WELCOMING YOUR LITTLE ONE

The process of childbirth

Today we want to consider what a wonderfully joyous experience childbirth is. And while all childbirths are different, there are three basic stages that women will pass through during childbirth.

The First Stage is the onset of labor, which goes on until the cervix is dilated to about 10 cm.

Second Stage , which continues from that point until you deliver the baby.

And then Third Stage: Delivery of the Placenta.

STAGE ONE
The First Stage of the childbirth process is the longest. Generally, the 1st stage of labor can be broken into two phases.

The early-labor phase called latent phase labor begins with labor's onset and goes until the cervix has dilated to around 3 cm. Next is the active-labor phase, which goes from the end of early labor until the cervix has dilated to about 10 cm.

Latent Phase Labor What should you do?

This usually starts with regular contractions, unlike braxton-hicks which you may have had these would come at regular intervals which may be up to an hour initially but progress to being much more closer together and of increasing strength. Try to relax as much as possible. Contrary to what you see in the movies, you don't have to rush to the hospital. In fact, you'll find it feels better and easier to relax if you spend this time with your family at home. If it's during the daytime, feel free to do some simple chores around the home. . . while conserving some energy. Eat a small snack, and drink lots of water. As you're going about your other tasks, monitor your contractions, especially noting how far apart they occur.

This early phase will last somewhere from 8 to 12 hours. During this time, the cervix should dilate to around 3 cm, and contractions should last somewhere from 30 to 45 seconds. You'll get about 5 to 30 minutes rest between them. They should get closer and closer to one another. Keep track of how long they're lasting and how many minutes apart they become. You water might also break at this point, note the color and odor of the fluid, as well as the time it broke.

Active Phase Labor

You should now proceed to the hospital i.e. either your water broke or contractions are getting closer together and lasting longer, 45 seconds or more and 15 minutes apart or less. Keep drinking water, and try to urinate occasionally. You can expect this phase to last anywhere from 3 to 5 hours. During this time, the cervix will dilate from around 4 cm to around 10 cm. Your contractions will now be up to about 45 to 60 seconds, with only three to five minutes rest between them.

As the cervix reaches 7 8 cm dilation you should know you are getting closer to your goal: meeting your baby, however you are getting into the hardest phase but keep encouraging yourself youre almost there. Contractions may now be up to a minute to 90 seconds with about 1 to 3 minutes rest between them. During this time, many women experience chills, hot flushes, nausea or gas. Also If you feel a need to push, tell your doctor. At 10cm dilation you have come to end of the first stage of labor and youre ready to move to the 2nd stage

2nd Stage Labor : The Delivery

The 2nd Stage of childbirth is the pushing and

delivery. In the first stage, your body did all the work, without much deliberate action from you. But now the cervix is completely dilated (10 cm), and so it's time for some willful assistance from you.

In short, get

Here's what you can expect during the push phase:

You can expect it to last somewhere between 20 to 120 minutes. Contractions will be about 45 to 90 seconds in duration, and generally have a three to five minutes rest between them. There will be an almost irresistible desire to push. Your rectum will feel a strong pressure.

Many women at this point have a small urinary or bowel accident. Toward the end of the process, the crown of your baby's head will be visible. Your doctor will instruct you not to push for a few moments. As time approaches for pushing, get into a position that will allow gravity to assist you.

When you feel the need, push. Relax the anal area and pelvic floor. Take a short breather between contractions, in order to gather your strength. Using as much energy as you can muster, push. Expect this to take a few tries. It's common for the baby's head to emerge and then go back into the vagina for a few times.

Now your babys out!

Here's what to expect next. Remember that your baby has been in a sac of fluid for nine months, so expect him / her to look like it. When he / she first emerges, the baby may have a conical head, a coating all over the body that will seem somewhat cheesy, eyes that are quite puffy, enlarged genitals, and a fine layer of hair that will cover his / her back, shoulders, temple and forehead.

But don't worry: Your new bundle of joy will clean up just fine!

Stage Three: Delivery Of The Placenta.

