Waiting for those first contractions to start can be exciting, but you may also be feeling anxious or even scared. Read on to find out what to expect during childbirth.
If you’re in the third trimester of pregnancy, you’ll probably find that more and more of your daily thoughts turn to the process of childbirth. The prospect of labour can be exciting (after all, with each contraction, you’ll be one step closer to meeting your baby), but it’s also completely natural to feel anxious or even fearful, especially if this will be your first experience of it.
One thing that can help ease any feelings of anxiety surrounding childbirth is learning as much as you can about what the experience might be like, and what happens at each stage of labour.
‘When a woman is approaching birth, fear of the unknown is common, but it can easily be diminished with the right support and antenatal education,’ says Marie Louise, aka The Modern Midwife, expert for Biamother and author of The Modern Midwife’s Guide to Pregnancy, Birth and Beyond. ‘Knowing what to expect not only empowers women to make informed choices and trust their bodies, but it also makes the process of labour and birth less daunting. It is incredible what knowledge and understanding can do to your mental state.’
Preparing for labour
The unknown can be scary, so researching your options and making a birth plan are good ways to help you feel more knowledgeable and empowered.
‘Before you go into labour, it’s a good idea to have a birth plan,’ says Marie Louise. ‘The purpose of this plan is to help you understand your options and communicate your wishes. There is no situation in birth that your values and wishes are not valid. When you go into labour, you will need to know how to manage it, how to focus on your body and breathing, and most importantly how to stay calm. If you do not know what happens, what your options are or what is available to you, then you can either be interrupted by questions from healthcare professionals or quickly feel out of control.’
You can discuss your birth plan with your midwife. They will be able to help guide you if there’s anything you’re unsure of. Alternatively, apps such as Biamother offer birth plan features.
Things you might like to consider include where you’d like to give birth, pain relief options and what you’d like to happen immediately after the birth.
When it comes to creating a birth plan, remember to remain flexible and open-minded.
When it comes to creating a birth plan, remember to remain flexible and open-minded.
So how do you know when labour might be about to start? Pre-labour is the stage during which your body gets set for labour to begin, and it’s often accompanied by some subtle signs.
‘For many women, they will start to feel a bit uncomfortable, get lower back ache that is coupled with irregular tightening in their tummy, and/or loss of their mucus plug,’ reveals Marie Louise. ‘The mucus plug doesn’t look pretty, but it does a brilliant job of protecting the baby from infection traveling up into the uterus. When the cervix starts to soften and loosen, it has the opportunity to fall out, which is why this can happen at this time. Occasionally, women’s waters break during pre-labour. Some women also report a pre-labour clear out and get diarrhoea. Other women say that they feel different and know that something is starting to happen internally – especially when they have tuned into their body and practised yoga, meditation and self-care.’
The first stage of labour
Following pre-labour, you will enter the first stage of labour.
‘The first stage of labour refers to the time when you go into labour right up to feeling like you need to push, when you’re 10cm dilated,’ says Marie Louise. ‘In reality, no one really refers to the first stage of labour – we refer to “early labour” and “established labour”.’
‘Early labour is generally when your cervix has changed, opened or moved forward, but is less than 4 to 5cm dilated,’ explains Marie Louise. ‘Most women will have irregular contractions during this time. First time mamas may be in early labour for a day or two, while for others things can progress more quickly into established labour. The best thing a woman can do in early labour is relax and almost ignore it, unless there are complications, bleeding, reduced fetal movement or any other concerns. If all is well, going about your normal day, eating, drinking and getting some rest is a good idea. The contractions will start to increase in intensity, length and frequency, and as this happens the woman tends to be going into established or active labour.’
‘Established labour is when a woman is having regular contractions that are rhythmic and predictable – usually three contractions in 10 minutes and her cervix is 4cm dilated or more,’ says Marie Louise. ‘That is when a midwife needs to provide one-to-one care, so she can help to monitor both mum and baby.
