What is labour really like?

Some mothers say it was the most beautiful experience of their life, others make wincing references to watermelons. One thing’s for sure, in the weeks leading up to the birth, almost all of us feel jittery about what awaits. ‘You need to trust your body and have confidence in yourself,’ advises Adele Hamilton, a midwife with 30 years’ experience. 

‘Research shows that a positive mindset can lead to a positive outcome.’ It’s hard to be positive if you have no idea what’s coming, so take note of the following information and march (or at least waddle) into that labour ward confident in the knowledge of exactly what is dilating, where. 

Early labour

What’s happening: ‘Your baby is starting to flex its head, move deeper into the pelvis and closer to the cervix,’ explains Adele Hamilton. At the start of labour your cervix starts out firm like your nose and by the end, it will become soft and stretchy like your lips.

Incredibly, some women don’t notice their early contractions and can be several centimetres dilated before they realise they are in labour. Pray this is you. For most mothers-to-be, there are a few telltale signs of early labour.  

The show: Many women experience a ‘show’, a pinkish/red mucus ‘blob’ of discharge which comes out of the vagina. This blob has been protecting your uterus from infection during pregnancy and its appearance is a sign that established labour will probably begin in the next few hours or days.

Lower back pain: This, the need to go to the loo and premenstrual-like cramps are other signs of early labour.

Your waters break: This may happen with a gush or a trickle, depending on how much amniotic fluid you have. The fluid is almost clear with a yellow tinge and can be bloodstained to begin with. Use a sanitary towel if your waters keep trickling, but if there is a lot of fluid you may need an old towel. You should contact the hospital as soon as your waters break because there is more chance of getting an infection now.

Contractions start: It can take hours, or even days, for your contractions to build up and put pressure on your cervix to open up (dilate).  Even though you’ll be desperate to get to the hospital and finally meet your baby, you’ll be much more comfortable staying at home unless there’s a medical reason to go in, especially as first labours tend to last 12 to 16 hours.

First stage labour

What’s happening: Your cervix is dilating to let the baby come out. Initially your contractions will be short and infrequent, and feel a bit like period pain. As your cervix widens they’ll become stronger and closer together.

As a general rule, you don’t need to go to hospital until your contractions are lasting 30-45 seconds and four minutes apart. Generally speaking you’ve now got around eight to twelve hours to wait until delivery. When you arrive, a midwife will consult your notes and ask whether your waters have broken, how frequently the contractions are coming and whether you’ve had a bowel movement. You’ll then change into the loose clothes you’ve brought for the labour and birth. Your midwife will palpate your abdomen to feel the baby’s position, she will listen to the fetal heartbeat, take your blood pressure, pulse, and temperature, and you’ll be given an internal examination to see how far your cervix has dilated. She may record the fetal heart on an electronic monitor for up to 30 minutes. You will also be asked for a urine sample which will be tested for protein and sugar.

When your cervix has dilated to three to four centimeters you are officially in active labour. At this stage contractions will be strong so you might want to consider pain relief. Options include using a TENS machine (a natural form of pain relief), gas and air, asking your partner to give you a massage, breathing exercises and relaxation techniques. If these things aren’t helping then you can choose to have pethidine or an epidural. The fetal heart will be regularly monitored and you will be given internal examinations roughly every four hours to check progress is going well.
Sometimes women reach a stage in labour where the rate at which their cervix is dilating either slows or stops. If this happens the best thing you can do is have a change of scene and go for a walk down the hospital corridor.

Transition

What’s happening: During the transitional phase the cervix dilates from eight to ten centimetres (the length of a mobile phone, yes really).

At this stage, contractions are long and powerful and you may feel angry and stressed, weepy, shaky or sick. “If you do experience any of these symptoms take it as positive sign you are making good progress,” says Fletcher. Some women feel the urge to push during the transitional stage, but you shouldn’t bear down until your midwife has confirmed that your cervix is fully dilated. For most women the end of this stage is marked by a noticeable change in their breathing pattern. You may grunt involuntarily, which is a sign you will soon start to feel the urge to push.

