A breakdown of the natural labour process

There are many terms that your family and friends will use to describe their own labour. But just like pregnancy and birth, the labour process is an individual experience, one that will likely be different from the stories you have heard from others.

The natural labour process

Let’s talk about natural labour. Ideally, this should start anytime from your 37th week of pregnancy up until two weeks beyond your due date (dependent on your healthcare provider).

This creates a five-week period in which you would expect your labour to begin.

The start of labour might be signalled by your waters breaking, though this can happen at any point in your pregnancy before labour. If and when it does happen, you must contact your midwife or obstetrician right away.

Labour can be described in many ways but it is often described by midwives and obstetricians based on four stages relating to the neck of the womb (cervix), and its readiness for birth (Figure 1):

• Early labour (cervix is open 0-3cm, you will have mild to moderate, short contractions becoming longer)
• The first stage (cervix is open 3-10cm, contractions will be regular, longer and stronger)
• The second stage (cervix is 10cm open and you will be pushing out your baby)
• Third stage (delivery of your placenta)

You may hear your midwife or obstetrician using these terms.

^{Fig 1. Cervix changing from a long firm closed cervix to a thin soft open cervix.}

Early labour

Early labour can be the longest stage of the labour process, sometimes taking days. This is because the cervix must shorten and open to approximately 3cm. The time it takes for this to happen varies between women.

Most women will spend this stage at home, using your coping techniques like breathing, massage, having a bath or a shower, using your birthing ball/peanut ball, hypnobirthing, listening to music and/or walking.

You may also use a TENS machine, a device with four pads that you place on points of your back (Figure 2). These pads then deliver small electrical impulses that help to relieve pain.

^{Fig 2. Graphic of a TENS machine}

Slow relaxed breathing is also crucial at this stage of labour. Once the cramps develop into contractions, continue using your coping techniques.

Contractions

Contractions will take your breath away and often you will have to stop what you are doing to breathe through the contraction. Be aware that some women may also have “false starts” in which cramps may begin but never develop into regular contractions.

If you feel the contractions are getting regular (every 5-10 minutes apart), it is a good idea to get your birth partner to start timing them. Your contractions should be getting longer, stronger and closer together.

First stage

Your contractions will be regular, lasting 40-60 seconds and approximately 3 minutes apart. Again, it can be different for every woman.

It is your choice whether you want to stay at home for as long as possible or whether you feel you need the supports of the unit that you choose to birth in.

When to go to your birthing centre or hospital will depend on multiple factors, including your birthing preferences, where you live, how long will it take to get to the birthing unit, your supports, and your coping techniques.

At this first stage, your cervix opens from 3 to 10cms.

Here are some tips to help manage this stage:

• Rest your body and mind when you can.
• Remain focused on the here and now.
• Try to walk and change positions as much as possible.
• Keeping upright will reduce your length of time in labour.
• Eat and drink small amounts and use the bathroom as required.

Second stage

During the second stage, you will feel pressure at your back passage. After some time, you will begin to feel the urge to push with each contraction. This is normal. Listen to your body, follow your instincts and go with the sensations.

You may like to be in an all-fours position (Figure 3) as this may assist to reduce any damage to your perineum (the area of skin or muscle between your back passage and your vagina). As you are pushing your baby down, listen to your midwife and your body for guidance.

^{Fig 3. All fours position}

If you have an epidural (it may be a walking epidural or an epidural that reduces sensation in your legs and requires you to lie down), you will not feel the urge to push but the midwife will advise you when there is a contraction and when you should push.

Third stage

This is the birth of your placenta or “after birth” (Figure 4). Just as with birthing your baby, standing, sitting (on a birthing stool) or kneeling will help with the birth of your placenta.

^{Fig 4. A placenta}

The release of oxytocin in your body will help to birth your placenta. Oxytocin is a ‘feel good’ hormone that also helps with bonding and when you breastfeed, a message is sent to your brain to let your body know that your baby is born.

This massage stimulates the production of oxytocin. Oxytocin will help you to push out your placenta vaginally.

How long will my labour last?

Unfortunately, no one will be able to answer this question. You might start to think about what you would like to do during each stage.

It is best to ask your midwife for personal advice as this might be your 1st, 2nd or subsequent pregnancy.

The advice will be different for you if you live near or far away from the place that you have chosen to birth in. It will also be different depending on your and your baby’s health.