The second stage of labour
Once your cervix is 10cm dilated, you have reached the second stage of labour – the stage during which your baby will be birthed.
According to the National Childbirth Trust (NCT), the second stage can be divided into a passive and active stage.
During the passive stage, it’s important to rest if you can. Contrary to what you may believe, it’s important not to start pushing immediately; doing so will leave you exhausted before the active stage begins.
You’ll know when the active stage begins because you’ll feel an uncontrollable urge to bear downwards with your contractions. The position you get into during this stage can be crucial in helping you birth your baby – upright positions can help to make this active stage shorter. These include:
- Resting over a birthing ball
As your baby’s head crowns, you’ll feel a stinging sensation. Now’s the time to stop pushing (taking small breaths can help to lessen the urge to push), to give your baby’s head time to emerge slowly, and also to help protect your perineum.
Once your baby’s head has emerged, a final contraction will help you birth the shoulders, after which your midwife will place your baby on your chest.
The third stage of labour
The third stage of labour refers to the delivery of the placenta.
‘There are two main options for delivering the placenta,’ says Lesley Gilchrist, registered midwife and founder of My Expert Midwife. ‘It can be birthed naturally – this is called a physiological third stage – or an injection can be given and, with help from the midwife, it is eased out by manipulating the umbilical cord attached to it. This is called a managed third stage.
‘If labour and birth have been straightforward, without any complications, then there is no reason not to expect the placenta to deliver naturally either. However, the surrounding environment should be kept warm and relaxed, with dimmed lights, as this encourages the body’s natural hormones to work better, which in turn enables the uterus to contract effectively and to expel the placenta more easily.
‘If labour is more complicated, has involved induction or an epidural, or there are other risk factors which may cause heavier bleeding, the midwife may advise a managed third stage. An injection is given to help contract the uterus and the placenta is delivered by a midwife or doctor by applying traction to the cord to ease it out.
‘However you choose to deliver the placenta, although it can feel a little uncomfortable, it generally comes out fairly smoothly and easily. Remember, it is soft tissue and smaller than the baby you have just birthed!’
What your midwife will do
While you are the only person who can physically birth your baby, you will not be alone during the process – your midwife will be there to support you, as will your birth partner if you have one.
‘A midwife is there to support you through labour and birth,’ says Gilchrist. ‘They are there to lend encouragement and emotional support, as well as monitor both you and your baby’s progress and wellbeing through labour.
‘Your midwife can provide you with pain relief, should you request it, and can also liaise with doctors for extra medical assistance, should you need this.
‘Immediately after childbirth, your midwife will be on hand to care for both you and your baby, as well as helping you to birth the placenta, have skin-to-skin contact and initiate breastfeeding.
‘The primary role of your birth partner is to give you not only help practically during labour, but to provide you with positive emotional support and to be your advocate during this time.’
Monitoring you and your baby during labour
Whether you have opted to give birth on a labour ward, at a midwife-led unit or at home, your midwife will monitor you to ensure everything is going smoothly.
‘If you and your baby are at low risk of complications during labour, then intermittent monitoring is offered, usually with a handheld doppler, listening to your baby’s heart rate every 15 minutes when you are in active labour and more frequently during the pushing stage,’ says Gilchrist. ‘If your midwife detects any abnormalities during this time, she may recommend transferring to continuous monitoring. This is a machine which constantly monitors your baby’s heart rate and is only available on labour wards/delivery suites. If you were at home or in a birth centre, you would need to transfer for this.
Your midwife will monitor you to ensure everything is going smoothly.
‘Being wired to a monitor can be restricting and make moving around in labour more challenging, but some hospitals offer machines that are wireless.
‘Your blood pressure and temperature are usually taken four hourly, to ensure you are coping well in labour. They will only be taken more frequently if a problem is detected.’
