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Labor & Delivery 2018-06-03T15:21:41+00:00

PREGNANCY

LABOR & DELIVERY

The process of giving birth

Congratulations, soon you’ll experience the amazing process of childbirth. Find out how to spot the signs of labour, get the facts on pain management and the 3 stages of labour.

THE SIGNS OF LABOR

As you approach you due date, you will be looking for any little sign that labour is about to start. The most prominent sign of labour are the strong contractile waves that move your baby down the birth canal. Some signs suggest that labour will begin very soon. Call you doctor or midwife if you have any of the following signs of labour. Call your doctor even if it is week before your due date, you might be going into preterm labour. Your doctor or midwife can decide if it is time to go to the hospital or if you should be seen in the office first.

  • You have contractions that become stronger at regular and increasingly shorted intervals.
  • You have lower back pain and cramping that does not go away.
  • Your water breaks
  • You have a bloody mucus discharge. This is probably the mucus plug that blocks the cervix. Losing your mucus plus usually means your cervix is dilating and becoming thinner and softer. Labour could start right away or may still be days away.

FALSE LABOR

A lot of women, especially first-time mothers-to-be, think they are in labour when they are not. This is called false labour. ‘Practice contractions’ called Braxton Hicks contractions are common in the last weeks of pregnancy or earlier. The tightening of your uterus might startle you. Some might even be painful or take your breath away. It is no wonder that many women mistaken Braxton Hicks contractions for the real thing. So don’t feel embarrassed if you go to the hospital thinking you’re in labour, only to be sent home. The only way to tell if the contractions are true is to time them. Use a watch or clock to keep track of the time one contraction starts to the time the next contractions starts, as well as how long each contraction lasts. With true labour, contractions become regular, stronger and more frequent. Braxton Hicks contractions are not in a regular pattern and they taper off and go away. Some women find that a change in activity, such as walking or lying down, makes Braxton Hicks contractions go away. This won’t happen with true labour. Even with these guidelines, it can be hard to tell if labour is real. If you are ever unsure whether the contractions are true or Braxton Hicks, call you doctor!

MANAGING LABOR PAIN

Childbirth is different for everyone. Most women worry about how they will cope with the pain of labour and delivery, but no one can predict how you will feel. The amount of pain a woman feels during labour depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. It is important to realize that labour pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing your baby down and out of the birth canal. In other words, labour pain has a purpose.

NATURAL METHODS OF PAIN RELIEFS

There are various methods to help women relax and make the pain manageable. Here is a list of things women do to relief the pain.

  • Breathing and relaxation techniques
  • Taking warm showers or baths
  • Getting massages
  • Using heat and cold, such as heat on your lower back and cold washcloth on your forehead
  • Finding comfortable positions while in labour
  • Using a labour ball
  • Listening to music
  • Having the supportive care of a loved one

MEDICAL METHODS OF PAIN RELIEF

A lot of women, especially first-time mothers-to-be, think they are in labour when they are Consult your doctor or midwife if you are in labour and need pain relief. Together with him/her you can decide which option suits you best. Nowadays women in labour have many pain relief options that work well and pose small risks when given by trained and experienced doctor. Doctors also can use different methods for pain relief at different stages of labour. Still, not all options are available at every hospital and birthing centre. Plus your health history, allergies, and any problems with your pregnancy will wake some methods better than others.

These are the most commonly used methods of relieving pain;

  • Opioids: they are medicines given through a tube inserted in a vein or by injecting the medicine into a muscle.
  • Epidural and spinal blocks: An epidural involves placing a tube into the lower back, into a small space below the spinal cord. Small doses of medicine can be given through the tube as needed throughout labour. With a spinal block, a small dose of medicine is given as a shot into the spinal fluid in the lower back. Spinal blocks usually are given only once during labour.
  • Pudendal block: A doctor injects numbing medicine into the vagina and the nearby pudendal nerve. This nerve carries sensation to the lower part of your vagina and vulva.

