Stages of Labour
Monitoring Your Baby's Wellbeing
The midwife will monitor your baby’s heartbeat throughout your labour. The midwife is watching for any changes in the heartbeat that may suggest your baby is becoming distressed or tired. The simplest method of monitoring is by using a Pinard stethoscope. This is a trumpet-shaped stethoscope that helps the midwife to hear your baby’s heartbeat through your tummy. A Doppler is a small hand-held ultrasound machine that looks like a microphone. It is placed on your tummy and allows you, your birth partner and the midwife to listen to the baby’s heartbeat. If there are any concerns about your baby’s heartbeat or if your pregnancy or labour falls into a ‘high risk’ category, continuous monitoring is recommended. This is done using a CTG machine. Two transducers are placed on your tummy: one records the contractions and the other records the baby’s heartbeat. Sometimes it can be difficult to get a good printout of the heartbeat this way. The midwife might suggest an alternative by placing a monitor on your baby’s head to improve the recording of your baby’s heartbeat. This involves securing a small monitoring device to your baby’s scalp during a vaginal examination. Some women are concerned that they can’t move around if they are attached to the CTG machine. In CUMH all of our birthing rooms have a telemetry device which allows mothers to walk around during monitoring. If you don’t feel like mobilising the midwife will help you to find alternative comfortable positions.
First Stage- Early Stage
The length of the first stage of labour can be different for every woman. If it is your first labour, the time from the start of labour to full dilation of the cervix (10 cm) is usually 6 – 12 hours. If it’s not your first labour, the time is usually shorter. Walking around helps the baby position itself for the labour, massage, TENS and warm baths/showers are great soothers. Music provides diversion and helps you to relax. In the absence of an epidural, small, light meals and fluids are encouraged to help keep you hydrated and provide energy during labour. The midwife will monitor the progress of your labour by continuously assessing the frequency, strength and length of your contractions. They will check every few hours to see how your cervix is dilating, what way the baby is presenting and how the baby is moving down through the pelvis. Generally, as labour progresses, your contractions will become gradually stronger and more painful and come closer together. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it’s time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters releasing/breaking. You may feel a slow trickle or a sudden gush of water that you cannot control. If your waters break/ release before labour starts phone the hospital for advice.
Throughout your labour, the midwife provides emotional support, including reassurance and encouragement. We encourage you to use breathing exercises and relaxation techniques and find a position that's comfortable. You may request additional Pharmacological pain relief if you need it, such as 'gas and air', pethidine or an epidural. We will tell you what is happening and help you to communicate your needs to other members of the team and help you to make choices that work for you. If you need any medical help to ensure your own safety and your baby’s safety, the midwife will explain the reasons for it.
Contractions will be more frequent and last up to 60 seconds. Once your cervix is dilated to 10 cm, you will feel the urge to push with each contraction. This stage can last from a few minutes to up to an hour. Getting familiar with pushing may take some time, especially if it is your first baby. If you don’t have an epidural, find a position that is comfortable and effective for you. You may wish to stay on the bed supported with pillows or to kneel, squat, stand or sit. These positions can be adopted on the bed or on the floor. The midwife ensures everything is okay to allow a safe delivery for you and your baby. An episiotomy is not routine. Your baby is put on your tummy at birth. The baby is dried, and skin-to-skin contact is encouraged as soon as possible after birth, to avoid heat loss. Your midwife will offer you the choice of you or your Birthing Partner to cut the baby's cord once all is well. If you have decided to breastfeed, we encourage you to begin as soon as you are comfortable.
Assisted Vaginal Delivery (vacuum or forceps delivery)
Some women need help to deliver their baby vaginally. This may be due to exhaustion and not being able to push the baby out. Also, the baby can show signs of becoming distressed during birth and the safest thing is to deliver the baby. The midwife and doctor will explain the process to you in advance of anything happening. While a choice of positions during the birth is encouraged, legs on supports or stirrups are used for vacuum, forceps or vaginal breech births. A vacuum is a shallow suction cup placed on the baby’s head to help guide the baby out of the birth canal if the baby needs to be delivered quickly. This is typically done during a contraction while you push. Forceps are metal instruments, which look like spoons. One part of the forceps is gently placed on each side of the baby’s head. You will be told to continue pushing during contractions while the doctor helps you using the vacuum or forceps. An episiotomy is more likely to be performed if you need an assisted vaginal delivery.
A caesarean section is an operation to allow the baby to be born without going through the birth canal. A caesarean section can be planned (elective) or unplanned (emergency). As a caesarean section is considered to be major surgery, it is only performed if there is a clinical need, following discussion between you and the obstetrician. The baby is born through an incision or opening in your tummy just below the bikini line. The midwife will come with you to theatre and will care for your baby when it is born. Sometimes it is possible for your birth partner to come with you to the theatre for the birth. This will depend on how urgent your caesarean section is. Also, the obstetrician and anaesthetist must agree that it’s ok. If your partner can’t come with you, the midwife will stay with you throughout the operation; your birth partner will wait outside the theatre and will see your baby as soon as possible after birth.
If possible, the operation is performed under an epidural or spinal anaesthetic. (A spinal anaesthetic is like an epidural but the drugs are injected into the fluid surrounding the lower spinal cord). A general anaesthetic (which puts you to sleep) is sometimes necessary in emergency situations when the baby needs to be delivered very quickly and an epidural is not in place. If you have the caesarean section under epidural or spinal, you will be awake throughout the operation. You won’t feel any pain but you may feel some tugging as your baby is born. The operation takes about 30 - 40 minutes but the baby is usually born within the first ten minutes. A curtain or divider will prevent you and your partner from seeing the operation being performed. Once the baby is born and providing your baby is well your partner will be given your baby to hold. Skin-to-skin contact will be commenced in the recovery room. Read more on Caesarean section.
At the CUMH, we recommend using an injection to help complete the third stage. The injection makes the womb contract which helps to separate the placenta. This reduces the risk of excessive bleeding. Some women choose to deliver the placenta without the use of drugs, this method can last up to an hour. We can help you to do this if you:
- are not at risk of any complications of bleeding
- had no drugs administered during labour
- have discussed this option with your doctor or midwife during your pregnancy and in early labour