Stages of labour
There are variations in how labour starts and progresses for every woman in every pregnancy however here are some guidelines as to what is most common. For first time mothers, labour usually takes 12 to 24 hours. Women who are having a subsequent baby can expect labour to progress more quickly, more like 7-8 hours.
Labour is described in three stages:
First stage
The first stage of labour is the longest, on average 8 to 16 hours for a first baby and 3 to 10 hours
for a second or subsequent baby. Labour contractions bring about softening and thinning of the cervix (effacement) followed by dilation from closed to 10cm. Initially there is not much change in the cervix, this is called the latent phase of labour, then the cervix progressively dilates from 4 to 10 cm due to regular contractions and towards the end of this phase it is quite common for the mother to become distressed which fortunately usually coincides with the stage where you are ready to push.
If your labour is slow, I may recommend further treatment to help labour progress which might include breaking the bag of waters if they have not already broken and/or giving medicine through an IV in your arm to increase the frequency of the contractions . This medicine is administered slowly and the rate is gradually adjusted to find the amount which you need to help your uterus to achieve regular contractions.
Second stage
This stage is from when the cervix is fully dilated until your baby is born. Most women feel a strong urge
to push, but that feeling can be harder to appreciate if you have an epidural. When your baby’s head is about to be born, I will ask you to stop pushing. This is so that your baby’s head can be born slowly, giving the skin and muscles in that area time to stretch without tearing. That can cause a burning sensation as the skin is stretching. Sometimes the skin of the perineum won’t stretch enough and may tear, or there may be a need for the baby to be born sooner, in which case, I will ask permission to cut the skin to make the opening bigger. This is called an episiotomy. Afterwards the cut or tear is stitched up again and heals quickly. Usually one more gentle push helps your baby’s body to be born. Your baby will usually be lifted straight on to your tummy before the cord is cut so that you can be close to each other. Your baby will be covered with a warm towel and you will be able to hold your baby. This type of skin to skin contact is encouraged for all babies where there are no concerns about baby’s wellbeing. If your baby needed to be resuscitated because they were having difficulty with breathing it may not be possible. Sometimes some mucus has to be cleared out of a baby’s nose and mouth or oxygen given to encourage your baby to breathe effectively. If your baby requires more assistance then that occurs on a special table called a Resuscitaire and this is in the same room as you. The Paediatrician will assess your baby and they will not be kept away from you any longer than necessary.
Third stage
After your baby is born, uterine contractions push out the placenta. This stage usually takes about 10 minutes but it can take up to an hour. After discussion with you, your midwife will give you an injection in your thigh, very soon after birth—this is called active third stage. The injection makes the uterus contract and separate the placenta and this helps to prevent a postpartum haemorrhage which is very heavy bleeding.
A physiological third stage is what happens if we do nothing to assist delivery of the placenta. That means we give no drugs and do not manipulate the cord. It sounds like a good idea but there is strong evidence that there is more risk of significant bleeding with this approach and I (and the World Health Organisation) do not recommend it.