Is the beginning of labour always painful?

No. It is more of a dull ache, felt at first in the lower back and moving around to the front This ‘stomach’ ache is often mistaken for colic and a woman may suspect she has eaten too much raw fruit The clue lies in the ache beginning at the back and moving round to the front. Gut colic rarely manifests itself in this fashion. In the case of a contraction, by placing your hand on your stomach you can feel the uterus harden as its muscle tightens.

This is very rare. Occasionally, a woman who has had several children and happens to be a litde plump may not notice the difference between the contractions of late pregnane)’ and actual labour pains. Either the former have been a litde more painful than usual or the latter less intense. As a result, the woman stays at home unaware that she is in labour and either arrives in hospital very late or even has the baby outside the hospital. However, this is most unusual and almost unknown in someone new to motherhood.

Hospital?

A midwife will greet you when you arrive. She will usually check the antenatal notes that are prepared at the clinic in previous weeks. It’s a good idea to take the communication card with you if you have it, just in case the notes are not readily available. The midwife will quickly examine your stomach to make sure that labour is proceeding well and that delivery is not imminent She will ask a few simple questions and probably check your blood pressure.

Some hospitals have now stopped giving the traditional enema at the onset of labour. Its original purpose was to encourage uterine contractions and guard against die embarrassment and possible infection of the bowels emptying during the birth. But it is now thought that the use of an enema doesn’t make the delivery any cleaner, nor does it bring on uterine contractions. If a woman’s bowel is full she may be given a suppository, but that is all that needs to be done.

Similarly the regulation close shave of all the pubic hair is no longer usual. Some hospitals still shave round the back of the vagina and between the lees. This is done to provide a clean area so that when the baby is being born the skin around the birth canal can be properly cleaned with antiseptic. Also, if an is needed or a tear occurs, this can be sewn up more tidily if there is no pubic hair in the way. Other hospitals only require a woman to clip the hair between her legs with a pair of small hair scissors in the last few days of pregnancy. This is quite enough preparation for a normal delivery. Some hospitals still give a bath on admission. After this, if the membranes have still not broken, you may be encouraged to sit up or even walk around as you wish. Once the ‘waters’ have ruptured, you will be asked to stay close to bed and offered pain relief as and when you need it.

Labour is divided into three stages. The first begins with the start of regular contractions and the gradual opening of the neck of the womb (dilation of the cervix) until it is fully open and wide enough to take the baby’s head.

In the second stage, the baby is pushed through the open cervix, normally head first, down the vagina and out into the world.

The third stage of labour is the placental stage which ends when the placenta, membranes and cord are completely delivered.

The different stages of labour vary in length. The first is by far the longest and, for the woman, the most tedious. I n a first pregnancy it can last as long as 18 hours, though usually it is around eight to 10 hours. The second stage generally takes about an hour, though again, with a first baby, it may be longer – up to two hours. The third stage is very quick, lasting for a few minutes only. It is speeded up by giving the mother an injection when her baby is delivered (I.e. at the end of stage two), thus accelerating the arrival of the placenta and reducing blood loss.

The second stage starts when the neck of the womb is fully dilated. Some women anticipate this with a feeling of fullness in the pelvis. There is a sensation of wanting to open the bowel and a little blood may pass from the vagina. A vaginal examination should clinch the matter.

You will need practice here. Most hospitals run antenatal classes which teach the art of pushing. Other classes are run by local authorities, and many private organizations, such as the National Childbirth Trust in Britain, have their own instructors.

When a contraction of the uterus is on the way, you will sense a tightening in the abdomen. You should first of all take a few quick breaths in and out, then a large breath in and hold it. For 10 to 15 seconds keep your pushing steady, down into the bottom of the pelvis, and hold your breath. Next, let the breath out and take in another large chestful of air to give a second push, again for 10 to 15 seconds. With control you should manage four or five pushes per contraction, each of which will ease the baby’s progress down the vaginal passage. Relax as much as possible in the minute or two between contractions, so as to be ready to tackle the next one when it comes.

