Sometimes labour can start early, before 38 weeks. Usually you will be able to tell it has started by contractions getting more frequent and stronger. Another sign of impending labour is a ‘show’ – meaning the plug of mucus, which is usually small, pink and sticky, that has helped seal the womb during your pregnancy, comes away. You can however have a show a few days before you actually go in to labour. Unless it is heavily blood stained or is accompanied by pain it is not something you need to worry about. You may feel a heavy ache in your back, similar to a bad period pain. Or you may feel either a steady trickle or large gush of water from your vagina which means your waters have broken. If you think your waters may have broken then put a sanitary pad on and call the hospital. If you are having regular contractions every three to four minutes lasting between 40 to 60 seconds then call the hospital. If you have had a previously quick birth or if you have not reached 37 weeks of pregnancy then you should call the hospital before the contractions are this frequent. The midwife on the phone will decide in partnership with yourself when you should come to hospital.
Knowing about the stages of labour and what to expect can help you feel more in control when the time comes.
Labour can be induced if you baby is overdue or there is a risk to your own health or that of the baby’s. Contractions are usually started by inserting a pessary or gel, or both, into the vagina. Induction is always planned in advance so you will be able to talk it over with your consultant or midwife.
There are three stages to labour. In the first stage, the cervix (neck of the womb) gradually opens up (dilates). The start of established labour to full dilation can take 12 to 18 hours for a first baby. Subsequent labours are usually shorter. If you can, try to sleep or take a warm bath to help you relax. In the second stage, the baby is pushed down the vagina and is born. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push. In the third stage, more contractions will push out the placenta. It is a good idea to have the baby lifted into you so that you can feel that closeness straight away. After being examined and weighed, your baby will be returned to you. We encourage prolonged skin-to-skin contact at this time as there is evidence that it really helps with bonding.
There are many alternative ways of easing the pain during labour.
- Hydrotherapy: a ‘natural’ pain relief method, water can help by relaxing you and making your contractions feel less painful. At Liverpool Women’s, we have a birthing pool available on the midwifery-led unit. Alternatively, we have 20 inflatable birthing pools that can be hired for a small charge and used at home for women planning a home birth.
- TENS: a gentle electric current is passed through four flat pads taped to your back. It creates a tingling feeling and works by stimulating your body to produce endorphins – its natural painkillers. This is better for use in the early stages of labour.
- Entonox: this is a mixture of oxygen and nitrous oxide. Often referred to as ‘gas and air’, entonox takes the edge off the pain. Many women like this option because it is easy to use and you can control it yourself.
- Pethidine-I or Diamorphine: these are pain-relieving drugs that are injected in labour. Pain relief can last up to four hours but the drugs may in some women cause feelings of ‘wooziness’ and sickness. We routinely give women that choose this form of pain relief a drug that reduces the side effect of feeling sick.
- Epidural: this numbs the nerves which carry pain from the birth canal to the brain and is given via a tiny tube inserted into the back. It offers complete pain relief for most women, making it useful in prolonged painful labour. However, it can increase your chances of needing help to give birth to your baby in the form of forceps or a ventouse. This could mean you feel less in control. And your contractions and the baby’s heartbeat will have to be continuously monitored to check all is well.
At Liverpool Women’s, we do everything in our power to ensure the safe birth of all our babies but there are times when things don’t go quite to plan. Sometimes we have to induce labour if we think there is a risk to either mother or baby, or both. Similarly, if we discover a baby is breech (positioned feet first) we may advise you that a caesarean section may be the most appropriate way for your baby to be born. And if an infant is distressed, the birth may have to be assisted with the use of equipment such as forceps or a vacuum (ventouse). All decisions about the safest way for your baby to be born will be made in partnership with you and the people supporting you through the process.
In some cases, babies need special care following birth and this is done in our well-renowned Neonatal Intensive Care Unit. Unfortunately on other occasions, we have to support women who experience a still birth where often the causes are unknown. This is a particularly emotional and distressing time for the families concerned and, as trained professionals, we do everything we can to provide the necessary support and counselling for women and their families both at the time of their babies birth and in the days and weeks afterwards.