Labour and delivery
What are signs of labour?
You may experience show, a bloody mucous plug that comes away from cervix that has started to change in preparation for labour.
Contractions may start at irregular intervals with irregular intensity, but becoming progressively more regular and strong. Some women experience back pain. Sometimes ‘waters break’ amniotic membrane ruptures and amniotic fluid leak through vagina.
Stages of labour:
- First stage
- Contractions increase in intensity and become regular every few minutes, lasting over one minute
- Cervix dilates until it is no longer felt on vaginal examination
- Second stage
- Begins with full cervical dilatation and ends with delivery of baby
- During this time baby will descend through vagina and you will start pushing
- Third stage
- Starts after baby delivers and finishes with delivery of placenta
- We recommend injection to help contract womb after delivery of baby, this speeds up delivery of placenta and it also decreases blood loss that you will experience
What kind of pain relief can I have?
There is range of natural and medical types of pain relief such as relaxation techniques, heat packs, hot shower, massage, TENS machine, sterile water injections for back pain, N2O or laughing gas, pethidine, morphine, epidural analgesia. Midwife or doctor will assess stage and progress of your labour and will offer you appropriate pain relief.
How is baby’s wellbeing being monitored during labour?
Labour contractions in labour cause compression of foetal cord and may cause distress to the foetus. Some foetuses are more at risk of distress during labour due to foetal or maternal complications.
Foetal heartbeat will be auscultated during labour in regular intervals (usually every 30 minutes) by midwife. Auscultation intervals will shorten in later stages. If there are any concerns regarding foetal wellbeing in labour or if there any risk factors present CTG will be applied to continuously monitor foetal heartbeat.
Sometimes it is difficult to pick up foetal heartbeat via abdominal wall so foetal scalp electrode may be attached to foetal head. Those are very safe and do not hurt baby or mother, however are not recommended in certain circumstances (eg Hepatitis of HIV infection, certain blood disorders in foetus).
If labour doesn’t start on its own
Induction of labour means starting labour artificially: it usually involves vaginal examination, artificial rupture of foetal membranes and hormone drip is started in order to produce uterine contractions. This is preformed if there are certain maternal conditions, foetal complications, pregnancy over 41 weeks or foetal membranes have ruptured but labour has not started.
If contractions are not strong enough or frequent enough
If labour starts on its own, but contractions are not strong or frequent enough to cause progressive dilatation of cervix we have to augment labour. If there are still intact membranes in front of foetal head they will be artificially ruptured. Often you need an infusion of a hormone that will make contractions stronger and more frequent.
If there is foetal distress
In uncomplicated pregnancy foetal heart beat if monitored intermittently. In certain conditions however its heartbeat needs to be monitored continuous with a CTG machine. Sometimes we notice some changes in pattern of foetal heartbeat that alert us that baby may not cope well with labour. You may need further investigations to be sure of babies’ wellbeing, and sometimes we need to expedite the delivery. You may need help in form of forceps or ventous assistance for vaginal delivery or you may need caesarean section.
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