You have been waiting for this day for 40 weeks. you are finally in labor. Here is what happens during birthing and what to expect at every stage of the process.
First stage (7 to 8 hours)
During early or first-stage labour, the cervix dilates three to four centimetres.
- Be excited, anxious, energetic, confident.
- Be more comfortable at home until labour become active.
- Eat lightly.
- Wonder if “this is it.”
- Do calming activities in the daytime or go back to sleep if it is nighttime.
- Usually result in cervical dilation to three to four centimetres and partial effacement.
- Build to a peak and recede.
- Are mildly to moderately painful and can begin in the lower back. (May feel like menstrual cramps.)
- May be light enough that normal breathing is comfortable.
- May become strong enough that you pay attention to your breathing and/or begin relaxation exercises.
- May be five to twenty minutes apart, becoming more intense, longer and closer together.
- May be thirty to forty five seconds long ( but not more than sixty seconds.)
- Result in baby beginning to bring chin to chest so the smallest diameter of the head can start to pass through the pelvis.
Your doctor or midwife may:
- Suggest coming to hospital if membranes rupture (the water breaks) or contractions are five minutes apart.
Second stage (30 minutes to 2 or more hours)
During the second stage of labour, the cervix dilates fully and the baby is born. Second-stage contractions:
- Are generally much less painful.
- May occur every two to five minutes and last approximately sixty seconds.
- May come in waves.
- Push the baby down through the open cervix.
- Help baby finish turning to face mother’s back (this starts in the first stage.) The shape of the pelvis is such that the baby can get through more easily with its head in a front-to-back position.
- Have a renewed sense of energy and excitement.
- Need to regroup after the intensity of transitional labour.
- Not feel the urge to push right away.
- Hold your breath when pushing or allow some breath to release, letting our a sound as you push.
- As long as your baby’s heart-beat is stable, there is no rush to push your baby out. It may take a while before your feel your have got the hang of it but you will gain confidence after a few contractions.
- Be surprised by the over-whelming urge to push (bear down) with contractions.
- Enjoy bearing down or find it painful.
- Be tired, especially as this labour stage progresses, and sleep in between contractions.
- Be frightened by the intense rectal pressure of fullness, and resist bearing down.
- Continue to have lower back pain.
- Be embarrassed about passing some stool.
Comfortable and effective positions:
- Semi-sitting at a five -degree angle or more.
- Side-lying: useful for severe hemorrhoids or unusually fast delivery. This position allows you to watch baby’s birth.
- Hands and knees. Excellent for back pain and may help posterior baby turn.
- Squatting: This increases the diameter of the pelvis. Especially helpful when there has been little or no progress.
- Sitting on toilet. Useful because of the association with “letting go:.
- Baby’s head slips out of the fully dilated cervix, leaving room at the top of the uterus. It may take a few minutes for the uterus to become taut again around the rest of the baby’s body. This is why there is sometimes a lack of urge to push upon full dilation.
- Baby’s oxygen level is affected if you hold your breath during pushing. Safe level is maintained when a new breath is taken at least every six to eight seconds.
- Eventually, the baby’s nearly born head causes the perineum to bulge and the vaginal lips to part when the mother pushes. The head becomes visible when it low enough.
- The baby’s head recedes out of sight in between pushing efforts.
- Eventually, baby’s head fully opens vaginal lips and does not recede. This “crowning” os stretching and burning sensation known as “rim of fire”.
- Perineal tissue is vulnerable to tearing at crowning. “rim of fire” sensation can be seen as nature’s way of discouraging the mother form pushing at this time, decreasing the likelihood of tearing.
- Baby’s shoulders follow. The rest of the body is born.
The medical staff or midwife may:
- Put a hand on your abdomen to feel when contractions occur.
- May encourage you to push during contractions and offer guidance/ instructions.
- Examine you vaginally while pushing to feel the baby’s head.
- Stretch perineal tissue with U-shaped massaging motions and warm compresses. This helps avoid tearing and is sometimes done instead of episiotomy.
- Perform episiotomy. Regional anesthetic is given if needed, unless you have had an epidural.
- Check fetal heart rate more frequently.
Third stage (5 to 30 minutes)
During the third stage of labour, the placenta is born.
- Need a few minutes to collect yourself before focusing on your baby.
- Be surprised by the baby’s appearance. The body a bloody, greyish-purple colour, covered with a white substance (vernix), and the irregular shaped head.
- Be engrossed with your baby. Be emotional, overwhelmed and cry.
- Not notice the birth of placenta.
In your body:
- The uterus contracts to enable the placenta to come away from the uterine wall. Contractions may be mildly painful.
- The placenta usually slips out in one to two pushes.
- The uterus contracts against exposed blood vessels from the former site of the placenta to control bleeding.
The medical staff/midwife may:
- Ask you to push for birthing the placenta at the appropriate time.
- Invite your partner to cut the umbilical cord. Wait until it stops pulsating.
- Check baby’s condition immediately and evaluate it at one to five minutes after the birth to give the baby an Apgar score.
- Give the baby a Vitamin K injection to facilitate blood clotting.
- Dry and wrap baby to keep it warm.
- Give you Oxytocin injection in your thigh or through IV as precautionary measure.
- Examine the placenta and umbilical cord to make sure they appear normal.
- Take routine blood samples from the umbilical cord.
- Repair episiotomy incision, if applicable. Repair tears if necessary.
After the birth (The first few hours)
- Be hungry, feel tired, elated and satisfied.
- Be mildly uncomfortable if an episiotomy has been performed.
Your baby may:
- Open her eyes and be alert and attentive to its parents . It is first period of reactivity.
The medical staff/midwife may:
- Encourage the baby to breastfeed. This helps control uterine bleeding. Also, if the baby is breastfed within two hours after birth, it is more likely to breastfeed successfully in the coming weeks.
- Check the height and tightness of the uterus, vaginal bleeding and blood pressure.
- Put antibiotic ointment in baby’s eyes. This can be delayed for an hour to allow the baby’s first glimpse of her parents.
- Leave the new family alone for most of the first hour together.
Every labour and birth is different. Yours may not proceed exactly as described especially with regard to the timing of each stage. No matter what kind of labour you have, congratulate yourself for your hard work and miraculous result.
Nancy Levy, RN, MS, is former childbirth educator at Women’s College Hospital in Toronto and York Central Hospital in Richmond Hill, Ontario.
The videos were produced by Global Health Media Project, and is intended primarily for frontline health workers in the developing world. The video and script (shown below) may be downloaded from their website: http://globalhealthmedia.org/videos/