THE THREE STAGES OF LABOR PAIN

Onset of labor

There are various definitions of the onset of labour:

FIRST STAGE: LATENT PHASE

The latent phase of labour is also called pre-labour and is generally defined as the point at which the woman perceives regular uterine contractions. In contrast with Braxton Hicks contractions that may start around 26 weeks and are infrequent, irregular and involve only mild cramping. Cervical effacement, which is the thinning and stretching of the cervix, and cervical dilation occur during the closing weeks of pregnancy and is usually complete or near complete, by the end of the latent phase. The degree of cervical effacement may be felt during a vaginal examination. A ‘long’ cervix implies that effacement has not yet occurred. Latent phase ends with the onset of the first active stage.

FIRST STAGE: ACTIVE PHASE

The active phase of labour begins when your contractions are more frequent than every 5 minutes and when you have a cervical dilation of 3 cm or more or when you have a cervical effacement of 80% or more. Your doctor may asses a labouring mother’s progress by performing a cervical exam to evaluate the cervical dilation, effacement and station. These factors form the Bishop score. The Bishop score can also be used as a means of predict the success of an induction of labour. Full dilation is reached when the cervix has widened enough to allow passage of the baby’s head, around 10 cm dilation. The duration of labour varies widely, but the active phase averages some 8 hours for women giving birth to their first child and shorter for women who have already given birth.

SECOND STAGE: FOETAL EXPULSION

The expulsion stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, women may have the sensation of pelvic pressure and an urge to begin pushing. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the pelvic inlet. The foetal head then continues descent into the pelvis, below the public arch and out through the vaginal opening. This is assisted by the additional maternal efforts of pushing. The appearance of the foetal head is termed ‘crowning’. At this point, the woman will feel an intense burning or stinging sensation. She is about to give birth. Complete expulsion of the baby signals the successful completion of the second stage of labour.

FIRST STAGE: ACTIVE PHASE

The active phase of labour begins when your contractions are more frequent than every 5 minutes and when you have a cervical dilation of 3 cm or more or when you have a cervical effacement of 80% or more. Your doctor may asses a labouring mother’s progress by performing a cervical exam to evaluate the cervical dilation, effacement and station. These factors form the Bishop score. The Bishop score can also be used as a means of predict the success of an induction of labour. Full dilation is reached when the cervix has widened enough to allow passage of the baby’s head, around 10 cm dilation. The duration of labour varies widely, but the active phase averages some 8 hours for women giving birth to their first child and shorter for women who have already given birth.

SECOND STAGE: FOETAL EXPULSION

The expulsion stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, women may have the sensation of pelvic pressure and an urge to begin pushing. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the pelvic inlet. The foetal head then continues descent into the pelvis, below the public arch and out through the vaginal opening. This is assisted by the additional maternal efforts of pushing. The appearance of the foetal head is termed ‘crowning’. At this point, the woman will feel an intense burning or stinging sensation. She is about to give birth. Complete expulsion of the baby signals the successful completion of the second stage of labour.

THIRD STAGE: PLACENTA DELIVERY

The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10 – 12 minutes dependent on whether active or expectant management is employed. Placental expulsion can be managed actively or it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Active management is described as the administration of drugs within one minute of foetal delivery, controlled traction of the umbilical cord and fundal massage after delivery of the placenta, followed by performance of uterine massage every 15 minutes for two hours.

THE FOURTH STAGE

The fourth stage of labour is the period beginning immediately after the birth of a child and extending for about six weeks. It is the time in which the mother’s body, including hormone levels and uterus size, return to a non-pregnant state and the baby adjusts to life outside the mother’s body. Although we call it the fourth stage of labour, most people don’t consider this to be a part of labour. Nonetheless, The WHO (World Health Organization) describes this postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies. As of 2014, early skin-to-skin contact is endorsed by all major organizations that are responsible for the well-being of infants. The WHO states that ‘the process of childbirth is not finished until the baby has safely transferred from placental to mammary nutrition.’ They advise that the new born be placed skin-to-skin with the mother, postponing any routine procedure for at least two hours. The WHO suggest that any initial observations of the infant can be done while the infant remains close to the mother, saying that even a brief separation before the baby has had its first feed can disturb the bonding process. They further advise frequent skin-to-skin contact as much as possible during the first days after delivery, especially if it was interrupted for some reason after the delivery.

Important Message

 

The World Health Organization or short WHO, recommends breastfeeding during the first 6 months of your child.

 

Unimilk® fully supports this recommendation from the WHO.

 

If you do choose, in consultation with your health care professional, to start bottle feeding, Unimilk® offers a good substitute.