All You Need To Know About Labour and Delivery

Labour is a unique experience that differs from one woman to another and in fact even from one pregnancy to the next one. For some, it is over within a few hours whereas for others, it can last much, much longer. Till it actually happens, it is impossible to predict how long it will last. By around the 33^rd week, your uterine muscles start contracting and relaxing in preparation for labour. These are known as the Braxton Hicks contractions. Changing your posture or activity generally takes care of them. Actual labour happens in three stages.

Stage 1: Early labour and active labour

During the first stage, the cervix opens and thins out to permit the baby to move into the birth canal. This is the longest of the three stages of labour and is divided into 2 phases: early labour and active labour. Early labour: During this time, your cervix starts to dilate, and you'll feel gentle contractions throughout this time. These contractions generally last for 30 to 90 seconds and occur at regular intervals. Towards the end of early labour, they last longer than five minutes. The average length of early labour is 6 to 12 hours for first pregnancies whereas subsequent deliveries have shorter early labour. You might see a blood-tinged discharge from your vagina as a result of cervical dilation. You may be able to go about your daily chores during the contractions of early labour, but if you experience any discomfort, the following tips may help ease that:

• Try slow and deep breathing or relaxation techniques
• Apply ice/heat packs to your lower back
• Have a gentle massage
• Eat light, healthy snacks
• Drink fluids
• Change positions
• Listen to relaxing music
• Take a shower or bath

Active labour: The contractions become stronger, longer and regular. You may experience leg cramps, nausea and increasing pressure in your back as well. Your cervix dilates to 10 cm and as your labour progresses, pain intensifies. This can often lasts up to 8 hours or even longer. To help with the discomfort, try breathing and relaxation techniques. Your healthcare team may provide you with required physical and psychological support. Even though you will feel the urge to push due to the intense contractions, you should resist the urge till your cervix is fully dilated. Try these to promote comfort during active labour:

• Change positions
• Take a walk, stopping to breathe through contractions
• Have a gentle massage between contractions
• Take a warm shower or bath

Stage 2: The birth of your baby

You deliver your baby during stage 2 active labour. You might take anywhere from a few minutes up to a few hours or more to push your baby out. Push your baby as per the instructions of your healthcare team. Once your baby's head is out, her airway will be cleared and your healthcare team will make sure the umbilical cord is free. The rest of your baby's body will follow shortly.

Stage 3: Delivery of the placenta

In the third stage, your healthcare team delivers the placenta and ensures your bleeding is under control. Your doctor massages your lower abdomen to ease the delivery of the placenta, and you may have to push one more time to deliver the placenta. The placenta expels out with a small gush of blood with the contracting of the uterus. This procedure typically takes about 5-30 minutes. You might still feel gentle contractions, chills or shakiness. Your placenta is examined to ensure it is intact, and your doctor removes any remaining fragments from the uterus to prevent bleeding and infection. If required, stitches and other repair work will be done. You will be prescribed medication to encourage uterine contractions and minimize bleeding.

FAQs from our Readers

What are labour contractions and why do they happen? Labour contractions are uterine spasms that brings your baby out into this world. They are an indication that you are in labour, and in some cases can be the only sign of labour. In early labour, the contractions come as period-like pains, pain in the lower back combined with some aching pressure behind the pubic bone. What is false labour? Before the real labour, your body sometimes practises for it. This gives rise to false labour, which generally fades away. An achy back, pressure and menstrual cramps which last just briefly don't necessarily mean you are in labour. These contractions seem to never end and occur intermittently, but their strength and intensity remains the same. They are usually tiring and frustrating. These contractions are short, last less than half a minute, and are less frequent unlike real labour. Moving around or drinking fluids sometimes diminishes the false labour. What do the labour contractions feel like? Your stomach muscles tighten in a sequence, which start from your tummy to your back and then comes back to the front. It feels like a strong, uncomfortable cramp all around the centre of your body. Sometimes, the squeeze can be felt also in the groin and thigh areas. Once this starts, it means you are entering the active phase of labour. The contractions become more frequent and regular, and the pain intensifies. As your cervix starts to dilate, you will feel the discomfort in your groin area as well. The intensity of active labour varies from woman to woman. How to tell from the contractions if it is a true labour? True labour contractions will be frequent, intense and closely spaced. If you are in doubt, try these to verify:

• Active labour makes movement difficult. Even talking will seem painful. If the pain diminishes with walking, then it is mostly probably not true labour.
• False labour vanishes with change in position.
• Dehydration is one of the causes of false labour, so the discomfort lessens with drinking fluids which will not happen if it is real labour.

