The Birth Process

Signs of Labor

It is natural to be perplexed, curious and even tensed about what is going to happen when the date draws close. If this is your first baby, fear of what to expect, curious if you will recognize when labor has actually started for you and other such related ideas are going to preoccupy your thoughts increasingly. Amidst all these feelings you will also feel a sense of relief (it is all coming to an end), sadness (strange but you are going to miss those pregnancy months), and happiness (now that your baby will finally be in your arms). Once labor begins you will experience clear indications that tell you it is time; however the signs are different for every woman.

The signs you can typically anticipate are described below:

Regular contractions:

At the onset of true labor, the contractions will feel like a tightening of abdominal muscles, a dull ache or a pressure on the lower pelvis or back. At about this time you may feel the baby drop down into the pelvis; this is known as engagement because the baby has settled into its position for birth. Another term aptly used is lightening because the baby's new position means the mother has now more space to breathe and digest food. With time the contractions start to come at a more regular pace and the pain intensifies. The sensation is like a belt tightening around your back which spreads round underneath the baby. As the labor progresses the contractions last longer and occur at decreasing intervals.

Bloody show:

A plug of mucous which seals the top of the vagina acts as a barrier against infection from invading the uterus. Sometimes this plug dislodges itself before the contractions commence and you will notice a 'show' i.e. thick vaginal discharge mixed with blood in your underwear. This however is no indication that you are into proper labor; it may be several days before the action commences. In other instances, the contractions begin well before the expulsion of the mucous plug.

Water break:

In about 20% of women, the pressure of the baby's head can puncture the amniotic bag causing the fluids to leak out before labor. Often it occurs in later part of labor. There is no mistaking a rupture; the leakage is clear and watery from the vagina and you can lose as much as 2 pints of fluid. The water can gush out or come in a slow trickle. Contact your hospital immediately; you will probably be advised to go in right away since baby is in risk of infection and chance of umbilical cord's descent into the birth canal is there. Water breaking can pose a risk to your baby either in the form of infection or the oxygen supply being affected.

Other signs:

You may experience other symptoms; nausea, diarrhea and backache. Sometimes you even feel some tightening the whole day before labor begins; this is indicative of the cervix ripening and shortening at a gradual pace or your baby could be probably lying with its back to your back. In the case of the latter the tightening occurs as the baby rotates round to assume the right position before making its entry into the world.

True or False labor - how can you tell

In the start, you might not know if you are in real labor. The most distinguishing factor is true labor pains are consistent and regular; they slowly increase in frequency, duration and intensity. False labor on the other hand, tends to disappear if you lie down or walk around or a glass of drink cold water, and do not increase in frequency or duration.

Contractions	False labor	True labor
Timing	Irregular, no increase in frequency or duration	Regular intervals which gradually become closely spaced
Change with motion	Stop and start at irregular intervals	Progress is continuous
Location	Abdomen	Back, then travels to the front
Intensity	Weak and remains weak	Intensifies with time
External changes	None	Mucus plug may dislodge; membrane rupture; bladder pressure
Occurrence	Happens when you are tired, especially in the evenings	Anytime

The three stages of Labor

Labor has 3 distinct stages, each with its own characteristics.

The first stage begins with the first contraction and ends when the cervix is fully dilated. The cervix undergoes many changes: it becomes softer, spongier, the cells thin out and the cervix shortens. This shortening and thinning is termed effacement. Before effacement the cervix is 1.5 inches in length and after effacement it somewhat disappears. Force from the contractions combined with the pressure from baby's head slowly compels the now 'thin' cervix opening to widen. This is termed as dilation, which basically means the widening of the opening. Full dilation is at 10cm, about the width of a hand. When the cervix is beginning to dilate most mothers will feel the contractions in the back. You will be conscious of this ache but you can still go about with your normal activities. If you do not experience this, the mucous plug will soon dislodge instead.

• The rate of dilation varies; tends to be slower in first time mothers.
• On average it will take about 9 hours for the cervix to dilate 2.5 cm (the latent phase). The time varies; some women take longer, some with lesser time.
• Next comes the active phase which causes the cervix to dilate from 3 - 10 cm; this phase lasts between 2 - 4 hours. Again the time varies. The pain is intense and the urge to bear down and push the baby out starts now.
• On average one hour is taken up for every centimeter that the cervix dilates

The second stage begins at full dilation and ends when the baby makes an entry into the world. Uterine contractions are now even more pronounced; they help in the dilation and force the baby down and out. The contractions now occur every 2-3 minutes, lasting between 1 to 1.5 minutes. As the baby makes its descent, the mother works hard on the pushing. In a typical, normal situation, first the head descends followed by the rest of the body through the vagina.

• It takes a first baby close to an hour to make its way down the birth canal, through the vagina to the vulva
• The appearance of the baby's head at the mouth of the vagina is called crowning.
• Following the crowning, the doctor may make a small cut into the area between the vagina and the rectum; this is called episiotomy. Many doctors feel that this procedure should be performed only when necessary

In the final stage, the placenta dislodges from the uterus and is expelled. After the baby is delivered, the uterus sheds the placenta (placenta provided nourishment to baby during the entire course). Contractions continue even after baby is born. The uterus begins to get smaller and its walls thicker. This reduces the surface the placenta was attached. The placenta then separates and is pushed down and out of the vagina. Blood clots form immediately at the site of separation preventing any excessive bleeding. Bleeding is also controlled by the uterus contracting and closing the blood vessels that previously supported the placenta.

 

First stage - first contraction to full dilation of cervix	Second stage - full dilation until delivery	Third stage - birth
Latent phase: 1st contraction to 3-5 cm of cervix dilationContractions every 5-15 minutesLasts for an average 8-10 hours for 1st pregnancy	Lasts for 2 hours or more	Begins with birth of baby and ends with delivery of placenta
Active phase: 3-5 cm to full dilation of 10 cm Contractions 3-5 minutes apartLasts an average 4 hours for 1st pregnancy	pushing begins with contractions and the urge to bear down	Lasts for about 20 minutes