Stages of childbirth
Video source: HUS
Every childbirth will progress at its own pace, but mothers often become worried if the dilation stage is taking long and the delivery is therefore delayed. It is good to know that plenty of other things are taking place in your body besides the dilation, and the delivery may be progressing well even if the midwife tells you that your dilation is slow. That is why you should also ask about the other signs of progress. These include your cervix turning forward and becoming softer and shorter, and your baby turning and settling lower in your pelvis.
Childbirth does not always progress in a linear way. First, it may take hours for the cervix to dilate one centimetre, but later it can dilate several centimetres in a single hour.
The dilation stage takes 8 to 15 hours on average with first-time mothers, but there can be vast individual differences. During the dilation stage, the contractions grow more forceful and spread over from the lower abdomen and lower back to the whole abdomen and back. You can also feel contractions in your thighs and legs. The purpose of the contractions is to push the child downwards in the birth canal, shorten the cervical canal and finally dilate the cervix to 10 centimetres in diameter. It is easier to tolerate the contractions if you are able to keep in mind that they are helping your baby; they happen for a good reason. Before the actual dilation stage, you might experience regular contractions for a few days, after which they can stop again. This is why you should calmly wait at home until your contractions are coming at regular and frequent intervals.
During the dilation stage, it is important to relax so that the contractions can work on the dilation, and the myometrium and the baby are able to get enough oxygen and nutrients. You should practise relaxation methods in advance, so that releasing muscle tension during contractions will be as easy as possible.
The following methods can help you relax and manage the pain:
- moving around, such as sitting on an exercise ball or rocking chair, swaying and walking around
- water; showering or bathing
- massage; strong or gentle touches, depending on your wishes
- reflexology, acupressure or yoga
- a warm bag of oats or gel.
During the dilation stage, the mother can move around, rest, sing and make noises if she wants. The midwife will monitor the situation and help choose the best possible position and pain management for the dilation stage. Often another person will best be able to help you relax and offer you support. A familiar face will also create a safe environment in the delivery room. If none of your loved ones can be present at the birth, the midwives will attempt to stay in the room with you as much as possible. In addition, maternity hospital students are available for company. Very few mothers want to be completely alone during the dilation stage, but that is possible too, if the mother prefers.
In addition to relaxation, movement, warmth and safety, the following methods could be used as pain management:
- Sterile water injections for back pain, just beneath the skin, which work similar to acupuncture.
- Pain medicine injected into the muscle to relieve the pain during early labour.
- Laughing gas, i.e. nitrous oxide, which is inhaled from a mask. As soon as you feel a contraction coming on, you place the mask tightly over your face and breathe the gas in calmly. When the contraction starts to pass, you remove the mask. Laughing gas is a strong gas that helps to dull the pain.
- An epidural or spinal anaesthesia, which an anaesthetist will administer when your labour is already well underway. The pain will usually fade quickly. Anaesthesia enables resting, even sleeping.
- Paracervical anaesthesia, which will usually help during the dilation stage. An injection is administered on both sides of the cervix.
- Pudendal anesthesia, which is injected in the cervix and perineum area to help with the pushing stage.
Anaesthesia may involve certain risks, such as a decrease in the mother’s blood pressure, delayed birth, baby’s oxygen deficiency, increased need to use a suction cup, increased risk of ruptures and delayed production of breastmilk. This is why the mother’s blood pressure and contractions are monitored and the baby’s heartbeat measured before and after administering the anaesthetic. However, you should know that nothing that would endanger you or your baby will ever be done during childbirth.
If the mother feels well, the baby will be well too, and the delivery will progress accordingly. During the various stages of childbirth, the mother and especially the myometrium and the baby will need oxygen. Relaxing the muscles will enable oxygen to reach them. Breathing freely is important throughout childbirth. A few deep breaths during a strong contraction will help to dull the pain. The midwife may instruct you to pant, if you need to push but your cervix is not yet sufficiently dilated.
During the pushing stage, the mother will push, guided by her body. If necessary, the midwife will guide her to breathe and push downwards. During the pushing stage, the mother is free to try out different positions. Possible positions include sitting on a stool, staying on all fours, leaning forwards, standing with the help of a support person, lying on one side or half-sitting on the bed. The pushing direction is similar to sitting on the toilet; downwards but not towards the anus. The pushing stage of a first-time mother usually lasts from 30 minutes to one hour, but this too varies widely.
