Labour is a series of rhythmic contractions of the uterus which gradually increase in intensity. They move the baby down through the cervix (neck of the womb) an vagina (birth canal) to the outside world.
Labour is divided into three stages. Each of these stages is explained below. The average time for each stage is given only as an indication. Labour usually lasts between 12-14 hours, in a woman’s first pregnancy and tends to be shorter (6-8 hours), in subsequent pregnancies. Labour is so different for everyone and can be a lot longer or shorter than the average time. However, the information below will give you an idea of the general pattern so that you will know what to expect and be prepared for labour and delivery.
First Stage: Dilation of the cervix to 10cm
Average length: 10-12 hours (first baby)
Yours cervix needs to dilate to 10cm before your baby can start to move down the birth canal.
Contractions of the powerful muscles at the top of the uterus open up the cervix (neck of the womb). Your progress during this stage is assessed according to how many centimetres dilated your cervix is. Once your cervix is dilated to 10cm you will then probably feel the urge to push and you will begin the second stage of labour.
You will be discouraged from pushing during this stage since pushing before the cervix is fully opened wastes energy and may tear the cervix.
You can help by keeping active and moving around, as your baby’s head pressing on the cervix encourages it to open. There are many different positions that you can adopt to ease the discomfort. Some women prefer to stand up and move around as this helps to strengthen contractions and accelerates labour. As the contractions proceed, you may instinctively choose a sitting or kneeling position.
During this stage, the heart rate of the mother and baby are monitored roughly every 15 minutes. This alerts the midwives if the baby becomes distressed. If the baby’s heart rate becomes too fast or too slow, the doctor may decide to deliver by caesarian section.
The Second Stage: The pushing stage and birth
During this stage you will push your baby down the birth canal and your baby will actually be born.
Once your cervix is 10cm dilated, you will probably feel overwhelming urges to ‘bear down’ and push your baby out with each contraction. Your baby’s head is pressing on your rectum, which gives you a sensation of needing the toilet but don’t let that worry you – push when you need to and remember each push is bringing your baby nearer. Each contraction is a squeezing of the uterus which pushes your baby down the birth canal.
If you are able to stay on all fours for the delivery, your baby’s head will stretch the tissues at the back of your vagina more gently and you’re less likely to tear. Otherwise you will probably be placed in a semi-upright position (between sitting up and lying down) propped up by pillows. This is to make good use of gravity and reduces the risk of tearing. It also puts less strain on your back and pelvis.
On average it will take one to two hours for your baby’s head to reach the opening of your vagina, known as ‘crowning’, when the midwife will tell you to stop pushing as she eases the baby’s head out to avoid a tear. Then the shoulders are born one at a time, and with a great slippery rush, the rest of the body is delivered, and you can hold your new baby. Once the umbilical cord has stopped pulsating, it is cut and clamped.
Your baby’s heart rate will continue to be monitored during this stage to check that the baby is not in distress.
The Third Stage: Delivery of the placenta
Average time: Few minutes to over an hour
After the baby has been born, the placenta needs to come out of the uterus. This is painless, and you may be offered an injection to speed up the delivery.
Your uterus will continue to contract to expel the placenta. During the first or second contraction after delivery, the placenta usually detaches from the uterus, and a gush of blood soon follows. Usually the mother can push the placenta out on her own. But the doctor or midwife will be able to help with pressure on your abdomen if you are having difficulty.
As soon as the placenta has been delivered you will be given oxytocin to help the uterus contract. Contraction is essential to prevent further bleeding from the area where the placenta was attached to the uterus.