Labor is the process through which a baby is delivered from a woman's uterus to the outside world. It involves several stages.
Labor is first associated with biochemical changes in the uterus and cervix. As these changes progress, a pregnant woman starts to experience uterine contractions and her cervix starts to open (dilate). The rupturing of fetal membranes, also known as 'water breaking', is generally one of the later stages of labor and usually happens once the contractions and dilation have started.
A pregnancy is considered to be 'term' if the baby is born around the 40th week. An early term, or preterm, labor is one that takes place before the 37th week, while a post-term labor doesn't take place any earlier than around the 42nd week.
Labor can be classified into three main stages:
Labor is the delivery of the baby.
The lower part of the uterus, leading out into the vagina.
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
Every woman's experience of labor is unique, but some general signs and symptoms associated with labor may include:
The latent phase is the point at which a woman first starts to notice regular uterine contractions. Uterine contractions help to thin, stretch and dilate the cervix.
Contractions experienced during the latent phase are distinct from the Braxton Hicks contractions felt by some women around their 26th week of pregnancy. Braxton Hicks contractions, or 'false labor' contractions, are usually described as being irregular, infrequent and less intense than genuine uterine contractions. Braxton Hicks contractions don't cause the cervix to dilate.
Dilation of the cervix occurs gradually over the course of the latent phase and the cervix may dilate to around 1.18 inches (three centimeters) by the end of this phase of labor.
The latent phase of labor is the most variable and for some women, it may last only a few hours while for others, it may last days. Some women may experience their 'water breaking' during this stage, which generally speeds up the labor process.
The active phase continues on from the latent phase and is associated with the most rapid cervical dilation. This phase is marked by strong and painful contractions that tend to occur 3-4 minutes apart and last from 30-60 seconds at a time.
The cervix can dilate from around 1.18 inches (three centimeters) up to 3.15 to 3.54 inches (eight or nine centimeters). This phase has a more standard course and lasts from 2-5 hours, lasting longer for first-time mothers. Once the cervix has dilated to more than 1.18 inches (three centimeters), it is referred to as 'established labor'.
The transition phase continues on from the active phase, but is associated with a slower rate of cervical dilation. For some women, there is a blurry distinction between the active and transition phases.
The contractions become more intense, painful and frequent during this phase and the baby continues its descent deeper down the birth canal while the cervix continues to dilate. Some women may experience shaking and vomiting through this phase.
Once the baby is positioned in the birth canal and the cervix has sufficiently dilated to 10cm, the mother actively starts to push out the baby. This phase can be variable in its length, with first-time mothers potentially taking hours to deliver their infant, while experienced mothers may deliver within a matter of minutes. This is the most physically demanding stage.
Once the baby has been delivered, further contractions help to push out the placenta. The placenta may be passed out immediately, or it may take up to 30 minutes. This stage is normally associated with moderate blood loss of up to 500ml.
This stage can be managed in one of two ways:
The lower part of the uterus, leading out into the vagina.
A hormone that causes the rate of uterine contractions to increase during childbirth and stimulates milk ejection into the breasts' milk ducts. It can also act as a neurotransmitter.
Some of the more common risk factors that may increase the likelihood of experiencing complications before, during or after labor may include:
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
Some women may find relief by breathing slowly and deeply. Focusing on maintaining a slow and rhythmic breathing pattern may reduce the likelihood of holding your breath. Holding your breath increases the tension in your muscles and decreases the amount of oxygen you breathe in. Some women find it beneficial to chant words to help keep their breathing slow and rhythmic.
Some women may find relief by being massaged, especially if they are experiencing muscular tension and back pain. Massage oil may prove useful in providing a comfortable and relaxing massage to ease some of the pain and stress associated with labor.
A mixture of oxygen and another gas called nitrous oxide can be self-administered through a mask. Nitrous oxide gas can reduce the feeling of pain and make it more bearable. Nitrous oxide gas takes about 15-20 minutes to be effective, so its use needs to be timed to coincide with the onset of a contraction. Side effects of the gas can include feeling light-headed, sick or sleepy.
A transcutaneous electrical nerve stimulation (TENS) machine is made up of four electrodes that are placed on the mother's back and a hand-held controller. The controller allows the mother to administer small and safe amounts of current through the electrodes that prompt the body to produce more of its own natural painkillers (called endorphins) and reduce the pain signals being sent to the brain.