The pushing stage differs from the dilation stage, as the mother is now more active and is receiving a boost from adrenaline. The mother’s position will matter during this stage, as well: the best way for the baby to have enough room to be born is when the mother finds the most suitable position for her to push in. If you are lying on your back, your pelvis cannot be as flexible as necessary, which is why this position is not recommended unless absolutely necessary. Ask your midwife for instructions on finding a suitable position. Normally, there is enough time to test out several.
During the pushing stage, it is important that you keep your pelvis relaxed when pushing. This will help you avoid ruptures, as your pushing will not be as strenuous, and the pushing stage will probably be shorter. Relaxing when pushing is difficult, because it is like having to use the toilet without the privacy provided by a toilet cubicle. It is good to be aware of this and aim to relax the pelvic floor and perineum area despite this. You can practise relaxing these areas with tensing exercises: first clench your pelvic floor muscles, as if you were holding in urine, and then let your pelvis relax completely. It is easiest to start training while lying down. Practise this in advance and ask for help from a physiotherapist or a prenatal class instructor, if necessary.
The facial muscles and pelvic floor muscles have a nervous connection, which will greatly help a woman during her pushing stage: the pelvic floor tends to relax when the face and lips relax. Therefore, you should try to keep your face and, in particular, your jaw relaxed. Blowing raspberries, making noises or keeping your mouth slightly ajar will help.
Finally, your child will be born and lifted to your bare chest. Babies are often covered in white, waxy vernix caseosa that protects their skin. This is the first time that the new parents are able to caress and admire their new family member outside the womb. The staff will examine the baby together with the parents while the newborn lays on the mother’s stomach. The baby’s heartbeat and respiration are checked. The newborn’s skin tone, flexibility and irritability are assessed. They are also given an identification cuff. After this, the birth partner or support person can cut the umbilical cord. A blood sample is taken from the umbilical cord in order to check for hypothyroidism, and arterial blood gas is measured to assess the oxygen level.
If the mother is Rh negative, the child’s blood group is also tested from the sample. The baby is given a shot of vitamin K in order to prevent haemorrhaging, either at this stage or later during the measurements. The baby is covered with a blanket and left naked on the mother’s chest so that they can listen to the familiar heartbeat and breathing sounds. This also helps to keep the baby suitably warm. The skin contact facilitates breastfeeding and makes it easier for the baby and the parents to get to know each other.
While the parents get to know their new baby, the third stage of childbirth begins. If necessary, the mother is given medication that will contract her uterus, and she will then deliver the placenta, membranes and the umbilical cord. Possible perineal tears or surgical wounds are stitched. The child will be introduced to the mother’s breast when they are ready, usually within the first hour. The baby will start to reach for the breast on their own. This reflex is activated through skin contact. The baby shares contact with the mother and will start looking for a nipple. The mother can help the baby to latch on to her breast properly. The first sucking motions may feel surprisingly powerful; the baby has been practising in the womb. The mother will now produce first milk, so-called colostrum, which contains antibodies and nutrients necessary for the newborn. The quantity of milk will not be large, but will be sufficient for a newborn.
A healthy newborn will usually not require additional milk at the hospital. If the child is frequently breastfed, lactation will begin in two to three days after the birth. After the first nursing session, the baby is washed, measured and weighed. The midwife will guide and help the mother’s partner and may take photos, if necessary. The mother is allowed to shower. After this, the adults are offered something to eat before being taken to the ward. Normally, only one midwife takes part in the delivery, assisted by another during the final stage. A gynaecologist is only asked to take part when necessary, and an anaesthetist to give the injections. If there are any concerns about the baby’s condition, a paediatrician will also be called in.
Abnormal birth refers to a birth in which a suction cup or obstetric forceps, nowadays rare, are used as aid. Such equipment is used if a labour becomes exceedingly long, the mother has no energy left or the baby’s condition so requires. A birth is also considered abnormal if there is over 500 ml of bleeding or the delivery of the placenta needs to be aided manually in an operating theatre. A caesarean section can be performed as pre-planned, urgent or an emergency C-section. Reasons for urgent or emergency C-sections include a rapid deterioration in the condition of the mother, baby or both. The birth partner will usually be able to see and care for the baby right away.
The best place for the baby after birth is to be held in skin contact. During the hospital stay, the baby will remain close to the parents. This enables the vital closeness and frequent breastfeeding for the baby. The closeness will also help the new parents to get to know their baby. The maternity ward staff is there for the entire family. Do not hesitate to ask them questions and request help so that you and your baby can start your new life together at home feeling safe. You should call your maternity clinic once your family has settled back in home with the baby, at the latest, so that a nurse can book a home visit as soon as possible.