The Delivery


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Several factors that increase the production of prostaglandins include oxytocin, which stimulates the force and frequency of uterine contractions, and a fetal lung protein called surfactant protein A SP-A. Surfactant production in the fetal lung does not begin until the last stages of gestation , when the fetus prepares for air breathing; this transition may act as an important labour switch.

Early in labour, uterine contractions, or labour pains, occur at intervals of 20 to 30 minutes and last about 40 seconds. They are then accompanied by slight pain , which usually is felt in the small of the back. As labour progresses, those contractions become more intense and progressively increase in frequency until, at the end of the first stage, when dilatation is complete, they recur about every three minutes and are quite severe.

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With each contraction a twofold effect is produced to facilitate the dilatation, or opening, of the cervix. Because its contents are quite incompressible, however, they are forced in the direction of least resistance, which is in the direction of the isthmus, or upper opening of the neck of the uterus, and are driven, like a wedge, farther and farther into this opening. In addition to forcing the uterine contents in the direction of the cervix, shortening of the muscle fibres that are attached to the neck of the uterus tends to pull those tissues upward and away from the opening and thus adds to its enlargement.

By this combined action each contraction of the uterus not only forces the amnion and fetus downward against the dilating neck of the uterus but also pulls the resisting walls of the latter upward over the advancing amnion, presenting part of the child. In spite of this seemingly efficacious mechanism, the duration of the first stage of labour is rather prolonged, especially in women who are in labour for the first time.

In such women the average time required for the completion of the stage of dilatation is between 13 and 14 hours, while in women who have previously given birth to children the average is 8 to 9 hours. Not only does a previous labour tend to shorten this stage, but the tendency often increases with succeeding pregnancies, with the result that a woman who has given birth to three or four children may have a first stage of one hour or less in her next labour. The first stage of labour is notably prolonged in women who become pregnant for the first time after age 35, because the cervix dilates less readily.

A similar delay is to be anticipated in cases in which the cervix is extensively scarred as a result of previous labours, amputation, deep cauterization, or any other surgical procedure on the cervix.

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Just as an abnormal position of the child and molding of the uterus may prevent the normal descent of the child, an abnormally large child or an abnormally small pelvis may interfere with the descent of the child and prolong the first stage of labour. About the time that the cervix becomes fully dilated, the amnion breaks, and the force of the involuntary uterine contractions may be augmented by voluntary bearing-down efforts of the mother.

With each labour pain, she can take a deep breath and then contract her abdominal muscles. The increased intra-abdominal pressure thus produced may equal or exceed the force of the uterine contractions. These bearing-down efforts may double the effectiveness of the uterine contractions.

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As the child descends into and passes through the birth canal, the sensation of pain is often increased. Article Media. This can happen if your contractions aren't coming often enough or aren't strong enough, or if your baby is in an awkward position. If this is the case, your doctor or midwife may talk to you about two ways to speed labour up: breaking your waters or an oxytocin drip.

Breaking the membrane that contains the fluid around your baby your waters is often enough to make contractions stronger and more regular. This is also known as artificial rupture of the membranes ARM. Your midwife or doctor can do this by making a small break in the membrane during a vaginal examination. This may make your contractions feel stronger and more painful, so your midwife will discuss pain relief with you. If breaking your waters doesn't work, your doctor or midwife may suggest using a drug called oxytocin also known as syntocinon to make your contractions stronger.

This is given through a drip that goes into a vein, usually in your wrist or arm. Oxytocin can make contractions become stronger and more regular quite quickly, so your midwife will discuss pain relief options with you. You will also need electronic monitoring to check your baby is coping with the contractions, as well as regular vaginal examinations to check the drip is working.

The second stage of labour lasts from when your cervix is fully dilated until the birth of your baby. Your midwife will help you find a comfortable position to give birth in. You may want to sit, lie on your side, stand, kneel, or squat, although squatting may be difficult if you're not used to it. If you've had lots of backache while in labour, kneeling on all fours may help. It's a good idea to try out some of these positions before you go into labour.

Talk to your birth partner so they know how they can help you. Find out what your birth partner can do. When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. You may get an urge to push that feels a bit like you need to have a poo. You can push during contractions whenever you feel the urge. You may not feel the urge to push straight away. If you have an epidural, you may not get an urge to push at all. If you're having your first baby, this pushing stage should last no longer than three hours. If you've had a baby before, it should take no more than two hours.

This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you. When your baby's head is almost ready to come out, your midwife will ask you to stop pushing and do some short breaths, blowing out through your mouth. This is so the head can be born slowly and gently, giving the skin and muscles of the area between your vagina and anus the perineum time to stretch. This is a small cut made to the perineum. You'll be given a local anaesthetic injection to numb the area first.

Once your baby is born, the cut or any large tears will be stitched up.

Find out about your body after the birth , including how to deal with stitches. Once your baby's head is born, most of the hard work is over. The rest of the body is usually born during the next one or two contractions. You'll usually be able to hold your baby straight away and enjoy some skin-to-skin time together. You can breastfeed your baby as soon after birth as you like. Ideally, your baby will have their first feed within one hour of the birth. Read more about breastfeeding in the first few days.

The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina. Your midwife will explain both to you while you're still pregnant or during early labour, so you can decide which you would prefer. There are some situations where physiological management isn't advisable.

If the placenta doesn't come away naturally or you begin to bleed heavily, you'll be advised by your midwife or doctor to switch to active management. You can do this at any time during the third stage of labour. Page last reviewed: 30 April Next review due: 30 April What happens during labour and birth - Your pregnancy and baby guide Secondary navigation Getting pregnant Secrets to success Healthy diet Planning: things to think about Foods to avoid Alcohol Keep to a healthy weight Vitamins and supplements Exercise.

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