Know what to expect when the contractions start, with Christine Hill’s blow-by-blow account of labour

There are three main stages to labour. The third stage is the aftermath once your baby’s born, stage two should be the hard work bit with a good end result, while the first stage can be long and tiring. It’s easier to understand what’s going on with your body during labour, if you brush up on a bit of basic anatomy first:

• The uterus (womb) is the shape of an inverted pear
• It’s made of muscle fibres which run from top to bottom
• The opening of the womb (the stalk end) is called the cervix
• The cervix is made up of much stronger muscle fibres which are less elastic. It has to remain tightly closed during pregnancy, so the baby doesn’t fall out
• The end of the cervix rests at the top of the vagina.

First stage of labour

The position of your baby’s head is one of the factors that dictate the type of labour you’ll have. Because of the shape of a woman’s pelvis, when a baby engages, she lies with her head facing her mother’s hip. But it’s easier if babies are born with the narrowest diameter of their head coming first, and that’s the crown or top back bit. (Think of pulling a polo necked sweater over a child’s head if you start at the back of the head it slides down OK; if you start at the front of the head, it gets stuck.) So during labour, the contracting uterus is doing two things at the same time:
1. Dilating the cervix
2. Gradually turning the baby’s head round so she faces your spine when she’s born.

How long does this take?
Quite a long time – for Mrs Average, around 15 hours, plus or minus six hours. However, Mrs Average is the mean of 1000 women’s labours, and the range is enormous. At one end of the spectrum, some women can dilate in as little as four hours, and at the other end, it can take as long as 36 hours.

The first stage of labour can be subdivided into 2 stages:

1. Latency stage = 0-3cms

This is the bit of labour that’s variable – with ‘silent contractions’ (ones that you won’t notice) it can take anything up to a couple of days. For Mrs Average in labour with her first baby, it will take about 6-8 hours.

What you’re supposed to do – The contractions last around 40-60 seconds, with a gap in-between of between 5 and 20 minutes. You’re likely to be at home for much of this time. Most women feel restless during early contractions – this is the upright and mobile bit of labour, as you can move around between contractions and help the uterus to rotate the baby’s head. During the contractions, find a position that’s comfortable, and start practising your breathing and relaxation.

Pain – Usually manageable.

2. Active stage = 3-10cms.

Mrs Average on her first baby will dilate approximately 1cm an hour. Mrs Average on her second or third baby will dilate approximately 1 1/2cm an hour.

The contractions become much stronger, lasting around 60-90 seconds and coming approximately every 3-5 minutes. They really mean business and become pretty powerful. You’ll probably be in hospital.

Pain – Yes. The uterus has to contract very powerfully in order to dilate the tough cervix, but the pain feels as if something is going right, rather than something is going wrong. This may be the time when you ask for an epidural. Otherwise, continue with your breathing and relaxation during contractions, trying to conserve as much energy as possible.

2nd stage
What’s happening?
The contractions have pulled the cervix back to 10cms. The cervix is now continuous with the uterine wall, or the polo neck sweater is moving down to ear-level. The contractions no longer need to dilate the cervix but, instead, they push the baby down the birth canal; hopefully, with his chin tucked onto his chest so the narrowest part of the head is delivered first.

These contractions feel completely different, and most women find they have an overwhelming urge to help the uterus by pushing or bearing down at the same time as the contraction.

How long does this take?
Only an hour or so. If your baby hasn’t been born after an hour’s pushing, your midwife will call an obstetrician, who may recommend an assisted delivery.

What you’re supposed to do

If the muscles around the vaginal opening can’t stretch quite enough, they may tear slightly at the baby’s head bears down. This is normal and occurs in about three-quarters of births. In order to stop severe tearing, the midwife or obstetrician can make a small cut to the side of the vaginal opening, widening it to allow the baby’s head to pass through. This is called an episiotomy.

As your baby’s head emerges, the midwife will ask you to pant. This is so she can check that the cord isn’t round her neck. If it is (and this is quite common) the midwife will loop the cord over the baby’s head to free it. Then one final push and you’re there – or rather your baby is.

How painful is this bit?

For most women it’s the hard work, rather than the pain, which is the problem. (Some women have said this is an orgasmic experience, but I’ve yet to meet them.) If you have the remains of an epidural working, you won’t feel any pain. And the good news is that the end’s in sight and you’ll see your baby.

3rd stage

>What’s happening?

How long does this take? A few minutes.

What are you supposed to do? Hardly anything – you will probably be holding your baby by this time.

Pain? As far as the mother is concerned, this is a non-event.

>Anything else? Yes, most women will need a few stitches to repair any tears to the vaginal opening.