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The Four Stages of Labour

by Maxine
Posted August 25 2010 02:31pm
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There are four stages of labour and here's where you'll find a step-by-step explanation of the labour experience.

STAGE 1:

  1. Starts with contractions or membranes rupturing
  2. Ends with cervix fully effaced (thinned) and dilated (open) Cervix must open to 10 cm to allow baby to pass out of uterus
  3. Longest stage 2 – 24 hours with an average of 12.5 hours (first time moms)

 

3 Phases: Early, Active & Transition:

 

Stage 1 – Early Phase

Frequency of contractions: every 5 – 20 minutes

Duration (length) of contractions: from 30 – 60 seconds

Dilation (opening) of Cervix: up to 3 cm.

  • You may not recognize that you are in labour in the early phase as contractions may feel like a backache that comes and goes with a pattern, menstrual-like cramps or aches in the groin that come and go with a pattern.
  • Typically, contractions are manageable in this early phase
  • Cervix can only be checked by hospital staff - your nurse, midwife or doctor - by inserting gloved fingers into your vagina and feeling the opening of the cervix.

Stage 1 – Active Phase

Frequency of contractions: every 3 – 5 minutes
Duration (length) of contractions: from 50 – 75 seconds
Dilation (opening) of Cervix: goes from 4 to 7 cm

  • Contractions become longer, stronger and you may find it harder to cope with them.
  • Membranes probably rupture some time during this phase
  • You are usually admitted to hospital/birthing centre during this phase 
  • Pain relief measures, such as narcotic medication, epidurals or nitrous oxide gas may be offered if mom needs once she is in hospital.
  • Lasts approximately 3 – 6 hrs

Stage 1 – Transition - The SHORTEST phase

Lasts 1 – 1 ½ hrs.

Frequency of contractions: every 1 ½ - 2 minutes

Duration of contractions: from 60 – 90 seconds with multiple peaks.

Dilation (opening) of Cervix: goes from 7 to 10 cm.

  • The shortest – and the toughest phase!
  • Often it feels like there is no break between contractions
  • You may be flushed, but have cold hands and feet
  • You may experience nausea and/or vomiting
  • You may lose your focus
  • You may do or say things that are out of character for you
  • You may not know what you want or what will help you

STAGE 2: DELIVERY of the BABY

Starts with full dilation (opening) of cervix

Ends with birth of baby

Lasts up to 2+ hrs.

3 phases: Early, Active & Perineal:

Early Phase - Latent or Resting Phase
From complete dilation to urge to push: about10 – 30 minutes

Frequency (how often) of contractions: every 2 – 5 minutes

Duration (length) of contractions: from 60 – 90 seconds.

  • There may be a lull in the strength of the contractions.
  • Baby’s station refers to the measurement of how far into the pelvis your baby has moved:  Negative numbers would mean that baby head has not entered the bony pelvis the area above your pelvic bone, while positive numbers mean baby’s head is moving past the pubic bone.  In the early phase the measurement is 0 - 2+ Baby must descent to 4 + before they are born.

Stage 2 – Active

From to urge to push to crowning: time variable 

Frequency (how often) of contractions: every 2 – 5 minutes

Duration (length) of contractions: from 60 – 90 seconds

Active pushing with each contraction

  • Strength of contractions resumes
  • With each push more of the baby’s head is visible at the opening of the birth canal. When the contraction is over, the baby slips back a bit until the next contraction pushes them further
  • Baby’s station is +2 to +4 (crowning)

Stage 2 – Perineal

From crowning to birth: about 5 – 15 minutes

Frequency (how often) of contractions: every 2 – 5 minutes

Duration (length) of contractions: from 60 – 90 seconds

Active pushing with each contraction

  • Your perineum bulges and the skin stretches as you push.
  • This causes a stinging or burning sensation – often called the ‘Rim of Fire’. This does not last long, seconds only.

STAGE 3: DELIVERY of the PLACENTA

Starts with birth of baby and ends with delivery of placenta.

After baby is born, the uterus contracts and the placenta begins to separate.You may need to push to help deliver the placenta.

Duration: from 10 – 20 minutes.

