Labour: Guide to basics
The physiological transition from being pregnant women to a mother means an enormous change for each woman, both physically and psychologically. During the last few weeks of pregnancy a number of changes may occur.
Mood swings are very common and you might find yourself veering towards melancholy. Women might become irritable and they might start having unexplained symptoms like dry mouth, a anxious feeling and jitteriness. This is quite normal at this stage of pregnancy and is generally taken care by simple reassurance and relaxation techniques.
Two to three weeks prior to onset of labour the lower uterine segment expands and allows the foetal head to sink lower in the pelvis and it may engage in the pelvis for the first time(engagement means that the foetal head has entered the pelvis and is now immovable. When this happens breathing becomes easier and the women experiences a relief called “lightening”.
At the same time as you near labour, walking will become more difficult and you might have problems climbing stairs.
The presence of foetal head also causes venous congestion in the pelvis and this leads to increased secretions from the vagina. During the last few weeks of pregnancy it is absolutely normal to have a wet feeling in your vagina.
Also, with the foetal head in the pelvis, women may feel pressure on the pelvic floor. Women will also have frequency of micturation and defecation. Women might also experience some amount of stress incontinence (involuntary passage of urine with straining).
Stages of labour:
Labour is traditionally divided into three stages.
It may last 8-10 hours in first time mothers. During this stage the cervix dilates from zero cm to full dilatation. In first timers, the dilatation of cervix proceeds at a slow pace of .5-1cm per hour. The cervix needs to dilate to 10cm for it to be called as full dilatation. During this time the length of the cervix progressively shortens and the cervix at the end of the first stage become a part of the lower uterine segment. This process is called “effacement”. Effacement starts with labour in first time mothers but in women who have delivered before, the cervix effaces during the last few days of pregnancy.
The second stage of labour starts from the time of full dilatation of cervix up to the delivery of the baby. In first time mothers it usually last for about two hours, but in some cases may prolong. In women how have delivered before, this stage may last a very less time, and some women have been known to deliver very fast once fully dilated, but a rough ballpark would be 30 min to an hour.
Stage begins with the delivery of the baby and ends when the placenta along with membranes is expelled. It varies from 5 to 15 min and usually hastened by an injection called Methergine.
Onset of spontaneous normal Labour
During the last month or so of the pregnancy, women will start to fell prominent tightening of the uterus. This is nothing but a rhythmic contraction and relaxation of the uterus. These contractions are usually mild and widely spaced apart. These are called as Braxton Hick’s contraction and are a normal phenomenon.
At the onset of labour these contraction will become stronger, longer and more closely placed. Initially women may experience waves of contraction every 30-45 min. It will continuously reduce and around end of 1st stage women will be having contractions lasting 1-3 min every 5-8 min apart.
Women may also see a blood stained mucoid discharge from the vagina a few hours before or within onset of labour. This is just a hint of blood along with mucous and any frank bleeding per vagina is not normal and should be attended to immediately.
During this time women should stay in her own surroundings and can continue with her normal activities. Women should also attempt to sit upright and remain active throughout this period. During this time women may experience some degree of stress incontinence, so you may not be sure if it is urine or liquor which you are passing.
During this time you can take a bath and a warm bath can be very effective in relieving the pain of labour. After bath wear loose clothes and stay comfortable.
While on the threshold of delivering your baby, you must learn trust your instincts, listen to your body and verbalise your feeling to get any support you need. You should feel in control of your body and if you have been a n active part of the decision making, you should have a easy and uneventful labour.
Labour is a time for great metabolic stress. So women must eats high energy foods during labour to gain sufficient nutrition, otherwise you will get very exhausted by the labour. The final delivery of your baby is entirely dependent on you pushing it out, so try to stay strong enough to push it out.
You can eat any food that is rich in energy, but it should be easily digested. You can try toasts, breakfast cereal, yoghurt, fruit juice, biscuits, and clear broth. You can also have ice creams and jellies.
Sucking on ice cubes will keep your throat wet and also take your mind of the pain. As labour progresses it is advisable not eat solids and instead drink liquids.
During labour make a point to empty your bladder every 1-2 hours. It will enable easy and fast delivery for you.
Pre labour rupture of membranes
Your baby grows inside a bag of water called amniotic sac. The covering of this sac amniotic membrane ruptures just prior to labour, but in some women it may rupture before labour. This is called as premature rupture of membranes (PROM). The presentation and management of this condition will depend up on how early it has rupture before labour. If it has rupture at term or about term, then we can be reasonably sure that the baby will be delivered soon. If however delivery is remote then PROM throws up a challenge. A detailed discussion of the management of PROM and normal labour is beyond the scope of this article, but you should remain informed about them.