Labour: What to Expect
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As you start reaching the end of your pregnancy, you may already start having the signs that your baby is ready to
come to the world even though the labour pains have not started yet. It is normal to be worried about your labour
and how you are going to cope with it. It is best to know as much as you can about what is about to come your way
so you can be ready and relaxed when it actually happens.

Yourlabour may last anywhere between 6 to 20 hours during your first pregnancy. The subsequent labours tend to
be shorter and easier. There are several stages of labour and it is good to know about them so you can observe and
see for yourself if you are progressing.

  •  Early Labour/Latent Phase:
    Also referred to as slow labour, this stage may last for hours or even days as contractions build up with time.
    During these short and irregular contractions, you may notice a ‘show’. Unless you notice something
    unusual, you can comfortably spend this period at home. It may last for 8-12 hours [1]. A warm bath can you
    relax during this period.
  • First Stage Labour:
    Also known as established labour, this stage is occupied by strong and regular contractions that last for
    about 30-45 seconds and repeat after every 5 to 30 minutes [2]. This is the time when your cervix thins or
    effaces and opens up or dilates. At this stage, you should call your doctor and ask if you should be coming to
    the hospital or stay at home. If you are planning a home birth, make sure to call your midwife around this
    time. Once you are in the maternity ward or your midwife has arrived, your abdomen will be examined for
    your baby’s position. Your baby’s heartbeat, your blood pressure, temperature and pulse will be periodically
    monitored.
    A vaginal examination will be carried out to assess how far your labour has progressed. During the first
    stage, your cervix should dilate to 10 cm [3]. You can have light snacks and isotonic drinks during this period
    to make sure your body has the energy required for the labour. As the labour progresses further, your
    contractions become stronger and stronger with very little to no gaps between them. Your partner can help
    you stay motivated and be strong.
  •  Second Stage Labour:
    Your cervix is fully dilated now but it may take up to two hours of active pushing before you can finally meet
    your baby. It can be hard and very painful to go through this stage but your partner and your midwife can
    help you get through this time. At the end, it will be all worth it when you will meet your little miracle.
    Your contractions will become very strong and you will feel an urge to push as each contraction comes
    through. With each push, your baby moves further down in your birth canal. Remain focused and listen to
    your midwife, you have got it!
  • Finally, your baby’s crown will emerge through your birth canal. Your doctor or midwife may encourage you

to take small, short breaths that will help with the stretching of perineum that may save it from tearing.


However, in some cases, you may still tear or you will be given a small tear, an episiotomy [4] to help your
baby’s head come out. Once your baby’s head is out, the next push with the contraction will help one
shoulder come out. The other comes out with the next contraction. Congratulations! The hard part is done.
Many women suddenly feel an immense relief from the pain and a feeling of happiness overtakes for what
they just achieved.


Your new born will be handed over to you to have skin to skin contact and then the umbilical cord will be
clamped and cut. In some cases, the new born dad may want to do this.
 3 rd Stage of Labour:
During this stage, the placenta is delivered. In most cases, it is pretty easy and straightforward. In some
cases, if you consent, you may be given an injection of oxytocin to hasten the delivery of placenta. The
injection also reduces the risk of heavy bleeding. [5] With an injection, the placenta is delivered between 5
to 20 minutes. On the other hand, it may take up to one hour without the aid of drugs and the risk of
bleeding also increases.

In rare cases, whole or part of placenta may persist in the uterus. It requires removal by the doctor under
anaesthesia.


Labour and Delivery Red Flags:
Understanding the potential risks associated with labour and delivery can give you an idea about possible risks and
outcomes. Some of the common risks and red flags to look out for include:
 Breech position: It is when the baby has their bum or feet lined up with the birth canal rather than the head.
[6]
 Shoulder Dystocia: It is a condition in which the baby’s shoulder becomes stuck in the birth canal after the
head has been delivered. [7]
 Cord Prolapse: In this case, the umbilical cord slips through the cervix and enters the birth canal before the
baby does. It is a concern because it can become compressed as the baby passes through the canal,
compromising their oxygen supply. [8]
 Fetal Distress: Baby’s heart rate and oxygen levels are monitored to see if there are any signs of distress.
 Prolonged Labour: In this case, the labour becomes abnormally long and does not progress as it normally
should.
 Feto-pelvic Disproportion: It is a condition in which the mother’s pelvis is too small to allow the baby’s head
to pass. It can be a reason for prolonged labour. [9]
 Meconium Aspiration: If the baby poops in the womb, there is a possibility for them to inhale the excreted
meconium. This may result in Meconium Aspiration Syndrome in which the inhaled meconium interferes
with the baby’s ability to breathe. The severity of it depends upon the amount inhaled. [10]
 Placental Abruption: It is a serious condition in which the placenta partially or completely detaches from the
uterine wall even before the baby is born. You may have symptoms if you experience this. Your baby will be
delivered immediately.
 Nuchal Cord: It is a condition in which the umbilical cord wraps around the baby’s neck.
 Placenta Previa: It happens when the placenta is not present at its normal position but occupies the cervix
which is the gate way for the baby. A c section is required in this case.


References:
[1] https://americanpregnancy.org/labor-and-birth/first-stage-of-labor/
[2] https://americanpregnancy.org/labor-and-birth/first-stage-of-labor/
[3] https://americanpregnancy.org/labor-and-birth/first-stage-of-labor/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175536/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611883/
[6] https://emedicine.medscape.com/article/262159-overview
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279180/
[8] https://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065844/
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290233/

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