Labour

The Stages of Labour

There are 3 main stages of labour.

The first stage :

The first stage can be divided into 3 phases – latent, active, transition.

The latent phase of labour is from the onset of contractions until the cervix is 3cm. dilated. During this time the contractions will strengthen and become more frequent. This phase can last for many hours.

The active phase is from 3cm. dilatation of the cervix to 8-9cm. The contractions will become more intense and more frequent and may last up to 70 seconds.

In the transitional phase of labour, the remaining 1-2cm of the cervix disappears. The contractions become more forceful and you may experience a change of emotions and feel an urge to push with the contractions.

The second stage is from full dilatation (10cm) of the cervix until the baby is born. The contractions become expulsive in nature and most women will have an overwhelming urge to push.

The third stage is from birth of the baby until delivery of the placenta (afterbirth). This stage is comparatively painless and usually occurs within half an hour of the baby’s birth.

Pain relief in childbirth

Non medical

Advantages

• safe
• simple to use
• able to be used at home
• non-invasive

Support/encouragement

• Most women find it very comforting and relaxing to have somebody with them in labour to provide support and encouragement.
• For many women, this will be her partner, but it may also be a trusted friend, sister or mother.
• The role of support person begins during the pregnancy, assisting with the woman’s preparation physically and emotionally for the sensations and feelings associated with labour and birth.

Environment

Friendly, private, familiar surroundings during labour do much to promote feelings of relaxation. In early labour, home is usually the best place to meet these needs. Some things that may help you to feel relaxed once you are in the Delivery Suite are:

• subdued lighting.
• companions of choice being present.
• bringing some articles from home (eg. photographs).
• music – the use of music/relaxation tapes. You will need to provide a small portable player and your own tapes.
• the use of mats/bean bags/stools/chairs to find positions of comfort.
• the use of aromas – essential oils or scented oils.

Heat

A combination of heat and water provides an effective form of pain relief for most women in labour.

• Hot packs placed directly on the lower abdomen and/or back provide pain relief.
• Hot shower
• Bath at home

Massage

Deep, firm massage has been found to reduce the pain of labour for many women. The ways in which to help in pain relief are:

• By promoting a sense of comfort and relaxation.
• By stimulating the body to produce some of its own pain relieving chemicals (endorphins).
• By providing a distraction, massage is thought to prevent some of the pain impulses from being registered by the brain.
• It would be helpful for your partner/support person to be familiar with how and where you like to be massaged, prior to labour.

Back massage

• use long strokes down each side of the spine which can be continued over the buttocks to the top of the thighs.
• sacral (lower back) pressure
• Effleurage – light, finger tip stroking over the abdomen
• Face massage
• Foot massage – a basic oil can be used for massage (eg. olive or almond)

• Essential or scented oils may be added to provide further relaxation/pain relief as desired, eg lavender.
• The use of different positions and movement (eg. pelvic rocking) may be of benefit alone or in combination with heat, water and massage.
• It is important that each woman be free to choose the position in which she is most comfortable while labouring. Most women are able to find positions of most comfort, which are likely to change frequently. You may find assistance and guidance from your midwife.

Natural Endorphins – pain relieving hormones produced by the body during times of stress.

During pregnancy, the level of endorphins is increased. The level increases significantly once labour begins and continues to rise throughout labour. You will begin to show signs that these endorphins are functioning by becoming more relaxed and even sleepy between contractions.

Endorphin production is at its highest at transition and falls dramatically after labour. Approximately two days after delivery, it is back to pre-pregnancy level.

Sounds

You can help reduce the pain and anxiety of labour by vocalising in any way you like. Sighing, moaning, groaning and grunting are all ways of releasing tension. You should not feel inhibited or worry about disturbing others.
 

Medical pain relief

Below is an outline of medical forms of pain relief. In certain medical situations, some methods are not suitable. Please discuss these choices for pain relief with your doctor or midwife.

Gas – (nitrous oxide and oxygen)

An odourless mixture of nitrous oxide and oxygen inhaled via a mask or mouthpiece. It provides pain relief through all stages of labour and delivery, and is gone from the woman’s body within minutes. To obtain maximun effect, the woman takes several deep breaths as soon as a contraction begins. Feelings of light-headedness, tingling in the hands and feet and occasionally an uncontrollable urge to laugh or cry may be experienced.

Injections of Morphine/ Pethidine

These drugs may reduce the severity of pain as well as aiding in relaxation for the labouring woman. They cross from the mother to the unborn baby and can affect the newborn baby. The midwife will check your baby after birth and if necessary a paediatrician will be called.

Epidural Block

A local anaesthetic is injected into the epidural space which is just outside the spinal cord. It numbs the nerves and therefore relieves the pain of contractions and stretching of the birth canal.

The anaesthetist who performs this procedure leaves a fine piece of tubing (catheter) in the epidural space so that further doses of local anaesthetic can be given. The catheter is withdrawn easily at the end of labour.

One of the commonest problems with epidural blocks is a slight drop in blood pressure which may affect the blood supply to the baby and make the mother feel dizzy. To minimise this, a drip is placed in the mother’s arm to give fluid. This helps to keep blood pressure stable. Blood pressure will be checked regularly while the epidural is in place.

The epidural block, with local anaesthetic, usually relieves the pain of both the first and second stages of labour. In most cases, the mother is able to move her limbs and take an active part in the labour and birth.

There is sometimes a slight backache at the site of the epidural. This is due to skin and ligament bruising. Very rarely a headache may occur after the delivery and the mother may need to rest in bed for a day or so.