Labour can be conditionally divided into two stages:
- Latent phase – from 0 to about 4 cm dilatation of the cervix;
- Active phase – from about 4 cm to complete cervical dilation with delivery of the newborn and placenta.
Latent phase of labour
This phase always begins smoothly. The initial contractions may be mistaken for preparatory ones and may not be felt as pain but as abdominal tension, tightness and discomfort. The interval between contractions is wide at first, but it decreases gradually. Simultaneously, the duration, force and sensation of contraction increases. Frequent urinary urges may be a signal of contractions that you do not feel as pain and tension.
The latent phase of labor lasts until the cervix dilates to approximately 4 cm. When the waters have not yet broken, it is normal for the birthing process to stop and resume again after hours (even after a few days). This is why we call this stage the “latent phase” – no labor stimulation and analgesia is undertaken except in cases of a possible problem (deterioration of the baby’s condition, transference, other signs of deviation from the norm).
If you go into hospital at this point, the likelihood that your contractions will disappear is high due to the stress of the change in environment. Epidural analgesia is not given at this stage of labor.
Active phase of labour
It takes place in several stages – dilation of the cervix, lowering the baby down into the pelvis, rupture of the amniotic sac; birth of the baby; delivery of the placenta. Our birthing beds allow a choice of different birthing positions, which it is advisable to test in the early stages of labor with your obstetrician to choose the most comfortable for you.
- Cervical dilation
The timing of cervical dilation varies depending on the individual characteristics of the body and the strength and intensity of the contractions. A dilation of about 10 cm is conventionally accepted as a “full” dilation. In practice, however, full dilation is that at which your baby can pass through the cervix.
In this stage, means of medical stimulation (most often intravenous system with oxytocin) and labor pain relief (epidural analgesia) are applied.
Movement and the assumption of different body postures will assist in the natural acceleration of the process. You can use birthing balls, a sling for support, a Swedish wall, mattresses. Directing a stream of warm water to the painful areas has a good analgesic, relaxing and hydrating effect. For this purpose, if desired, use the bathroom attached to the delivery room and the hand-held shower in it.
In active labour, the disclosure usually progresses by one centimeter per hour (contractions lasting more than an hour, lasting about 30-40 seconds and spaced about 5 minutes apart are considered active labor). Water intake during this period should be in small sips, with good moistening of the oral cavity and throat. Sugar candies will quickly bring into your body pure glucose, which is necessary for the good work of the muscles of the uterus and the effectiveness of uterine contractions.
- Amniotic bladder rupture
In normal childbirth, the amniotic bladder opens spontaneously at an opening of about 6-7 cm. Before this, it softens the pressure of the foetus on the cervix and so the sensation of pain is less, but the opening progresses more slowly. After rupture of the bladder, pain sensations increase due to harder pressure of the baby’s head on the cervix.
- Descent of the preterm part of the foetus into the bony birth canal
As it descends into the pelvis, the baby, under the force of contractions, gradually adapts the shape of its head and its position relative to the bony birth canal so that it passes with the smallest possible circumferences and diameters through its widest possible spaces. The process is slow and, with normal progression of labour, occurs simultaneously with the opening of the cervix.
The duration of the rotation and descent of the pre-term foetus depends largely on the characteristics of the laboring woman’s pelvis, on the size of the baby and its individual capacities for adaptation, on the efficiency of the uterine contractions. The upright position and movement of the parturient acts as an additional stimulus to this descent along with the uterine contractions and the force of gravity.
The baby’s condition is monitored by periodically checking his heart tones and, if necessary, by recording with an obstetric monitor. Vaginal examinations (tumescence) are routinely performed every two hours or so (more frequently if necessary) to assess the progress of labour.
- Birth of the baby
The birth of the baby takes place in the delivery room under the care of an midwife and an obstetrician-gynaecologist, and if you have chosen epidural anaesthesia – an anaesthetic team as well. The paediatrician is on standby immediately after the birth to take over the newborn.
At this stage, the sensation of pain is no longer there – it has been replaced by a feeling of being pushed. The semi-upright position of your body will make pushing easier, reduce the strain on the soft tissues at the pelvic outlet, and reduce the likelihood of trauma and tearing.
Infant heart tones are monitored after each contraction to assess the baby’s condition in a timely manner and to reassess management of life and health risks.
When the midwife supporting you during labour signals you to stop pushing and breathe, try to follow her instructions – at this point the midwife is trying to help the baby’s head delivery go smoothly and avoid any possible trauma and tearing.
The delivery of the baby’s shoulders and body usually proceeds without any problems. In the event of difficulty – follow the instructions of the midwife and physician so that the baby’s shoulders are released consistently.
- Placenta delivery
There is no sensation of pain when the placenta is being delivered, you will be instructed to push for its spontaneous delivery. Often a medication is given to hasten the delivery of the placenta (intravenously, most commonly methergine/oxytocin for epidural analgesia) and to reduce blood loss.
After placental abruption and delivery, the placenta is examined to assess its integrity. If there is any suspicion of retained parts, the uterine cavity is cleaned using instruments (revision of the uterine cavity). The procedure is carried out under short-term intravenous anaesthesia or with anaesthesia through the epidural catheter under epidural analgesia. For intrauterine manipulation, the standard of good medical practice requires the administration of intravenous antibiotics.
If you have chosen to store your child’s stem cells, it is necessary to inform the team who will store the stem cells, as well as the team at the bank you have chosen, when labor starts. They must be present in the delivery room at the time of your baby’s birth.
If you do not wish to store stem cells, after the placenta has been delivered and inspected it will be processed in accordance with the Ordinance on Control of Biological Waste.
Inspection of the soft birth canal is carried out after each vaginal birth, and any tears found are repaired with sterile instruments and suture material. The reconstruction shall be carried out under local anaesthesia, epidural analgesia or, if necessary, short-acting intravenous anaesthesia.
After the birth is completed, it is recorded in the delivery sheet, the baby’s sheet and the delivery room’s regulatory books. For the next two hours you remain for observation in the Delivery Room with the baby. If this early postnatal period is uneventful, you are then stirred and transferred to the Postnatal Clinic with your baby.