If there is a tear or episiotomy, it will be sutured (stitched) once the placenta is delivered.

  • Placing baby on your abdomen, skin-to-skin, helps your body to release oxytocin (a natural hormone), which causes the uterus to contract. This helps to minimize bleeding. The skin-to-skin contact also has benefits for baby as it helps to keep them warm and helps their vital signs (breathing, heart rate, and temperature) to stabilize after delivery.
  • You will receive an injection of medication to help your uterus contract and prevent possible post birth haemorrhage
  • The nurse or midwife may also massage your uterus to keep it firm and contracted.

STAGE 4: RECOVERY

From the end of Stage 3 to approximately 2 hours

  • Comfort and monitoring for you
  • The nurse will check your breathing, heart rate, blood pressure, temperature and bleeding from time to time
  • The nurse will clean your perineum, apply a sanitary pad and an ice pack to reduce swelling
  • You may need a clean gown and a warm blanket. You may want something to drink and eat – ask the staff before eating or drinking anything.
  • Relax 
  • Bond with your baby
  • Skin-to-skin contact with your baby encourages breastfeeding during this stage. 
  • This is a special time for all of you to be together as a family, for the first time.

Find out more about the benefits of keeping your baby with you with this informative video.

 


Video Alert!
Learn more about labour and delivery with these informative videos.
Everyday Miracles: A Celebration of Birth Healthy Birth Your Way - Intro to Safe & Healthy Birth Keep Your Baby With Your After Birth

 

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Baseline Measurements

by Guest
Posted August 25 2010 04:19pm
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Your team of healthcare providers may encourage both you and your partner to be in the recovery room. This allows you both to be involved as the medical staff gather the baseline data. You’ll see exactly what is being done, plus you can be there to soothe your baby, if need be.

A nurse will record baseline measurements of your baby’s weight, height and head size. This helps assess the progress of your newborn, as well as determine growth patterns. Hospital staff is usually willing to delay this procedure for a few hours after birth, so you both have the chance to bond with your new baby.

 

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Coping with Labour

by Maxine
Posted August 25 2010 02:34pm
Filed under:

On this page you will find strategies that may help you cope while going through labour and delivery. The information has been split up with ideas both for the mother-to-be and the father (or partner). Read this alongside The Four Stages of Labour to understand the different stages and how to make them more comfortable for both of you.

What Should We Do in the Early Phase?

Mom:

  • Have light, easily-digested snacks for energy – you won’t be fed in the hospital.
  • Drink fluids: water, juices, popsicles etc.
  • Take a walk – it helps with comfort; it helps labour progress; it’s a diversion.
  • Other comfort measures, such as shower, massage, rocking, paced breathing
  • Finish packing, make phone calls etc.
  • If labour begins during the night, and you are comfortable, try to sleep or at least rest – there’s a lot ahead!

Dad:

  • Dad, stay close by.
  • Take Mom for a walk, if she wants.
  • Encourage changing positions.
  • Play a game with her, watch TV together.
  • Use comfort  and coping measures, such as touch, massage, support, reassurance, paced breathing
  • Use a cool or warm cloth – ask her preference – on Mom’s face and forehead.
  • Offer Mom easily-digested food and drinks, ice chips or mouthwash.
  • Put lip balm on her lips.
  • Help Mom take a shower or a bath.
  • Remind Mom to pee often.
  • Time her contractions.

What Should We Do in the Active Phase?

Mom:   

  • Changing positions can help with comfort and with labour progression.
  • Try to stay in a new position for at least two contractions, to give yourself time to adjust. If you’re still uncomfortable, change positions again.
  • Use positions that allow gravity to help the baby descend. e.g.: Lying flat on your back is NOT a good idea because it decreases the blood supply to your baby and it also creates ‘uphill’ work for labour, instead of allowing gravity to help.
  • Squatting or sitting on a toilet can open the pelvic outlet as much as 2 cm. This can make a big difference!
  • Empty your bladder – pee often.
  • Sip fluids.
  • Massage; heat; cold;
  • Start your paced breathing - whichever level feels comfortable.
  • Rest between contractions.
  • Take a bath or a shower –If your membranes have ruptured only showers would be allowed to prevent any possible risk of infection.  Use of water has been linked to decreased pain and increased coping with pain. Stay in water only up to one hour. The positive effects last up to 2 hours, then you can go back in water. Water shouldn’t be > 39°C.

