you can take rests in between contractions.

Sometimes, the baby is already at the vagina, but the opening is too small to pass through. If this happens, you might need to have a cut on the skin between the vagina and the anus to create more room.
The baby’s head will be delivered first, and then the doctor will clear the nostrils and check that the umbilical cord is not tangled. After a few more efforts, the baby will be delivered and the umbilical cord cut. You will finally be able to see your baby, and he or she will be taken aside briefly to be cleaned and examined. Congratulations!!!

Third stage of labour
This final stage starts from the time baby is delivered to the time of delivery of the placenta. It usually takes a few minutes, but can last for up to 30 minutes. The contractions will still be present, but would have become mild. You will have your uterus massaged a bit to stimulate it to contract and deliver the placenta, you might need to push once more.

Once it’s delivered, it will be examined to be sure that it is complete. If you had an episiotomy or a tear, it will be stitched at this point, and you can get more pain relieving medications. Afterwards, you will be cleaned up and made comfortable again, ready to meet your little one properly.