It’s the Time to Labour! Or is it?

Is it time to labour or is it yet another false alarm? Should you head over to the hospital or wait at home until a more pressing signal alarms you? These are only a few of the many doubts that surface on the anvil of delivering your baby

Labour is defined as the series of continuous, progressive contractions of the uterus that set off the process of birthing the baby. Ideally, one is expected to go into labour after the 37th week of pregnancy. As the due date approaches, mothers-to-be are fraught with an unsettling apprehension – is it time yet?

Certainly, the mixed signals don’t make it any easier. By mixed signals, we are referring to the occurrence of false labour pain. Also known as Braxton Hicks Contractions, this pain is described as a ‘tightening’ in the abdomen that does not cause dilation. In other words, during false labour, the pain does not increase in duration, intensity, and frequency, and is generally irregular. How then, does one identify when true labour occurs?

True labour, as the definition suggests, is marked by progressive and continuous contractions. This implies that the contractions will occur at regular intervals, increasing in both frequency and intensity. With contractions getting closer together, you will know that it is labour for sure. The contractions are coupled with cervical changes, that is, dilation, and the passage of show, which is basically the discharge of mucus with some amounts of blood.
However, it is completely alright if you are confused. Just pay close attention to how far apart the contractions occur. If that is stressing you out, stop worrying over it and head right to the hospital, even if that means going back home because it is not yet time to deliver the baby. It will not be a trip wasted, for it will make you feel at ease, reassuring you that your doctor has always got your back.

While that is sorted, it is important to note that labour progresses in three stages. The first stage begins with the onset of true labour and culminates in the full dilation of the cervix. This stage is further divided into the latent stage and the active stage. During the latent phase, the cervix dilates upto 4 centimetres. This is known to be the longest phase of labour, lasting around 12-16 hours, with generally 12 hours for first time mothers (primies) and 6 hours for those who have previously delivered children.

At this phase, treat yourself to some soothing music, light some scented candles, and make sure that you are as comfortable as you can be. Surround yourself with people you trust, have your birthing buddy by your side, and keep yourself informed about the progress of that someone inside. Avoid consuming heavy food items. Rather, have a light serving of soup or crackers. Although this is the least intense stage of labour, make sure that you are close enough to make it to the hospital in case of any worries in a timely manner. The active phase of labour begins when the dilation exceeds 4 centimetres and extends upto the end of the first stage at 10 centimetres. Here, the contractions are likely to increase in frequency and intensity with 1-2 contractions every ten minutes. It is during this phase that you are likely to be admitted to the hospital. At the Gracias Maternity Hospital, patients are welcomed to the appealing aura of the pre-delivery room, a safe, comfortable space to lounge in before they are moved to the labour room when the second stage of labour begins.

Full dilation of the cervix sets off the second stage of labour, which lasts until the baby is delivered. Now in the sterile delivery room, the patient is cared for by a well-equipped medical army of sorts. A team of two experienced doctors, two hands-on nurses, and one paediatrician oversees and ensures a safe and successful birthing process. This stage is characterised by active pushing of the baby through the birth canal, ultimately culminating with the birth of your baby. Relatively shorter than the first stage, the second stage generally has a duration of thirty minutes to one hour.

After the baby is delivered, your body embarks on the third stage of labour. This time, you deliver the placenta. Yes! The organ that nourished your baby, all warm in the womb, has served its purpose, and now needs to pass. It would take around 30 minutes for this process to play out. The World Health Organisation (WHO) has prescribed a proactive approach to the active management of the third stage of labour (AMTSL). This strategy comprises a three-fold plan of action that includes oxytocin administration, uterine massage, and controlled cord traction. These three components of AMTSL are crucial to mitigate postpartum haemorrhage, a known killer that rides on maternal mortality. Instead of a passive approach, this active management technique involving the administration of oxytocin helps to contract the uterus, thereby preventing excessive blood loss. Uterine massage involves repetitive rubbing of the lower abdomen and gently massaging inwards to stimulate the uterus, enabling it to contract. The third major component of this approach involves clamping the baby’s cord, and pulling on the cord whilst simultaneously applying pressure to expel the placenta.

As the body prepares for post-partum the fourth stage of labour sets in; this stage is all about recovery – you have birthed a beautiful baby, and now it is time to breathe a sigh of relief, marvelling at the wonderful human you created. Two or three hours after birth of the baby, the uterus naturally contracts and expels any remaining materials, shrinking it gradually. This process is hastened by the miracle of breastfeeding, which prompts the generation of oxytocin, aiding in further contraction of the uterus. With the poignance of this phenomenon, one can say that the baby gives birth to the mother.

The question arises – how does one prepare to deal with labour? The answer is simple and clear – the preparation begins from the first time you meet your doctor. Make sure that you have got all your questions answered and all doubts clarified. Promptly attend the pre-natal classes. This will enable you to learn more about the journey that lies ahead, right from identifying the signs of true labour to giving yourself time to heal when it is all over. Bond with your birthing buddy and deliberate on your birthing plan. Weigh your options, make your choices – whether or not you want painless labour or who should be the immediate point of contact in case of priority decision making. While all these essentials factor in to ensure preparedness, don’t force yourself to control each and every aspect of this stage to a point that it overwhelms you. Remember, your doctor’s objective lies in your safety and that of your baby, so don’t shy away from relying on your doctor in any way. Ask as many questions as you can, show up to the hospital as many times until you are sure – do whatever makes you feel secure.

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