Remember: The baby will come out!  

Dad:

  • Continue to be supportive. Stay close and be responsive.
  • Encourage her – "You’re doing such a great job with this contraction."
  • Massage.
  • Help Mom to change position.
  • Help her to take a shower or bath.
  • Coach her paced breathing.
  • Offer sips of fluids, ice chips.
  • Remind Mom to empty her bladder.
  • Provide warm or cold packs (ask her preference).
  • DON’T criticize or question – "You just said you didn’t want ice"
  • DON’T personalize anything Mom says or does. She may act differently or be irritable. This is normal.
  • DO stretch tired muscles and rest when you can.
  • DO eat when you can.

 


Video Alert!
Learn more about coping with labour by watching these videos.
Walk Move & Change Position Have Continuous Support Everyday Miracles: A Celebration of Birth

 

What Should We Do in Transition?

Mom:   

  • Do what is most comfortable with regard to positions and paced breathing.
  • Try to focus on one contraction at a time.
  • Try to rest in between contractions, if you can.
  • Urge to push. Two ‘schools of thought’ around pushing when you get the urge to push:
      • 1. Listen to your body and start to push with guidance from and your caregivers.
      • 2. Pushing before you’re fully dilated may slow labour by causing swelling of the cervix. Pant, or pant-pant-blow to stall pushing.
  • Urge to push sometimes is absent. Your care providers will provide good coaching as to when it’s time to push.

 

Dad:

 

  • Mom will need your help to focus in order to get through this tough stage. This may mean having her look right into your face.Mom may not feel like talking so use her cues for comfort and coping needs.
  • Encourage her.
  • Provide socks and blankets for warmth, if she’s cold.
  • Remind her re paced breathing and do it with her – i.e. pant-blow.
  • Advocate for her around issues that arise.

What Should We Do in Second Stage?

Mom:  

  • Tell caregiver when you have urge to push

Effective Pushing:

  • Ensures maximum amount of oxygen for you and your baby.
  • Allows the tissues of your perineum to gradually stretch.
  • Bend your elbows and grip your legs or the squatting bar with your hands. 
  • Ease your chin towards your chest and open your mouth slightly.
  • Relax your pelvic muscles.
  • Unless there’s a reason to quickly birth the baby, bring the baby down with 3 -5 short pushes per contraction:
    • Gives your tissues a chance to stretch gradually, in order to avoid or minimize tearing.
    • Easier on the baby.
  • Avoid ‘purple pushing’ – avoid holding your breath longer than five seconds.
  • Grunting can be effective as it helps to push the diaphragm against the top of the uterus.– Screaming is not (interferes with pushing).
  • Rest/relax between contractions.

 


Video Alert!
Get upright and follow your urges to push. This can help the delivery progress and may result in a faster birth.
Watch this video to learn more


 

Dad

  • Mom may need your help to position herself for pushing. 
  • Support Mom
  • Encouragement and feedback as to the progress - ‘Her head is almost out!’
  • Guide her with breathing and pushing.
  • Help to make her comfortable between contractions
  • Advocate where necessary – i.e. warm compresses and perineal massage to avoid/minimize tearing; avoiding  episiotomy.

 

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Vitamin K

by Guest
Posted August 25 2010 04:20pm
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Soon after birth, your baby will be given a needle with Vitamin K to prevent bleeding problems. This injection is necessary, as newborns are unable to produce vitamin K until 8 days after birth.

The procedure will be done 2 to 6 hours following birth. Although the intramuscular injection is the most effective, it is also invasive and can cause your baby pain.

Vitamin K can also be given to your baby by mouth. This approach is not generally recommended, because it is less effective in preventing your baby from extensive bleeding from cuts, incisions or disease.

Once this procedure is done, comfort your baby by allowing them to suck or nurse at the breast; these help your baby cope with the pain from this injection.

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