Childbirth pain relief options
There are many options available to you when it comes to pain management during labour, should you require support. According to Gilchrist, these include:
- Paracetamol and codeine
- Gas and air
- Opiate injections, such as methadone
- Regional anaesthesia, such as an epidural
‘For some women, using non-pharmacological methods will be enough, especially if they have good support from their birth partners, and have a comfortable and relaxed environment in which to labour,’ says Gilchrist. ‘For other women, pharmacological pain relief will be a better option for them, especially if they are having a more challenging or complicated labour, which is longer or more difficult and tiring.
‘Many women use a combination of both through their labour and, as labour and birth can be unpredictable, it’s better to know about everything that is available, to help you to choose at the time. All options for pain relief can be discussed with your midwife during pregnancy and during any antenatal classes taken. It is completely down to the woman to decide what she does or doesn’t want.’
What is an episiotomy?
You might have heard the term ‘episiotomy’ mentioned in relation to birth, but be unsure what it is.
‘An episiotomy is a carefully performed surgical incision in the muscle between the bottom of the vagina and the anus, performed by a doctor or midwife just before the baby is due to be born,’ explains Mr Ellis Downes, consultant obstetrician and gynaecologist at The Portland Hospital, part of HCA Healthcare UK. ‘Episiotomies are necessary if a midwife or doctor needs to make the opening of the vagina wider, allowing more room for baby to come out. This might be because the baby needs to be born quickly, or if there is a need to use a suction cup (ventouse) or obstetric forceps to help deliver the baby.’
Mr Downes says that other reasons for an episiotomy include:
- If the birth is breech, where your baby is being born with their feet or bottom first
- If the baby is experiencing foetal distress (the baby’s heart rate is abnormally slow or fast) and the doctor is keen to expedite delivery
- If certain stages of birth have lasted for a long period of time and an episiotomy will help the mother to have a normal delivery
‘Although having an episiotomy can sound scary, it can help prevent perineal tearing, which is not uncommon during birth and may be more difficult to stitch,’ says Mr Downes.
‘Episiotomies are associated with faster healing and lower rates of severe tears than episiotomies. ‘If your doctor or midwife feels they need to go ahead with an episiotomy, they will let you know prior to the procedure and local anaesthetic may be used before the procedure is performed. Generally, it’s good to chat about the need for an episiotomy before labour, and in early labour.’
What is an assisted vaginal delivery?
While Mr Downes says that the majority of births occur naturally, there are some instances where assistance may be needed, for example if the mother is exhausted or if the baby is showing signs of distress.
While the majority of births occur naturally, there are some instances where assistance may be needed.
‘Generally, a suction cap called a ventouse or kiwi cap is used,’ explains Mr Downes. ‘These apply gentle suction to the baby’s head, allowing the obstetrician to gently pull the baby and assist the mother’s pushing to help deliver the baby. Sometimes obstetric forceps, metal instruments designed to gently shape around the baby’s head, are applied. The doctor can then apply gently traction to aid delivery. Ventouse caps and forceps are only used when necessary and are entirely safe for mum and baby.
‘Approximately one in every five vaginal births require the use of forceps or ventouse. It is more common for those who are giving birth for the first time.’
Emergency caesarean: what to expect
While the majority of caesarean sections (c-sections) are planned in advance, there are sometimes circumstances where a vaginal birth is planned but a c-section becomes necessary instead.
‘Although these are called “emergency” caesarean sections, this simply means that they are not planned or scheduled,’ says Mr Downes.
Mr Downes says that some of the most common reasons for needing an emergency c-section include:
- Concern about baby’s position during childbirth
- Concern about baby’s well-being
- A health condition: very occasionally if a health condition arises during birth, an emergency c-section might be necessary to reduce the risk to mum and baby
‘Emergency c-sections go ahead as soon as possible once the decision has been made, generally within 30 to 60 minutes,’ says Mr Downes. ‘Generally, it is possible for your birthing partner to be there as well.’