Most women find the second stage of labour a relief after the more passive first stage. They feel comforted and reassured from taking an active part in delivering their own baby.

Push?

Some women do have difficulty in pushing. Often this is due either to fear of pain or lack of training during pregnancy. This is a pity, as pushing is a primitive, instinctive response to the Feeling of something filling the pelvis. They can be helped, however, by a good doctor or midwife.

Doctors will prescribe safe, pain-relieving drugs that will not affect the baby. In the first stage of labour, the best of these injected into the muscle of the buttock. It takes about 20 minutes to start working and the effect usually lasts two or three hours. If labour is lengthy, more than one injection will be needed and the mother should warn those around her when the effect is wearing off so that she can be given a second one in time.

Another method of relieving pain is by the anaesthetic, which numbs the nerves as they flow from the uterus towards the spine. This calls for a skilled anaesthetist to be present It is an effective method and popular with many women as it leaves the mother fully conscious to take an active part in the birth process.

In the second stage of labour pethidine injections should not be administered as they can affect a new born baby’s breathing. An epidural would be difficult to insert for the first time at this stage, and so most hospitals recommend nitrous oxide and oxvgen. Tnis gives pain relief very quickly as it is inhaled and absorbed through the lungs. Women wishing to use nitrous oxide need to be shown how to use the face mask during pregnancy so that they know how to control the gas when the time comes.

The baby’s head moves down the vagina, gra dually stretching the opening ahead of it With each contraction and bout of pushing, more of the surface of the head becomes visible. Between contractions it may retreat a litde, but soon re- emerges when the next one occurs. Eventually, the head reaches the point of no return, and « passes through the entrance.

There is no need for any more pushing. From f now on, the midwife takes over delivery. The f hardest part of labour is over, and the shoulders ;| and body slip through easily. You can see your | baby being born if your head and shoulders are f raised up on pillows.

It is vital to follow the midwife’s instructions at J this stage, to avoid pushing too hard once the baby’s head has passed the entrance. This would damage the tissues of the lower end of the vagina. The best way not to push is to pant quickly in and out when the midwife asks you.

Often during delivery the baby’s head over-stretches the tissues and they tear. To try to prevent a tear, an episiotomy may be carried out; this is a small surgical cut which is made under local anaesthetic to relieve tension at the bottom of the vagina.

This mini-operation is usually hardly felt, and all doctors and midwives have been trained to perform it. Afterwards, the area will be stitched up carefully to bring tissues together and allow them to heal neady.

It is up to the person doing the delivery to decide whether or not an episiotomy is necessary. If it is your first baby, you are more likely to need the operation than if you have already had one or more children.

Being born is one of the greatest shocks in life. Inside the uterus the baby has been living in a gravity-free, dark, warm, quiet environment. Suddenly he is pushed into the outside world where the force of gravity is influencing him. He has to breathe – through lungs which have never been used before – to get his oxygen, while light, touch and a cool temperature are all new sensations for him.

He starts to breathe by sucking in a big breath. But before this happens the midwife removes any excess fluid from his nose and mouth with a very small suction tube. Most babies take their first breath within 30 seconds of birth, and 96 per cent of them do so in three minutes. Once breathing is established it is essential to keep the baby warm. The midwife will wrap the baby in a prewarmed blanket, as a damp child can lose neat very readily even in an apparently warm room. Most rooms are not more than 75°F and a baby has been used to an internal body temperature of 98°F. The midwife examines the baby soon after it is born, to make sure there are no external abnormalities.

Once the baby is born and breathing well, the midwife awaits the arrival of the placenta. She feels for the next contraction which often comes within five minutes of birth. When this happens she can usually guide the placenta out of the uterus by pulling at the cord in a controlled fashion. The placenta is soft and causes no pain, being much smaller than the baby. Usually an injection has been given during the birth, to help the uterus contract and expel the placenta, so reducing blood loss. Any stitching needed is usually left until after the placenta has emerged.

Usually, yes. The labour tends to be shorter and the woman is more mentally prepared for what is going to happen. She has been through the experience before and knows the ropes. Most women, as a result, find it easier to have their second and third babies.