A woman having contractions may thus mistakenly believe she is inbut, alternatively, the onset of can be so gradual that she is not aware of it. Little wonder, therefore, that many woman are concerned that they may not know when they are in – and may delay seeking medical assistance longer than advisable. In practice, this rarely seems to happen but it is a good idea for every expectant mother to learn the signs that herald the start of labour so that she can decide whether the feelings she is having are, in fact, the ‘real thing’.
Labour may begin with regular contractions. To distinguish them from the Braxton Hicks variety it may be necessary to time them. The contractions of true labour occur more often (usually less than 15 or 20 minutes apart) and last longer (40 seconds or more). As labour progresses they come closer together and last longer.
Another early sign of labour is the loss of the mucous plug from the cervix. This forms in, keeping the baby safe from outside infection. As the cervix gradually dilates, this plug comes away as a fairly solid lump, sometimes tinged with a little blood. Although this usually means labour has started the plug may be lost a couple of weeks beforehand or it may come out without being noticed. Usually at the same time as the mucous plug is dislodged, a small amount of blood will pass out of the vagina. This is known as the ‘show’.
When a woman has a show she should contact her doctor or midwife for advice. However, if contractions are not yet established or at least not frequent or painful, it is unlikely that she will be admitted to hospital at this time, or that the midwife will need to be called out. There is still a long way to go. It is better to be out of bed and moving around at the start of labour because this tends to make contractions more efficient. The mother-to-be is also likely to be more content and less anxious if she keeps active.
For some women, the first sign of labour is the waters breaking – the rupture of the membranes surrounding the baby and the loss of some of the amniotic fluid. In most cases, the waters break later in labour, or they may be ruptured artificially by the doctor or midwife to speed up contractions.
Contractions normally begin a few hours after the waters break but there is a risk of infection if labour fails to begin within a day. It may then be necessary to start contractions artificially. If a lot of fluid is lost from the vagina there is also a danger that the umbilical cord may be carried down with it and trapped, restricting the baby’s oxygen supply. For these reasons, medical advice should always be sought even if no other action proves necessary for the time being.
First stage of labour
Regular contractions every five minutes or so indicate that labour is well and truly established. As the first
free it again rotates spontaneously to come in line with the shoulders, which are still in thecanal. One further contractation is usually enough to push out first one shoulder and then the other, the midwife helping by gently moving the head down and then up. The rest of the baby’s body, being narrower, follows quickly and easily.
Sometimes, in order to ease the delivery of the baby’s head, perhaps because the perineum is not sufficiently stretched and seems in danger of tearing, the doctor or midwife will perform an episiotomy (a cut from the edge of the vaginal opening towards the anus). In some hospitals an episiotomy is almost routine, particularly for first babies, but recent evidence suggests it may not be needed as often as was once thought. A careful, controlled delivery, with the mother trying to avoid violent pushing, may be all that is necessary. After delivery, the baby is checked to make sure it is healthy and breathing. At first it appears a rather purple colour but as it starts to breath, its body gradually gets pinker. The umbilical cord will be clamped and cut, although this may be delayed until the placenta has been expelled. The mother can then hold her new baby.
Third stage of labour (after)
For many mothers, engrossed in their new offspring, the third stage of labour – the expulsion of the placenta – passes almost unnoticed because it is seldom painful. With the continuing natural contractions of the uterus this stage may take 20 to 30 minutes but more often the mother will be given an injection of a drug called ergometrine maleate which hastens the process by making the uterus contract more strongly; it also reduces the risk of haemorrhage.
The placenta is helped out by the midwife gently pulling on the cord with one hand while pressing on the mother’s abdomen with the other. Any episiotomy or tears are then repaired with sutures. This can take time because both the muscles and skin must be carefully joined together.