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Most women remember their labor and delivery experiences as single slots of time in their life where they felt immense pain, anxiety and then enormous joy. Labor and delivery really is divided into three stages. To better understand these stages let’s look at the anatomy of the womb.
The womb or uterus is shaped like an upside down pear opening out into the vagina or birth canal. The vagina in this case is not the outer physical genitals but is a tube or passageway that leads to the outside. The bulb of the pear or womb is lined with endometrial lining in which the fetus implants itself in the early stages of pregnancy. Amniotic membranes forms after the fetus is implanted, holding amniotic fluid and it is this membrane that may burst signaling the commencement of birth.
During labor the baby passes from the womb through the cervix, which can be thought of as slightly ajar gates. A glob of mucous called the mucous plug blocks this gateway until it is time for the first stage of labor. Before the baby can pass through, the gates or cervix must be thinned or pushed out of the way.
Think of it as folding the gates away until the way is made clear and at the same time the gateway is made larger as the cervix dilates. The baby passes through the cervix and into the birth canal with her head facing toward her mother’s back. As she passes through the birth canal her head flexes toward her chest and as she approached the rim of the vagina or perineum her head will then flex backward almost to a ninety-degree angle. The perineum, which is the skin and muscles surrounding the vaginal opening, stretches as the head descends making way for the baby to be born.
Signs of Labor
- Loss of the mucus plug or a bloody mucus discharge (show)
- Breaking or leaking of the amniotic sac or water bag
- Strong regular contractions that do not change when your position changes or strengthening/persistence of Braxton-Hicks contractions
- Low backache
First Stage of Labor and Delivery
The first stage is characterized by contractions that open up (dilate) and thin (efface) the cervix to a maximum of ten centimeters preparing it for birth and may last as long as twelve hours. As it draws nearer to your due date, the level of prostaglandins in your blood rises while the level of progesterone in the blood decreases signaling parturition or the birth process. Muscle fibers in the uterus prepare themselves to receive oxytocin, which helps with strong, efficient contractions.
You may realize that you are in active labor when your membranes burst leaking (or gushing) amniotic fluid and/or you begin to experience strong consistent uterine contractions. If labor begins and your membranes did not break on their own your doctor may rupture them manually. Sometimes the membranes rupture naturally but contractions do not begin immediately. Instead they may actually occur during the next twenty-four hours but if labor does not commence during that time, infection can take place. In these cases, the doctor administers pitocin to help induce labor or make the contractions stronger.
In some women, the first stage can occur over a period of days without their knowledge whereas in others this stage presents the pain and horror that is labor. It is also during this stage that analgesics or painkilling medicines are administered.
Second Stage of Labor and Delivery
In the second stage, the baby is birthed through the open cervix and this stage may last as long as two hours. It is during this stage that the woman assumes a birthing position that makes the best use of gravity. Gravity, the force of the mother bearing down and the now intense uterine contractions work together to deliver the baby while the doctor or midwife helps to guide the delivery.
If the mother becomes too tired to push or the urge to push isn’t strong enough forceps or a vacuum may be used to help guide the baby out of the birth canal. Sometimes a baby’s head can be too large for the perineum resulting in the doctor or midwife slitting the perineum, which is called an episiotomy. If the baby becomes lodged between the pelvic bones, is in the wrong position or is showing signs of distress she will then be delivered by a Cesarean section, which is an incision in the abdominal wall and uterus.
After the baby is delivered, the doctor will suction or clear the throat of mucous or fluid and cut the umbilical cord. He will then proceed to grade the baby using the Apgar score. This score tests the baby one minute after birth and three minutes after birth on pulse, skin tone, reflexes and breathing. In some countries the baby will be given a vitamin K shot which helps promote the clotting of blood, while in other countries such as Canada and the United Kingdom babies are given oral vitamin K. During this time other data is also recorded such as the baby’s weight and length and the baby is returned to her mother where bonding begins.
Third Stage of Labor and Delivery
In the third stage, the placenta which served to provide nourishment to your baby during your pregnancy is released. The placenta detaches itself from the walls of the uterus and uterine contractions push the liver-like mass through the birth canal where it is delivered. The midwife or doctor may allow the placenta or after-birth to birth on its own or may help to speed the process along by massaging the abdomen or encouraging the mother to bear down much like she did during the birthing of the baby. After the passing of the placenta, the attending doctor or midwife will proceed to tend to any tears or episiotomies and the new mother will then be moved to the recovery room where she will remain until she is discharged.
What Dad can do
Labor is a team effort. Even though you are not in active labor, you can be of great help to your partner now. During labor you can:
- Offer to massage your partner’s abdomen or back.
- If permitted by the health care givers, offer her ice chips, light snacks or water.
- Time her contractions and breathe with her while they last.
- Give her words of encouragement but avoid idle chit chat which may be annoying to her.
- Sponge her face and neck with a damp, cool cloth.
- Make sure the nurses attending have copies of your birth plan and ensure that your partner’s wishes are met within reasonable boundaries. Be supportive of the choices that she may make during this time as long as her nor the baby’s life is in danger.
- If she chooses, help her to relax by entertaining her with reading, music or television
- Keep visitors to a minimum if she chooses
- During the birth, relay to her what you are seeing and the progress that is being made. While you may take pictures or record those precious moments, do not neglect her.
- You may be given the opportunity to cut the umbilical cord. Take this opportunity if you think you are able; you are of no value to your partner if you lose consciousness.
- After the birth, give her words of encouragement. Ensure that your partner has a drink of water or fluids, as she will be very thirsty.