What Happens during Labour?

Labour begins naturally from 37 to 42 completed weeks, dated from the first day of the last normal menstrual period. Before 37 completed weeks, this is considered premature and post-term after 42 completed weeks. During labour, the baby and the placenta (afterbirth) are delivered from the uterus (womb) through the birth canal into the outside world. Typical labour ends in the cephalic (headfirst) delivery of a live, healthy baby to a healthy mother.

How long does labour last?

In general, labour lasts between 15-16 hours during the first pregnancy, and between 6-8 hours in subsequent pregnancies. To reiterate, labour can be a lot longer or shorter than the average times.

What are the stages of labour? 

The effort of labour occurs in three stages. First stage comprises latent (initial) and active phases. 

FIRST STAGE

From the beginning of labour to the full opening/dilation of the cervix to about 10 centimetres.

 

 


(a) Latent/Initial Phase

Contractions: Progressively stronger and rhythmic. Will become more regular, intense and painful

Discomfort: Minimal 

Time: Average of 12 hours (first pregnancy) and five hours (subsequent pregnancies).

Cervix effaces (thins) and opens to about 4cm. However, the mother can still walk about and even talk through contractions.

 

(b) Active Phase

Contractions: Progressive from medium to strong from 30 seconds to two minutes and interval from 15 minutes to 2 minutes.

Discomfort: Extreme

Time: Averages about six hours (first pregnancy) and 2-3 hours (subsequent pregnancies.)

Cervix opens from about 4cm to the full 10cm. Breathing as well as relaxation techniques pain relief may be administered. The presenting part of the baby, usually the head, begins to descend into the mother’s pelvis.  The mother begins to feel the urge to push as the baby descends. 

POSITIONS FOR 1ST STAGE LABOUR

During latent phase (resting).

You can either be semi sitting in bed or couch, or with one foot up. Asymmetrical position aids in descend of baby’s head.

Side lying with one pillow aids in comfort.

Active phase of labour (4-10cm)

The rocking swaying motion allows movement of pelvis and encourages the baby to descend down. Rocking whilst sitting on a chair and being monitored is also possible.

   Rocking       

   Swaying with the ball        

                                                  Slow dancing

           

Positions for Back Labour pains (back pain, irregular contraction, slow progress)

Particularly if the baby’s descent and facing upwards, the intense back pain can be alleviated with the mother leaning forwards, with the husband massaging her back. Any of these positions help to get pressure of the mother’s spine

Activity:

Walking, climbing stairs, lunging. Movements help to ease labour pain as well assist in baby’s descent and rotation. This is particularly with gravitational forces of baby’s head helping to dilate the cervix. However, caution not to exhaust oneself before second stage.

Squatting, lunges, stair climbing, tailor stretching are movements that allows mothers to move and gravity speeding labour progress.

Hands and knees / kneeling

 

These actions relieve back pain, help posterior baby

rotate and easier access for back rubs.

Can rest upper body on pillows, chair or birth ball.

SECOND STAGE

From the complete opening of the cervix to the delivery of the baby, this stage averages about 45 to 60 minutes in a first pregnancy and 15 to 20 minutes in subsequent pregnancies. There will be an overwhelming urge to push.

POSITIONS FOR 2ND STAGE LABOUR

An ideal position would:

  • open the pelvic outlet as widely as possible
  • provide a smooth path for the baby to descend
  • use the advantages of gravity to help the baby move down
  • give the mother a sense of being safe and in control of the process.

“Standard” Positions

These can be done by anyone. These are the positions that most doctors are used to delivering babies in. Try positions between contractions. There are no magic positions!

(a) Semi sitting

For extra comfort and support, put a pillow under your knees and bend them slightly, or sit in a semi-reclining position with head and shoulders elevated and resting on a bunch of pillows. This is the most common in the hospital setting.

(b) Lithotomy

This position involves lying on your back with your legs in stirrups. This position is necessary for forceps or vacuum assisted delivery, in the event of an episiotomy, or during the delivery of a breech baby (baby who is not head first). In lithotomy position, the mother will feel more in control, whilst caregivers will have a good view and easy access to perineum.

(c) Semi-lithotomy.

This position is the same as a lithotomy, but with your the head and shoulders at about 30-45 degrees.

(d) On your hands and knees                                              

 

If the mother is not on any narcotics pain relief, this position would work fine and good for back labour. However, the mother should always check with the caregiver if this position is possible with the setting, to avoid entanglement with the surrounding medical accessories i.e. IV tubing, monitor.


(e) On your side

With the back curved and upper leg supported by husband, this position is good for a fast second stage, and is a comfortable position for the mother.

(f) Squatting during delivery

Squatting allows the pelvis to open wider and baby has more room to move down the birth canal. A bed with a squatting bar or two extra bodies may help support and sustain this position. The positions that may require mobility may be a problem if mothers are on epidural as their legs may feel numb to support or balance in an upright position.

Regardless of whichever positions, it is important to keep an open mind, and concentrate on the breathing and relaxation techniques. Changing positions is the key, but always stay focused on one goal – YOUR BABY.