This third stage is the shortest one: It is the delivery of your babys placenta. While every situation is, of course, different, generally it will take somewhere between five and 30 minutes to deliver the placenta.

Here's what you can expect and what you should do:

After the baby is born, your doctor will wait for some small contractions to start up once again. This will tell him / her that the placenta is pulling away from the wall of the uterus, and that it's ready now to be delivered. The doctor will apply some pressure to the uterus by massaging it. He / she will also gently pull on the umbilical cord. The final result will be the delivery of the placenta (which is often called the afterbirth).

After this, you will have completed all three stages of childbirth. For a few hours following this, the medical staff will monitor you, just to make sure that your uterus keeps on contracting and also checking to make sure there is no excessive bleeding.

After this, the real joy comes: You get to take home your new little one and enjoy all the pleasures -- and pains -- of motherhood!

Possible Problems
There are problems that can arise in the various stages of labour and we will take a look at some of them.

First Stage Mal-presentation Poor progress in labour Fetal distress Maternal exhaustion

Mal-presentation
This happens when your baby is coming out with a part of the body other than the head, it could be the buttocks, the leg, the shoulder or even the cord may present just in front of the head. However if you are regular with your antenatal visits such presentations should be detected early and an elective Caesarean Section offered depending on the gestational age as your baby commonly changes his/her position in the 2nd trimester and early part of the 3rd. However even when you baby is presenting with its head the cord may still present ahead of it and this would not be observed till you are examined when in active phase labour. This is a situation that would require your baby being delivered by an emergency Caesarean Section.

Poor Progress Of Labour

As your labour is being monitored, a certain amount of progress is expected to occur within a given time frame. This progress is ascertained by
The cervical dilatation. For a first delivery it is expected that the cervix will dilate at a rate of 1 cm in 1 to 2hrs and for women who have delivered before 1 cm in 1 hr. A fibroid, contractions that are irregular and not strong enough are some of the reasons this may not occur. It is not an absolute reason for a caesarean section but most times in the face of other factors a caesarean section would be of most benefit. The strength, frequency and duration of your contractions. In active phase labour, its expected that you should be having contractions which are 3 minutes or less apart and lasting at least 45 seconds or more. If this is not the case an oxytocin infusion is usually started to augment the labour and make your contractions stronger and increase their frequency. However if adequate progress is still not achieved a caesarean section would be done.

Fetal Distress
In addition to monitoring you in labour, an eye is also kept on your baby. This is achieved by monitoring your babys heart rate. This can be done electronically using the CTG machine which gives a graphic representation of your babys heart rate. Babys heart rate usually ranges between 110 170 beats per minute. Single readings outside this range can and do occur when the uterus is contracting. If the heart rate remains persistently below or above this range it is a sign that baby is not doing well and must be delivered immediately by the fastest means possible usually an emergency caesarean section.

Maternal exhaustion
Bringing your baby into the world can be a hard though rewarding effort. It is therefore not unusual for some mothers to get exhausted but if you have followed the guidelines we discussed before and relaxed during the latent phase this may not occur. However during active phase labour you may be placed on a plain dextrose infusion to boost up your energy supplies.

Second stage labour

Obstruction of labour: this occurs when despite full dilation of the cervix and adequate effort from the mother, delivery is not achieved. Is commonly due to a disparity between the size of the foetus and the mothers pelvis. This may be due to a big baby, 4kg and above. This can also occur if the mother is of small stature resulting in a small pelvis. Maternal exhaustion: this can be resolved by assisted delivery where the obstetrician helps bring out your baby using an instrument called the vacuum extractor. Perineal tear: can occur if the mothers pushing is not properly coordinated leading to a tear around the vulval area, however this is easily repaired.

Third stage of labour

Adherent placenta: sometimes the placenta is adherent to the uterine wall and difficult to remove. This requires its being removed in the theatre. This is a short procedure and done under anaesthesia or if you had epidural analgesia virtually painless. Bleeding: can occasionally occur if your uterus is not well contracted. This is corrected by giving additional medication to make your uterus contract.

Now that you know what to expect when your Labour starts, we believe you are now better equipped to

Welcome your little one!

THANK YOU