Assessment of Labour
Labour can be induced or happen spontaneously. However, the ability to achieve a completely unassisted, or spontaneous vaginal birth (that is, without needing any direct help to get your baby out) can depend on a number of factors. These can include:
- The shape of your pelvis
- The position of your baby and the degree that their head is turned
- Your position during labour and birth
- Physiological factors like how effective your contractions are (strength, length and regularity)
- Environmental factors such as place of birth and support
- Emotional factors that can include your response to pain, attitude, fears, history etc.
Labour: What is it?
Labour, from a physical perspective, can be described as the process by which your baby is expelled through your vagina (or birth canal) followed by the sac and placenta. However, each labour is unrehearsed and unique - it is your own experience that encompasses the physical, emotional and spiritual aspects of yourself.
Labour that starts spontaneously, with a single baby, and at term (37-42 weeks) is more likely to progress to a spontaneous vaginal birth.
The average length of labour is 14 hours for a first birth, and around 8 hours in subsequent pregnancies, however many women may experience much longer or shorter births. The length of your labour is generally assessed from the time you go into active labour. If you count labour as starting from the time you feel your first contraction, and include the latent phase (see definition below), then the length of labour can be considerably longer. Some women will experience spurious contractions when they are not yet in proper labour.
The stages of labour
Understanding the different stages of your labour can be very beneficial for your overall birth experience – as it may help to provide you with a sense of what to expect, and you may also feel more confident in identifying how far along you are when it starts to happen.
Stage One: Latent phase of labour
The first stage of labour is divided into two phases: latent and active. The latent phase takers place before the active stage and may last 6-8 hours or more for many first time mothers.
During this time, your cervix will continue to efface (shorten) and then dilate (open) from 0 to around 4 cm. Early labour feelings in this phase may include cramps or period-like pains, bloating, changes in bowel motions, nausea, and contractions that are perhaps irregular, relatively mild, and short, but are slowly increasing in their strength, length and frequency.
Early labour may also start with getting your “show” or your “waters breaking”, although this is not necessarily the case. During the early stages of labour you may want to eat and drink light meals or snacks and drink plenty of water.
Stage One: Active phase of labour
In active labour, the cervix will become fully effaced and dilate from 4 up to 10cm (full dilatation). This process will usually happen more rapidly than latent labour and will occur alongside rhythmic contractions that have become much stronger, longer and closer together.
Typically during this time your contractions will be so strong that you can not talk through them, and will last around a minute or more, and come every few minutes. The contractions will be in an established and regular pattern. During this time you may want to be actively moving around, sitting in a water pool, or focusing on your breath and relaxation strategies.
Transition
Somewhere around the time where the cervix is 8-10cm dilated (or until expulsive contractions for the second stage are felt by a woman) many women will enter a period called transition. During this time it is very common for women to feel overwhelmed- for example you may want to go home or escape the birthing room, or feel you cannot cope or do it any longer. This may be the time when you may think you need further pain relief because of the normal emotional feelings surrounding this phase.
Somewhere around the time where the cervix is 8-10cm dilated (or until expulsive contractions for the second stage are felt by a woman) many women will enter a period called transition. During this time it is very common for women to feel overwhelmed- for example you may want to go home or escape the birthing room, or feel you cannot cope or do it any longer. This may be the time when you may think you need further pain relief because of the normal emotional feelings surrounding this phase.
This is where having a really good support person can play a vital role in helping you get through to the second stage. This stage is usually lasts about around an hour, and sometimes you can see a lull in the intensity of uterine contractions between the end of the first stage, and the start of the second stage of labour.
Second stage of labour
The second stage of labour is also known as the “pushing stage”. This is the stage where your baby continues to descend through the birth canal and is finally born!
This stage begins when the cervix is fully dilated. At this point you will often feel an incredible urge to push your baby out. During this time, the contractions often change and are felt to be much stronger. These contractions sometimes begin to space further apart slightly, so for example if they were coming once every two minutes during the first stage, they may come once every three minutes. The urge to push is often so strong; it is as if you can’t help but push along with your uterus that is also contracting to expel your baby. Feeling this urge to push can be affected by your choices of pain relief in labour.
The second stage of labour can be as short as a few pushes to an hour or longer. Usually, for first time mothers the second stage is longer than if you have previously given birth.
Third stage of labour
Congratulations! Your new baby is now born! However, you will still need to deliver your placenta and the membrane sack that your baby has lived in for the past nine months.
This can be done in two ways. The first is the physiological delivery of your placenta (or the natural method), and the second is called active management of your placenta.
In a physiological delivery of your placenta, the umbilical cord is clamped and cut after it has stopped pulsating, and the placenta is delivered by you pushing it out. This is much softer and easier than birthing your baby and your body will continue to have natural contractions to expel the placenta. It may only take several minutes following birth, but can take up to an hour.
The second method, called active management of the placenta, involves having an injection of a hormone into your thigh immediately following the birth of your baby, and once the cord has been clamped and cut. This injection (usually of a drug called syntocinon or syntometrine) helps to separate the placenta from the wall of your uterus. Your midwife or doctor will then pull the placenta out.
It’s good to discuss your choices and care with your midwife or doctor beforehand and include it in your birth plan.
For advice about how to have a more comfortable labour, read our tips for getting through labour.
Breastfeeding straight after birth
Having skin-to-skin contact with your baby is recommended immediately following their birth because it helps with establishing breastfeeding, and is a very effective method for preventing heat loss. It is also great for kick-starting their immune system, and helps to build your intimate bond with your new baby. If you choose to breastfeed your baby, it is good to do so as soon as possible following their birth, and when your baby shows interest.