Second stage labour

What’s happening: Your womb is pushing the baby down the birth canal and its head will soon be pressing on your pelvic floor.

There’s often a lull after transition when the contractions stop and you and your baby can have a rest. When contractions start again you might feel the pressure of your baby’s head between your legs. Once the cervix has dilated to ten centimeters you can start pushing.
‘The ‘pushing’ stage tends to last up to 90 minutes if it’s your first baby,’ says Hamilton. “Try to regard each contraction as one step closer to meeting your baby and have confidence in yourself and your body.” It might be painful but the end is in sight.

Pushing is much easier if you are upright, squatting, sitting up supported, on all fours, or on your knees leaning against a chair or your partner. This way you have the force of gravity to help you. Your pushing should be smooth and continuous. All of the muscular effort should be down and out and your baby’s head will eventually make it far down your pelvis and stretch the opening of the vagina. When this happens you’ll probably feel a hot, stinging sensation and your midwife will tell you that your baby’s head has ‘crowned’. As your baby’s head begins to emerge she may ask you to stop pushing. This helps to ensure your baby is born gently and should reduce the risk of tearing. Once the baby is born the pain stops immediately, the cord will be clamped and cut and the baby handed to you if you want skin-to-skin contact.

Third stage labour

What’s happening: When the baby is born the uterus rests. After approximately 15 minutes it starts to contract comparatively painlessly to expel the placenta.

On request, your midwife will give you an injection of syntometrine to speed up the placenta’s arrival. ‘If you decide to deliver the placenta without an injection it tends to take about 45 minutes, but normally mothers are exhausted by this stage and can’t be bothered,’ says Hamilton. ‘The midwife will feel your abdomen to check the uterus is contracting after the birth and will look at the placenta to ensure it’s normal and that nothing, such as membrane, has been left behind.’ And now, it’s for tea and toast on the NHS.

What I wish I’d known…

‘That if you’re sick, have diahorrea and are eight days overdue you're probably in labour and not coming down with a stomach bug.’ Katie Gale, 27.

‘That it’s a very bad idea to watch a video of a woman giving birth. If you were going to have your appendix out you wouldn’t watch an operation of it on TV first, would you?’ Laura Coles, 29.

‘Disposable knickers are really not attractive or comfortable.’ Sarah Kundra, 23.

‘It can happen early and very quickly first time around - contrary to what everyone says.’ Clare Worrell, 33.

‘That things don’t always happen in the order they’re supposed to. My waters broke, but my contractions never began. Two days later I had to be induced. I didn’t have a show until the consultant checked how dilated I was. And I ended up having pain relief before my contractions started because they were about to hook me up on a drip.’ Denise Nicholls, 38.

‘That the Birth Plan never does go to plan.’ Helen Gibbs, 39.

‘How you “do” labour is largely irrelevant to the process of parenting - a bit like people stressing hugely about their wedding and not investing any time in the marriage.’ Pip Vincent, 33.

So, what was the pain like?

‘No idea. I was getting a bit uncomfortable when the midwife suggested an epidural, and I suddenly wondered why on earth I wasn’t having one. Once the anaesthetist had done his job the whole experience was delightfully pain-free.’ Bridget Griffin, 27.

‘Contractions were like an electric shock shooting through my thighs.’ Zara Barratt, 31.

‘To be honest I was surprised at how well I coped with the contractions, but I was shocked by how painful the internal examinations were. That was the worst bit.’ Sophie Whitbread, 32.

‘It was a long time before things got painful and when they finally did I was actually quite relieved - finally something was happening! The pushing was excruciating, but when I got to that stage I felt like I was nearly there, which got me through it.’ Kerry Elliott, 28.

‘The transition was the hardest bit, before the urge to push. Fortunately that was when they brought in the gas and air. My labour wasn’t overly long so although it hurt, it wasn’t unbearable and during the pushing I felt like I was doing what my body wanted me to do.’ Michelle McMinn, 38.
 
‘I remember thinking at the time that I could never do it again. While I had drugs it was absolutely fine, but when the epidural stopped working I’d never felt anything so painful in my life. Clearly it hasn’t put me off because I’m pregnant again…’ Angie Kay, 31.