A B C D E F G H I J K L M N O P R S T U V W

NORMAL LABOUR

What is Normal Labour ?

Normal labour is the process in which your baby and afterbirth (placenta) are delivered through the birth canal. It starts naturally between 37 and 42 weeks. It ends in the head-first delivery of a live, healthy baby. With modern management, few women are in active labour longer than 12 to 14 hours. It occurs in three stages. The first stage is from the start of labour to when the neck of the womb (cervix) is fully open. The second stage is from when the neck of the womb is fully open, to the birth of your baby. The third stage is from the birth of your baby to the delivery of your afterbirth.

Can I deliver my baby at home ?

Yes, you can, although most babies are born in hospital. It is possible to deliver your baby at home if your midwife and general practitioner offer this service. In some instances you may be advised to opt for a hospital delivery if your pregnancy is complicated, or if you have had problems in previous labours. Many hospitals are trying to improve the birth experience by having home-from-home rooms (where the delivery room mimics a bedroom), midwifery labour wards (where medical input is minimized), and birthing pools. You should discuss the available options with your doctor and midwife you will be welcome to visit the hospital labour ward.

How do I know Normal Labour has started ?

There are several signs. The first of these is a "show" which is a small discharge of blood and mucus. This is the plug which sits in the opening of the cervix. A "show" means that the cervix is opening, and that labour has started or is about to start. The painless and irregular contractions that you may have had in pregnancy change to painful and regular contractions. As you enter labour, your contractions come more often, and become stronger and longer. Sometimes the membranes (the waters) around your baby break first. You may have a sudden gush followed by a steady dribble of fluid from the vagina. If you think that your waters have broken or you think labour has started, you should ring and ask the advice of your midwife or the staff of the hospital labour ward. Your midwife will either come, or you will be advised to go to the hospital's labour ward. Sometimes it can be difficult to know whether you are in labour. Some women have quite a long period of contractions, with little or no change in the cervix. This so-called latent phase can last up to 12 hours. It can be exhausting. Having a warm bath can help. Taking action to speed up the active phase of labour is not usually a good approach: the neck of the womb has to undergo gradual relaxation, ideally at its own pace. If the baby is healthy, waiting is usually recommended.

What happens when Normal Labour starts ?

A midwife will look after you throughout your labour. After welcoming you and your partner, she will talk through your pregnancy with you. She will examine you carefully and do a vaginal examination to see if the neck of the womb is opening. Your baby's heart rate will be checked, either by your midwife listening herself, or by an electronic monitor which records the heart rate. If your baby's heart rate is normal (even during a contraction), this usually means that your baby is coping well with your labour. If there are any problems with your baby's heart rate, then a doctor will be called. The colour of the fluid around your baby is also checked. If it is green/brown, this means that your baby's bowels have opened, and can sometimes mean that the baby has been stressed. A sample of your urine will be tested, and your pulse, temperature and blood pressure will be regularly measured. Every few hours you will be examined by your midwife to see if the cervix is opening and to check the position of your baby's head. In normal labour, your cervix should open by about 1 cm (half an inch) each hour until it is fully open. All these measurements are charted on a single sheet of paper (or partogram), which shows the progress of your labour at a glance.

Different positions in labour

You can adopt any position you wish provided your midwife can monitor your baby and is happy with the condition of your baby. You may wish to labour reclining or lying on your side, squatting, in a birthpool, or sitting in a rocking chair. Your midwife will also be flexible regarding the position you adopt when delivering your baby, provided the position is safe for you and your baby.

Types of pain relief for Normal Labour

The amount of pain relief needed varies very widely, and it is best to keep an open mind as to your choice of pain relief until you are actually in labour. Your midwife will discuss with you the different options that are available. These include relaxation and breathing control . In your antenatal classes you have probably been taught breathing patterns. These help you to "ride out" the contractions, and remain in control. "Gas and oxygen" is a mixture of oxygen and a gas called nitrous oxide. Breathing this mixture gives you good pain relief and is safe for both you and your baby. It takes about 40 seconds to work, so you should start to breathe it at the start, or just before, the contraction. It wears off very quickly. Pethidine is a drug which you midwife can give you by injection. It gives powerful pain relief but also makes you drowsy. Because it reaches your baby as well, you should not really be given pethidine within 2 to 3 hours of your baby being born: otherwise the baby may be too sleepy and slow to start breathing. Powerful pain relief can also be given by injecting some local anaesthetic around the nerves which transmit the pain of your contractions. This is called an epidural . First of all, some fluid is given through a needle in an arm vein, to make sure that your blood pressure does not fall when the epidural is given. After some local anaesthetic to the skin over the lower part of your back, a small needle is passed through a space in your spine. A thin tube is threaded through the needle and the needle taken out again, leaving the tube in place. Drugs can then be given through the tube to give you constant pain relief. Recent advances in the type of drugs given mean that you may have pain relief without affecting movement of your legs: this was a problem with some earlier drugs.

Who will deliver my baby ?

If there are no problems, your midwife will deliver your baby. Many hospitals train doctors and midwives. As part of their training, student doctors and student midwives are involved in the delivery of babies. You may be asked if a student can help your midwife care for you in your labour and help deliver your first baby. If any problems do occur (for example, if you find it hard to push your baby out, or if your baby's heart rate alters from normal), there will be a doctor available to help deliver your baby.

After my baby is born

An injection will be given after you have delivered the baby. This helps your womb to contract down. It will persuade the afterbirth with the membranes to be delivered as well. Your midwife will check that the afterbirth and the membranes are complete, to be sure that nothing is left inside your womb. Your baby will also be carefully checked and weighed. If you plan to breast-feed, then you can do so as soon after the birth of your baby as you wish.