For a vaginal delivery, you can expect labour from around 38 weeks onward and you are advised to be prepared to go to hospital at any time. You may already have pre-booked your bed prior to arriving at the hospital. Depending on how strong your contractions are, you may first need to report to reception and be ‘booked-in’ or, if you are in strong labour, you may need to proceed directly to the labour unit while your partner assists with the admission.
Once your pregnancy reaches term – this is between 38 to 41 weeks of gestation – your baby is ready to be born. He or she is now fully developed and ready to make an entrance. The foetus has special haemoglobin that carries extra oxygen, a much faster heart rate than mommy and is intended to assist the baby to cope with labour.
The baby’s head moves deep into your pelvis as your due date approaches. Your body has been adapting for this moment and the foetus is ready to commence labour. How will you know your labour has started? The entrance to the uterus – the cervix – undergoes a gradual process of thinning and opening, during which a mucus plug is released. The plug will resemble bloody mucous, and is also referred to as a show.
The uterus will begin to expel the baby and you will initially experience irregular contractions, which will gradually become stronger and more frequent as time passes. The membranous sac (known as the amniotic sac) around the baby may burst and your waters (amniotic fluid) will start to drain. This could be either a big gush or a constant trickle.
There are 3 stages of labour – first, second and third stage.
The first stage is further divided into latent and active stages.
First stage: Latent stage
• Cervix has begun to dilate from 0–4cm
• This is the longest stage and can persist for 12–19 hours
• Contractions last approximately 30 seconds and can happen every 5–20 minutes. As time progresses, the contractions will become stronger and more frequent First stage: Active stage
• Cervix dilates at approximately 1cm per hour
• Dilatation ranges from 5cm–8cm
• Contractions last up to 60 seconds and come every 3–4 minutes. The top of the uterus pushes the baby downwards, while the lower half is thinning and opening to allow for passage of the baby’s head The final part of the active phase is the transition:
• Dilatation ranges from 8–10 cm – the cervix is now thin and completely dilated, and the head has passed through the cervix to the birth canal
• Contractions last between 40–60 seconds and occur every 2 minutes
• Eventually, you will experience an urge to push which will signal that the baby is moving deep into the birth canal and is ready to be expelled
• You are now fully dilated and the doctor will instruct you when to push
Pushing to birth:
• Contractions last up to 60 seconds and occur every 2 minutes
• The entire process can last up to 1 hour
Baby’s skull: Your baby’s head has been formed so that it is flexible to pass through the birth canal – the head must be the right size, in the right position and flexible to pass down into the pelvis, under the pubic bone and out of the vagina.
Your baby’s skull bones are like puzzle pieces that fit together but are not joined yet. This allows the head to mould itself to your pelvic shape. This moulding is a protective mechanism that prevents the brain from being compressed by overlapping of the skull bones. Additionally, in the first few of years of life, your baby’s head grows at a tremendous rate – up to 40% – and the soft, pliable skull bones allow for this growth.
It is also important for the baby’s head to be in the right position with the head down and tucked in. In the following diagram, you will see that if the head is not tucked in correctly, the diameter to pass through the pelvis is bigger and might require an assisted delivery with either forceps or a vacuum (soft cup on baby’s head) to manoeuvre the head slightly to allow delivery.
Your doctor will explain this if necessary. Fontanelles are soft spots on top of the baby’s head where bones have not fused yet. Once the baby is born, the two fontanelles or ‘soft spots’ – one large spot on the top of the head called an anterior fontanelle, and one small spot at the back called the posterior fontanelle – will close gradually over the first year of life.
Conclusion: Birth can and should be an amazing experience. If properly managed, you will be filled with newfound strength and confidence, which will prepare you for the journey you are about to embark on as a mother.
