Labour:

Labour is defined as uterine contractions causing cervical dilation. We are still learning about what makes labour start and how your body decides that it’s time. It’s all still a bit mysterious! 

A pregnancy is considered to be full ‘term’ once you’ve reached 37 weeks. This means that the babies major organs are finished developing and that your baby is ready to survive on their own in the outside world. You could go in to labour any time between 37 - 41 weeks, although if it is your first baby it is often sometime after 39 weeks. 

Your labour will usually start out with fairly mild uterine contractions. Contractions are when your entire uterus squeezes tightly and becomes firm to the touch. The contractions will start off mild in intensity, short (a few seconds) and at irregular intervals. This is called early labour. In early labour it’s best if you stay at home so you can easily move around, eat, stay hydrated and rest when possible. Warm baths or showers can be very comforting in early labour. Back rubs, foot rubs and hip squeezes from your partner are also helpful. 

Over time, usually over a number of hours, the contractions will become more intense and painful, longer and closer together. When you are in active labour, the contractions are very intense and you will not be able to talk through them. They will last at least 45 seconds each and they will be about 4 to 5 minutes apart from the start of one to the start of the next. 

Once you think you are in active labour, it is likely time to go to the hospital to be assessed. Please call your maternity provider on call to give them a heads up that you are on your way in so that they will know to expect you. 

When you arrive at the hospital, the nurses will check your vital signs and listen to your baby’s heart rate. The doctor on call will come and meet you, learn about you and your pregnancy and examine your belly and your cervix. The vaginal exam is important to determine how dilated your cervix is. Usually we prefer to wait to admit you to hospital until your cervix is at least 4cm dilated. Sometimes you may come to the hospital to be assessed and the doctor will determine that it is too early to admit you to hospital and will recommend that you return home for a few more hours. The reason that we prefer not to admit people to hospital when they are in early labour is that it has been shown to result in more labour and birth interventions, that may not have been necessary if we had waited a bit longer to admit you. If you are experiencing a lot of pain and discomfort in early labour, you can be given some morphine which can alleviate some of the discomfort. It is very safe to take morphine in early labour and the effects will have worn off by the time your baby arrives. 

If you are in active labour and it is time to admit you to hospital, you will be brought up to your own private labouring room. Your room will have a hospital bed, a bathtub, a bathroom, and a modest area for your partner to sleep. You will have a nurse who will be with you throughout your labour and who will frequently monitor your vital signs, the babys heart rate and the progression of labour. You are encouraged to move around in labour and we have birthing balls, bars and other accessories to help you be as comfortable as possible. Laughing gas can be helpful in pain relief during labour. You can also request an epidural at any time during active labour. 

You will be assessed at regular intervals by the doctor to determine how your labour is progressing. Once you are admitted to the hospital in active labour, it typically takes somewhere between 8-16 hours for your baby to be born. 

Once you have reached full cervical dilation, or 10cm, then it is finally time to push. Pushing, or the second stage of labour, typically takes between 1-3 hours. It will take some time to get the hang of pushing, especially if you have an epidural. 

Pushing occurs during contractions only, and we recommend that you rest in between contractions. Pushing involves holding your breath and engaging your abdominal and pelvic floor muscles in a sustained contraction to move your baby down the birth canal. It uses the same muscles that are involved when you are having a bowel movement. You will be encouraged to try and push about 3 times for 10 seconds each time during every contraction. Your nurse and doctor will help you to learn how to push effectively and help you to change positions regularly. Your baby will slowly move down the birth canal until it reaches the perineum. At this point your doctor will help guide your baby’s head out while you push. The body or shoulders usually deliver very quickly after the head. When your baby is born, the doctor and nurses will dry off their head and feet vigorously which encourages them to breathe and cry. Your new baby will be brought right on to your chest. The nurse will give you an injection of oxytocin in your thigh muscle. This is important to help prevent excessive bleeding. 

The umbilical cord is cut after 2 minutes. This delay allows some extra blood to flow from the placenta to the baby which is very beneficial to baby. The placenta is usually delivered in the first few minutes after the birth. 

Your perineum will be examined and may need to be sutured. It is likely that there will be a small amount of natural tearing. This will be repaired with dissolvable stitches and heals extremely well and quite quickly.