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Everything You Need to Know About Normal Labour

Labour is a regular & painful uterine contractions causing progressive dilation and effacement of the cervix. The World Health Organization defined normal birth as "spontaneous in onset, low-risk at the start of labour & remaining so throughout labour & delivery. The infant is born spontaneously between 37 and 40 completed weeks of pregnancy. After birth, mother and infant are in good condition."

Normal labour usually begins within 2 weeks of the estimated delivery date. In a first pregnancy, labour usually lasts 12 to 18 hours on average; subsequent labours are often shorter, averaging 6 to 8 hours.

Book an online appointment with Dr. Nidhi Agrawal for Pregnancy & Gynecology related issues.

How to Know If it's True Labour?

A woman might have a plug of mucus and blood fall out of the opening to the cervix, sometimes called a "bloody show", in the third trimester, before labour starts. Sometimes, the amniotic sac might rupture, and is called "water breaking". Either of these can trigger the onset of labour and so-called true labour contractions. These pains are different from the milder, non-productive contractions you may experience earlier in pregnancy, known as Braxton Hicks contractions (or practice contractions). Once they start, true labour contractions progress in frequency, duration & intensity, and they can feel like waves that build up to a peak intensity and then gradually decrease.

However, false labour pains are not well-coordinated, do not progress, and are usually relieved with rest, analgesia, or sleep. They do not harm the baby.

Stages of Labour

Even though labour is a continuous process, we can see three stages of labour.

1. First Stage

This first stage is again has two phases. The first phase is the early phase or latent phase and usually lasts up to 20 hours or until the cervix dilates to 3 centimetres. The contractions are irregular and of low intensity.

Then, regular contractions follow - they happen every 3-5 min and last about a min or more, and this causes the cervix to dilate from 3 cm to about 6 cm. This marks the beginning of the active phase of labour, during which the cervix dilates from 6 to 10 cm. Contractions are intense, each lasting between 60 to 90 seconds, with only 30 seconds to 2 min of rest in between. Sometimes, they even overlap a bit, with one contraction beginning before the previous one ends. Often, the amniotic sac also ruptures at this point if it hasn't already.

2. Second Stage

In this stage, the cervix will be fully dilated. It can be treated as the pushing stage. During this stage, the baby, and in particular the baby's head, has to pass through the maternal pelvis, and normal vaginal delivery takes place.

3. Third Stage

This stage starts with the delivery of the baby and ends with the delivery of the placenta. (The placenta is the organ inside the uterus that brings a baby nutrients and oxygen and carries away waste.) It usually takes 5 min to 30 min.

After your baby is born, the doctor will give the baby first to a paediatrician. If you and your baby are in good health, the doctor might wait a min or so before they clamp and cut the umbilical cord. This allows the baby to get some of the blood from the placenta. Then, the baby is shown to the mother, and skin-to-skin contact is established.

If there is an episiotomy (intended cut given at the vaginal opening), or any small tears, repair is done with suturing under local anaesthesia.

4. Fourth Stage

This stage begins with the delivery of the placenta and ends 1-2 hours later; it is meant for observation of vital signs of the mother, her bleeding and assessment of neonatal wellbeing. Breastfeeding is preferably initiated in this golden hour.

Management of the First Stage of Labour

Initial examination — The goals of the initial evaluation are to:

  • Check the prenatal record for medical or pregnancy issues that need special attention during delivery.
  • Evaluate fetal status.
  • Confirm that the patient is in labour

The following assessments comprise the initial examination:

  • Admission vital signs include blood pressure, heart and respiratory rates, temperature, etc.
  • An abdomen examination to confirm the lie and presentation of the baby, to assess the frequency, quality and duration of uterine contractions; and fetal heart rate (FHR). Normal labour is meant for longitudinal lie and cephalic (head down) presentation.
  • A doctor will only perform a digital exam if there's no evidence of placenta previa or prelabour rupture of membranes (PROM). If needed, this is checked through your medical history, physical exam, lab tests, and an ultrasound. Assessment of fetal size & weight, assessment of maternal pelvis, and to rule out any cephalopelvic disproportion.

Patient preparation

Oral intake - Hydration is necessary, and oral intake of water and fluids is encouraged during the latent phase of labour.

Intravenous fluids - We provide maintenance intravenous fluids whenever a patient is unable to tolerate or take oral fluids or is in the active phase of labour.

Medication management

Regular medications – Patients can take their usual daily medications orally during the latent phase of labour; if absorption or oral intake is a concern, a non-oral route of administration is preferable.

Position - Patients should assume positions that are comfortable to them. The duration of the first stage is found to be shorter in patients in upright positions (standing, sitting, kneeling, walking around) than in those in recumbent positions or bed care. In complicated pregnancies, however, specific positions may be required for maternal or fetal monitoring.

Pain and pain management - The first stage of labour and the second stage of labour causes pain.

Continuous support - A nurturing, supportive companion during labour has obvious psychological benefits, and almost all pregnant people feel that frequent or continuous support during labour helps them cope with its challenges. It can be anyone- the partner, some close relative or a "doula". Continuous support can also improve obstetric outcomes.

Pain relief options - There are various pain management options. Ideally, patients can seek information about these prior to the onset of labour so they can make informed decisions about labour analgesia. Multiple nonpharmacologic, pharmacologic, and anaesthetic options (painless labour) are available to help manage pain. The choice depends on patient values and preferences unless the method has medical contraindications.

Monitoring in Labour

  1. Maternal vital signs - pulse, BP, temperature, respiratory rate
  2. Uterine contractions - frequency and duration of labour pains
  3. Digital examination - per vaginum examination is performed by a doctor at regular intervals and whenever required to assess the cervical changes and progress of labour.
  4. FHR monitoring – can be intermittent or continuous. Usually, continuous EFM (electronic fetal heart monitoring) is performed.

Induction of labour-In some cases, doctors will decide to "induce" labour. This sometimes involves first giving you medicine to soften your cervix. Medicine is usually needed to start contractions. This medicine is given by oral, vaginal route or into your vein (by "IV").

Immediate Neonatal Care

After birth, the paediatrician will do a quick examination to check your baby's body and general health. Part of this exam is known as "Apgar test." It checks baby's heart rate, breathing, movement, muscles & skin colour. Babies will get Apgar tests at 1 min and 5 min after birth.

Soon after birth, you can hold your baby and can even breastfeed them, if you choose to breastfeed. Your baby will then have a detailed check-up and receive a dose of Vitamin K soon after birth.

Before your baby leaves the hospital, they will have a:

  • Detailed physical exam
  • Blood test for various congenital serious diseases. This test is done with a heel prick.
  • Hearing test
  • Vaccination at birth and guidance about future vaccination.

Postnatal Warning Signs

After you leave the hospital, you are counselled to call or visit the hospital emergency if you:

  • Have heavy bleeding from the vagina – It is normal to have some vaginal bleeding for a few weeks after giving birth. But let your doctor or nurse know if you have large blood clots or if your bleeding increases.
  • Feel dizzy or faint
  • Have a fever
  • Vomit
  • Have new belly pain
  • Have a severe headache or problems with your vision
  • Feel sad or helpless or hopeless

Every delivery and every experience are as unique as the mother and the baby themsleves. A brief knowledge about the journey helps you anticipate and plan things. Happy Birthing Moms!!!

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