the show: this is the release of the mucus plug, or operculum, which seals the opening of the cervix. In some women it comes away as a single blob of pinkish jelly; in others it is a series of smaller pieces, and in others it can be reddish brown. It is a sign that the cervix is beginning to stretch and soften a little, in preparation for labour. It can be several days between the show and the start of labour proper, or just an hour or so, or anything in between;
rupture of the membranes or 'breaking of the waters': the membranes are also known as the bag of waters, or amniotic sac, which is the fluid surrounding the baby inside the uterus. When the membranes rupture, the amniotic fluid, also known as liquor (pronounced 'ly-kwor'), escape. It can happen as a sudden gush of liquid down your legs. More usually, though, it will start to trickle. Telephone your doctor, midwife or the hospital if your waters break;
contractions: these are only a sure sign of labour if they come closer together over a period of an hour or two, and last longer than 40 seconds. You should feel them getting stronger and longer, too.
First stage:
at the start of the first stage, you may be getting one contraction of 40 or 50 seconds every 10 minutes. At the end, each contraction will last longer than a minute, and there will be a gap of no more than a minute between each one. There are variations to this, however; not every mother follows the same pattern.
Each contraction helps the uterus push the baby out, and at the same time the cervix gradually opens up and becomes thinner. By the end of first stage, the cervix is fully open, and it's completely taken up by the uterus. This is described as being 10 centimetres dilated or fully dilated, ready for the birth of the baby.
At the beginning, labour often progresses quite slowly. When you are five to six centimetres dilated, contractions are longer and stronger and labour begins to progress more quickly.
Second stage:
begins when the cervix is fully dilated, and ends with the birth of the baby.
You will probably feel a very powerful need to push downwards. It's called 'bearing down'. You can often feel when it's right for you to do so, without anyone telling you but your midwife can help guide you if you feel it is necessary. You will probably feel the need to push about three times in each contraction. You may feel you need to hold your breath to bear down; don't hold it too long.
Some women don't feel the urge to bear down, and in some labours it isn't necessary — the baby is born without any effort. If you have an epidural you may not feel the urges to push, or not as strongly. The midwife will tell you when you should bear down.
As the head stretches the birth canal and the perineum (the skin between the birth canal and the anus), you may feel a powerful, burning sensation. It only lasts a short time. When the head becomes completely visible at the vulva, it is said to be 'crowning'.
With the next contraction or two, your baby's head emerges, and then your baby's body is born.
Third stage:
the delivery of the placenta and the membranes begins just a few minutes after your baby's birth. For most women, the third stage passes totally uneventfully. You might hardly be aware of it happening.
In many hospitals, the third stage is 'actively managed'. This means some actions are taken routinely to speed up the progress of this stage of labour.
The first action taken is to give you an injection of syntometrine or syntocinon, a form of synthetic oxytocin, which stimulates the uterus to contract. This injection is given when your baby's being born, usually when the first shoulder is emerging. The injection goes into your thigh or your buttock. The midwife should ask you for your consent before she does it.
The second action happens when your baby is born. The umbilical cord is clamped, and cut. It's usual to ensure the baby is breathing well, as this indicates the baby's oxygen supply is no longer dependent on the placenta. The cord may be cut, or left intact until it stops pulsating or until after the delivery of the placenta, if you have not had syntocinon or syntometrine.
The injection you had just a couple of minutes ago now takes effect. It stimulates the uterus into contracting very strongly, becoming smaller and harder and tighter. This results in the placenta peeling itself off the inner wall of the uterus. The expulsive force of the contraction may make you want to push again, and you may be able to push the placenta out. More usually, the doctor or midwife then carries out a third action, and helps the delivery of the placenta by a manoeuvre called controlled cord traction. They put one hand on the abdomen to protect the uterus, while the cord is kept taut with the other.
At the same time as the placenta comes away, the blood vessels which were 'holding on' to the placenta close off as your uterus contracts, and this prevents bleeding (though it's normal to bleed a little). You may feel the placenta slide down and out between your legs, followed by the membranes.
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