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WELCOMING YOUR LITTLE ONE The process of childbirth

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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 willpass 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.

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STAGE ONE

The First Stage of the childbirth process is the longest.

Generally, the 1 st 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.

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L atent Phase L aborWhat 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.

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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.

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Active Phase L abor

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.

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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 encouragingyourself 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 2 nd stage

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2nd Stage L abor : The Delivery

The 2 nd 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

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H ere's what you can expect during the pushphase:

You can expect it to last somewhere between 20 to

120 minutes.

Contractions will be about 45 to 90 seconds induration, 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.

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M any 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.

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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.

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Now your babys out!

H ere'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 willseem 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 !

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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.

H ere's what you can expect and what you should do :

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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.

H e / 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).

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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!

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Possible ProblemsThere are problems that can arise in the various

stages of labour and we will take a look at some of

them.

First Stage

M al-presentation

Poor progress in labour

Fetal distress

M aternal exhaustion

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M al-presentationThis 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 shoulderor even the cord may present just in front of the head. H owever 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 2 nd trimester and early part of the 3 rd .

H owever 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.

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Poor Progress Of L abourAs your labour is being monitored, a certain amount of progress

is expected to occur within a given time frame. This progress isascertained byThe cervical dilatation. For a first delivery it is expected that thecervix will dilate at a rate of 1 cm in 1 to 2hrs and for women whohave delivered before 1 cm in 1 hr. A fibroid, contractions that areirregular and not strong enough are some of the reasons this maynot occur. It is not an absolute reason for a caesarean section butmost times in the face of other factors a caesarean section would beof most benefit.The strength, frequency and duration of your contractions. In activephase labour, its expected that you should be having contractionswhich are 3 minutes or less apart and lasting at least 45 seconds ormore. If this is not the case an oxytocin infusion is usually started toaugment the labour and make your contractions stronger andincrease their frequency. H owever if adequate progress is still notachieved a caesarean section would be done.

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Fetal DistressIn 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.

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M aternal 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.

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Second stage labourObstruction 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.M aternal 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.

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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.

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Now that you know what to expect when your Labour starts, we believe you

arenow better equipped to

Welcome your little one!

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TH

ANK YOU