Labor at a glance..
Regular contractions with dilatation of the cervix
define labor. Contraction sans the dilatation or opening
of the cervix is considered as latent phase or early
labor which is different from proper, established
labor. There are 3 stages to it
| Stage
1 |
The toughest
part of labor which starts with the onset of
regular contractions with gradual opening of
the cervix to reach full dilation of 10cm. First
babies cause this stage to last an average of
10-14 hours. This stage shortens with subsequent
babies. |
| Transition |
Not a stage but a period
between stages 1 & 2; it usually marks the
last 2-3cm of dilatation and lasts from 15 mins
to an hour. Women either feel the urge to push
though not fully dilated (feeling that comes
with contractions of the 2nd stage) or lose
the urge to push despite being almost fully
dilated. |
| Stage
2 |
Comparably an easier stage
which starts with a fully dilated cervix to
the birth of the baby. With the cervix fully
open the mother will be able to push the baby
down the birth canal. First babies take an hour
on the average to make an entry into the world.
This stage shortens with subsequent deliveries. |
| Stage
3 |
The final stage is essentially
the delivery of the placenta and membranes or
bag of fluid that contained the baby. This can
be as short as 10 minutes. |
What is happening in the
first Stage
When contraction peaks, baby's heartbeat dips
to its lowest level, and then quickly rises back to
normal as the contraction subsides. Quick, shallow
breaths help the mother cope with the pain at the
peak of a contraction.
Labor
Signs
Contractions
The pain associated with contractions has been described
differently by women. These include severe menstrual
cramp, persistent backache or a wave of discomforts
that peak and subside in turns. Overall the contractions
grow in frequency and intensity and last longer
as birth approaches. When the placenta starts to
perform inefficiently, the baby's brain responds
by producing oxytocin which crosses into the mother's
bloodstream. The mother's body responds by producing
oxytocin as well which stimulates contractions.
Additionally baby's adrenal gland secretes the hormone
cortisol which again crosses into the maternal bloodstream
triggering the release of hormone-like chemicals
called prostaglandins. Prostaglandins are responsible
for the softening of the cervix and this act causes
the uterus to start the contractions.
| Latent
phase |
Mild irregular
tightenings, which gradually last longer and
become more frequent |
| Stage
1 |
More intense and rhythmical;
contraction progresses to last about 30-60 seconds
in intervals of 1-2 minutes |
| Stage
2 |
Sensation of contractions
change; the urge to bear down and push starts
here. Contractions last about 60-90 seconds
in intervals of 5 minutes |
| Stage
3 |
Relatively less painful
contractions with the purpose of expelling the
placenta and membranes |
The show
It is the release of the mucus plug which had sealed
the cervix opening from the start of pregnancy.
In some women the pinkish jelly like blob dislodges
itself while in others the blob disintegrates into
smaller pieces. It can appear in your underwear
or when you wipe yourself with a toilet paper. Basically
this is indicative of the cervix stretching a little
in preparation of labor. Several days or sometimes
only few hours may lapse before true labor kicks
in. A show with slight bleeding indicates early
labor. If you don't have a show or somehow miss
noticing it, you may still be in labor.
The Waters
When the amniotic sac ruptures, the fluid may escape
either as a gush down your legs but more often it
comes out in trickle form. Most women don't even
realize this because it feels more like a dribble
of urine. Wear a sanitary napkin. Sometimes the
trickle slows down and comes to a stop, meaning
the rupture wasn't complete and the sac has sealed
itself. Usually ruptures don't occur in first pregnancies.
If the fluid continues to escape but there are no
signs of labor within 24 hours contact your doc
immediately. Baby is vulnerable to infection if
waters continue to trickle out over a day in the
absence of labor. Membranes are usually left to
break on their own. There are times when it is necessary
to break the bag e.g. when labor needs to be induced
or speeded up or if baby is under duress.
Add-ons
Internal checks
Internal examinations during labor provide important
information on the labor progress. They can be uncomfortable
so it helps to empty your bladder and relax your muscles.
Once labor is in established stage, an internal check
will done every 4 hours or so. Being aware of the
progress will help the mother decide on the form of
pain relief she may need.
Monitoring baby
A cardiotocograph or a CTG consists of two transducers.
The device will be strapped on the abdomen of the
mother with a connection to a monitor. A print out
from the monitor will indicate baby's heartbeat and
the uterine contractions. It is a mobile device so
movement by the mother will not affect the monitoring.
Continuous monitoring is only required in instances
such as premature labor, when oxytocin or epidural
is used of if baby is in distress. On other counts
when everything is going good with the mother and
baby, there is no need to be strapped to this device.
1st stage
It is important to stay mobile between contractions
by walking around as much as you can. Three things
happen: the labor progresses, the mother's coping
ability increases and contraction speed picks up.
Women who remain mobile and sit upright during labor,
stand and squat, instead of lying down on the whole
have shorter labors and need to rely less on pain
relief.
