Written By : Dr Gunasegaran Rajan, Consultant Gynaecologist & Past President OGSM
MBBS (malaya) MRCOG (UK) FRCOG (UK) FAMM (Mal)
Damansara Specialist Hospital
When am I in labour?
You are in labour when you experience regular contractions accompanied by cervical changes. Cervical changes is when the cervix (the lower end of the uterus) becomes softer, thinner and begins to open (dilate). The contractions may not be painful but, more importantly, they are more regular, coming every five to 10 minutes apart.
How many stages are there?
There are three stages
[P1] of labour.
What does each stage mean?
The first stage is when the cervix opens from zero to 10cm dilatation, which is also known as full dilatation. The second stage is from full dilatation to the birth of the baby. The third stage is the period between the birth of the baby to the complete removal of the placenta.
How long does each stage last?
The first stage can last between eight to 12 hours on average. It is not uncommon for this duration to be shorter or longer depending on individual.
The second stage lasts about one hour in a primigravid mum (first childbirth) and 30 minutes in multigravid mums (subsequent childbirths). It is common for the second stage to be allowed to last longer than this by the doctors after a good assessment.
Typically, the third stage lasts from five to 20 minutes. To wait longer for the third stage can increase the risks of retained placenta and bleeding, and hence the doctor should assess the situation.
What happens during first stage?
The contractions become closer and stronger and the cervix begins to change. This is the time to slowly make your way to the hospital. There is no rush, but you should try to get there in about two hours to at least be assessed. During this stage you can walk about, change positions in bed, consume plenty of fluids and some light snacks. You should empty your bladder regularly, have a shower or just get some sleep. Rest is important, too, to conserve energy for the later stages. You can perform your relaxation exercises or breathing techniques, listen to music or watch movies to distract yourself. Your partner can massage your back. You and the baby will be monitored by the midwives regularly. The water bag may burst spontaneously or, sometimes, the doctors break it to check on the colour of the fluid to determine fetal wellbeing. You may also request for pain relief at this stage.
What happens during second stage?
This is when the baby is very low in the pelvis and you have the urge to bear down. You will be positioned with the head elevated, with lots of pillows to support the back. The bed incline helps as gravity helps in pushing. Your legs are not necessarily in the stirrups. Initially there may not be pelvic urge or pressure. Once you feel the urge and strong pressure in the anal area, you will also have the natural urge to push. The doctor will coach you to push and in between the pushes you can take sips of water, relax and breathe deeply. You would need some Entonox if you are not already on other painkillers, as contractions can be intense.
What happens during third stage?
You will still feel some contractions which are milder as the uterus contracts and expels the placenta. Sometimes you will be asked to push as well as to expel the placenta. You may feel palpitations and some light headedness, and this is normal. The injection (oxytocin injection) given to you can also give you this symptoms. You will continue to be monitored and repositioned to lie almost flat.
What is a latent stage?
It is the initial part of the first stage of labour where there are contractions but no significant dilatation of the cervix. This can sometimes last for a day or so.
Which stage is the most risky?
For a healthy pregnancy with good antenatal outcome, there is a low risk of any complication. However, the second stage is probably the most likely to be risky with poor descent of the head, cord complications, fetal distress and need for instrumental delivery.
The third stage can occasionally cause heavy uncontrolled bleeding.
At which stage does one opt for a ceasarean section?
The labour can result in an emergency caesarean section at any time during the first or second stage. It commonly happens when there is fetal distress or poor dilatation of the cervix. During second stage, caesarean section can happen if the instrumental delivery attempt fails.
Do the stages differ with age and pregnancy?
Multigravid women tend to have shorter stages of labour. Mature women, on the other hand, are sometimes slower in their stages due to the inefficiency of the uterine contractions.
Do the stages differ with breech delivery?
No, they don’t, and the stages are the same. Generally, nowadays, most breeches are delivered by caesarean section.
At which stage is the monitoring important?
Monitoring is important at all stages especially so in the later part of the first and second stages.
At which stage is the doctor involved?
The doctor is in charge overall, and the routine monitoring and care is provided by the midwives. The doctor is called if there are any problems at any stage and will be present during the second stage.
At which stage does one require painkillers?
Pain relief is very individual and few women can go through labour without any. The painful contractions usually get more intense in the later part of the first stage, which is when you can request for pain relief.