If your contractions last longer than a minute and are about 5 minutes apart for at least one hour, call your doctor. What is the active labour phase like? During this phase, the cervix dilates more than 8 cm in most cases. The discomfort is more frequent than you like and contractions seem to occur every 2-3 minutes and last for a minute or longer. Nothing seems to relieve the pain, and walking and talking seem impossible during the contractions. Massaging you back or resting it against the wall will ease the pain a bit. After each minute of contractions, you experience a break for about 5 minutes where you feel no pain at all and can rest. Is there a way to predict how long my labour will last? Just like every pregnancy is different, so is every labour. Once the contractions are regular, you are said to be in active labour. In first time mothers, the labour phase is longer and the contractions are more intense. The latent phase which comes next also lasts longer (usually for 6 hours or more) in first-time mothers. As a general rule, labour for first time moms last 12-24 hours. For subsequent births, the labour period is shorter if there are no other complications. For some women who have had vaginal deliveries before, labour can be rather short lasting a brief 2-3 hours or even minutes. If you suspect your labour has started, contact your doctor immediately. Is it true that you lose control in labour? It is very difficult to control your contractions or the pain associated with it wilfully, but there are certain techniques that can help you cope with the pain. You can control your response to the pain. When the labour is very intense and overwhelming with not much breaks in between, there is not much you can do. In some cases, it is prolonged and you are exhausted and just want to get it over with. Once you accept that this is how you will bring your bundle of joy into this beautiful world, you will learn to work with the labour to help you manage. Can water, shower and bath help with managing the pain of labour? Warm water greatly helps reduce the pains, you can choose a shower, whirlpool or a bathtub. The massaging effect of water will go a long way in calming you down, and the buoyancy helps relieve pressure on the pelvis. There are hospitals with whirlpool facility. If not, a shower works just as well. Aim the shower head to where you need it most. In a tub, lean back and relax against bath towels with the water covering the bump to be effective. Water also works at lowering elevated blood pressure, reducing the length of labour and lowering the risk of tearing. How is labour triggered? When your baby is ready to be born, her brain sends a series of chemical messages to your body. The foetal brain and the placenta release CRH (corticotrophin-releasing hormone) indicating to the mother and baby that it is time to deliver. This usually happens any time between weeks 37 and 42 in a healthy pregnancy, though it can vary greatly from mother to mother. The 'fetoplacental clock' decides the rate at which the hormone is released. If you are past your due date and labour has not begun, it means the fetoplacental clock has not triggered the onset of labour, and your baby is not ready to be born just yet. What is placenta previa? Placenta previa is a condition in which a baby's placenta partially or totally covers the mother's cervix, it is seen in as many as one in every three pregnancies before the 20th week of pregnancy. There are several types of placenta previa:

• A low-lying placenta does not cover the cervical opening but lies near it. It will usually move upward in the uterus as your due date approaches.
• A partial placenta previa covers part of the cervical opening.
• A total placenta previa covers and blocks the cervical opening completely.

About half of all pregnancies have some form of placenta previa in the early stages. In most women, it resolves and only in 5% of women is it present at term. It seems to be more prevalent in women who have had it before, in women having babies at an older age, in women who smoke, in women who have had several pregnancies before, who have had scarring on the uterus lining during a previous C-section or abortion, and in a multiple pregnancy. It also occurs where the uterus or placenta is abnormally developed. What are the symptoms and the complications of placenta previa? Placenta previa causes painless bleeding in the last trimester, though this is not very common. The blood is bright red, coming from the placenta and is usually intermittent, ranging from light to heavy. It usually occurs at the end of the second or the beginning of the third trimester. Bleeding may continue for a few days and then stop on its own, only to start again a few days or weeks later. Placenta previa can be dangerous if not attended to appropriately.  If you notice any form of vaginal bleeding, please inform your doctor immediately. How can placenta previa be treated? Treatment will be based on how serious the placenta previa is, i.e., the amount of blood loss, the extent of the placenta previa, age of the infant and if the mother is already in labour. Other considerations include the baby's position and the number of pregnancies prior to this one. If it is a partial placenta previa, then bed rest with abstinence from sexual activities, straining to pass a stool and douching will be strongly advised. If the blood loss is substantial, blood transfusion along with medicines to prolong the pregnancy to at least week 36 and delay labour (after which baby can be safely delivered), and medicines to help in the maturity of infant's lungs will be administered. Both mother and baby will be closely monitored at the hospital or home under the doctor's advice. What is placental abruption and its symptoms? Sometimes, the placenta deteriorates and separates partially or completely from the uterine lining before birth. This condition is known as placental abruption and most often occurs in the third trimester or during labour. The symptoms of placental abruption include continuous bleeding with abdominal pain, the severity of which will depend on the size of the area that has torn away. If the blood has collected high in the uterus, there is no vaginal bleeding. The degree of separation is determined by ultrasound. Massive blood loss can lead to premature labour or even a stillbirth since the baby is deprived of oxygen and key nutrients prematurely. What causes placental abruption? One of the most common reasons for placental separation is uncontrolled high blood pressure or hypertension. Other reasons include trauma to the abdomen (a fall, accident or abuse) smoking, drinking, sudden rupture of membranes or if the mother has autoimmune diseases. However, in most cases, no obvious medical reasons can be found. Complete or even partial abruption is life-threatening for the foetus.  The amount of placenta that has detached from the uterus wall will determine how serious the foetal distress is. Complete abruption can put the mother’s life at risk too. Unless the mother already has some form of haemorrhage or shock, partial abruptions is not as dangerous to the mother. How can placental abruption be treated? A scan is ordered for confirmation if placental abruption is suspected. If the separation is small and baby's heartbeat is good, the mother will be advised bed rest and given medication to stop the contractions. The mother is given an injection of steroids to help mature the baby's lungs. If abruption occurs before week 36 and foetus is showing no signs of distress, treatment will include a close watch over the foetus until it is mature or distress signals are seen, which alerts the obstetrician to go in for a C-section.