An intramuscular injection of an opioid called pethidine may be offered during labor to ease pain and to aid relaxation. Pethidine may take up to 20 minutes to take effect and it can provide relief for between 2-4 hours.
Side effects of pethidine can include nausea and feeling unwell. If its effects are still present at the end of labor, it may make it more difficult for the mother to push out her baby. The baby's breathing may be temporarily affected by pethidine and it can potentially interfere with the baby's first feed after birth. Medication can be given to the newborn to block these side effects.
An epidural is a local anesthetic that is administered into the epidural space of the spinal canal for pain relief. During an epidural, the mother has an intravenous fluid (IV) drip inserted into a vein in her arm and an injection is administered into the spine to block pain impulses from the uterus to the brain.
An epidural takes about 10 minutes to set up and may take a further 10-15 minutes to provide pain relief. Once an epidural has been administered, there is ongoing monitoring of the baby's heart rate and the mother's uterine contractions.
Side effects associated with an epidural may include:
In some situations, labor may not be able to occur spontaneously and is instead induced. Some situations that may require labor to be induced may include:
A midwife or doctor may insert their finger through the cervix and then sweep their fingers in a circular motion over the baby's head. This action can stimulate labor through the production of natural prostaglandins.
Synthetic prostaglandins are synthetic hormones that are administered by a gel or as a vaginal pessary. These hormones help the cervix to ripen and also help to induce labor.
In some women, prostaglandins alone can be enough to induce labor, but other women may also require oxytocin. There is a very small risk that using vaginal prostaglandin may result in overstimulation of the uterus, which may cause distress in the mother and her baby. Other possible side effects may include nausea, vomiting and diarrhea and an allergic reaction to the gel.
The body normally produces the hormone oxytocin to start and maintain labor contractions. A synthetic form of oxytocin can also start and maintain labor.
Oxytocin may be offered if a membrane sweep or prostaglandins haven't been able to start labor, or if the contractions are not yet strong enough. The waters need to have been broken before oxytocin can be administered. This can be done manually by the doctor if it has not occurred naturally. Oxytocin is administered through an intravenous (IV) drip.
As oxytocin intensifies the frequency and strength of contractions, the mother has not had the typical gradual build-up to the final stages of labor. Without this build-up, the mother's body has not had time to release endorphins, or natural painkillers and she can experience a higher level of pain and distress.
Oxytocin is also associated with possible overstimulation of the uterus, which can distress the baby.
Most babies turn head-down between the 32nd and 36th week of pregnancy, which prepares them for delivery down the birth canal. When babies have not turned, or when they are positioned feet-first or bottom-first (breech position), a technique called external cephalic version may be performed.
During an external cephalic version, a doctor gently tries to turn the baby into the right position for delivery by applying pressure with their hands over the mother's abdomen. If successful, this technique can reduce the need for a caesarean delivery.
For more detailed information regarding fetal position during pregnancy, please refer to our report.
An episiotomy is a cut that is made in the perineum, the area between the vagina and anus, to enlarge the vaginal opening for delivery of the baby's head (crowning stage). A local anesthetic may be injected into the area before the cut is made. An episiotomy may be performed when extensive vaginal tearing seems likely, or if the baby is in an abnormal position. The incision is sewn up after birth.
When there are major complications with the baby and/or mother, a caesarean section can be the safest and quickest delivery option. During a caesarean section, the mother is first anaesthetized and an incision is made in the abdomen and the uterus, through which the baby is delivered.
Some of the more common reasons a caesarean section may be advised include:
A thin, flexible tube inserted through a narrow opening into a body cavity for removing fluid.
The lower part of the uterus, leading out into the vagina.
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
Passing watery stools in large volumes. Liquid feces and/or frequent stools.
A type of chemical messenger (neurotransmitter) that is produced by the brain in response to fear, emotion and pain.
A type of medication that, when administered to an area, creates a localized loss of sensation by blocking nerve activity.
A class of drugs that contain opium, derivatives of opium, or have similar effects to opium. They are powerful painkillers that act on the central nervous system and cause drowsiness and include drugs such as morphine and pethidine.
A hormone that causes the rate of uterine contractions to increase during childbirth and stimulates milk ejection into the breasts' milk ducts. It can also act as a neurotransmitter.
A group of chemicals acting as hormones in the body.
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
A group of deep muscles and ligaments at the bottom of the pelvis that support the organs that lie on it and control the anal, vaginal and urinary openings.
Some of the potential complications associated with labor include: