Melanie Audette, MD PhD
As the end of pregnancy approaches, it is normal for women and their families to have lots of questions about labour and the delivery.
Keep reading to learn the answers to some of the most common questions regarding labour.
How will I know when I'm in labour?
Let's talk about the process of labour, also clinically referred to as parturition. There are two major body part players in labour – your uterus and cervix.
The uterus is a balloon shaped organ, made of tissues and muscle. The uterus expands and grows as pregnancy progresses, and the baby gets bigger.
The cervix is the opening of the uterus into the vagina. When a woman is not pregnant, the uterus is small and the cervix is closed. The cervix is also closed throughout pregnancy. Near the end of pregnancy, the cervix can either be closed or partially open. When labour begins and the uterus begins to contract regularly, the cervix will start to open or dilate. Regular, strong contractions by the uterus force the cervix to dilate and kick starts labour.
Some women experience Braxton Hicks contractions before full labour begins. These are irregular contractions, or contractions that begin in a regular pattern but then taper off. Braxton Hicks can occur at any time throughout pregnancy, however, are more common near the end of the third trimester.
Contractions in the early stages of labour can be irregular and can last for hours and even days. However, once true labour starts, it will progress until the baby is born.
Will my water break before contractions start?
In pregnancy, the baby is surrounded and protected by an amniotic sac, a thin membrane that is filled with amniotic fluid. When we think of your 'water breaking', this water is amniotic fluid.
Women have very different experiences when their water breaks. Some women experience a big gush of fluid all at once when their water breaks. Other women experience a small amount of ongoing leaking without a big water break, and find it tricky to tell if their water has broken. If you think your water has broken, the best thing is to go into the hospital and get checked out. Doctors can do a speculum exam to check for the presence of any amniotic fluid.
There is no correct or right order when it comes to your water breaking and labour beginning. Some women have their water break prior to contractions, some women have contractions first, and others experience their water breaking and contractions together.
If the water does break first and contractions don't begin within a reasonable period of time, women may need to be started on medication called Pitocin. This is a synthetic form of the hormone oxytocin, a natural hormone your body produces in labour; this medication helps to kick start contractions.
Conversely, if labour contractions begin without water breaking, doctors can use a small little hook to break your water manually.
Using Pitocin to start contractions and manually breaking of the waters are two methods used to initiate or augment labour, meaning that they are techniques to start labour or help move it along more quickly.
Why is it important to know if my water breaks?
Near the end of pregnancy, doctors will perform a vaginal & rectal swab to test for a bacteria called Group B streptococcus (also called GBS).
The GBS bacteria is naturally acquired by some women in pregnancy. If a pregnant woman has GBS, it does not impact her health.
However, doctors do not want the GBS bacteria to spread to the baby during delivery. It is not very common for GBS to spread to the baby during vaginal delivery, but it can cause a very serious infection in the baby if it does.
To prevent this from happening, all pregnant women who are positive for GBS will be given antibiotics during labour to prevent the bacteria from spreading to the baby during vaginal delivery.
When a pregnant women's water breaks, the amniotic sac that was protecting the baby from the outside world and potential infections is no longer there. To protect the baby, pregnant women positive for GBS need to start antibiotics shortly after their water breaks.
If a GBS-positive pregnant women has her water break but contractions do not begin shortly after, doctors may need to give her Pitocin to get kick-start contractions - it is not safe for her baby to be exposed to the GBS bacteria for too long without the protective amniotic sac.
If a GBS-negative pregnant woman has her water break but contractions do not begin shortly after, doctors can wait up to 12 hours to see if contractions start on their own. After 12 hours, Pitocin will also be given to help start contractions.
When should I go to the hospital?
Most doctors suggest you go to the hospital when you experience moderately intense contractions every 5 minutes for an hour or two, with each contraction lasting about 1 minute.
Pregnant women who have had a baby before are suggested to go to the hospital as soon as contractions become regular and moderate in intensity, since babies tend to be born more quickly if it's not the first delivery.
Women should always call the local hospital triage desk if they are unsure when to go to the hospital.
What will happen when I get to the hospital?
Once you arrive to the hospital and check in to the hospital and check in at the maternal triage desk, you will head to an assessment room.
A nurse will first check your blood pressure, heart rate, temperature and breathing rate. They will also review your pregnancy and medical history to ensure that all of your information is up to date in the hospital’s records.
After this, monitors will be placed on your belly to listen to the baby’s heart rate; this is called fetal heart rate monitoring.
The doctor or nurse will then do a vaginal exam to check how dilated your cervix is. This exam can be quite uncomfortable. While wearing gloves, the doctor or nurse will insert two fingers into the vagina and will check:
• How dilated your cervix is
• How thick the cervix is
• How high or low the baby’s head is
If your cervix is less than 2cm dilated, this means that you are probably very early in labour. At this point, most women will be recommended to walk for a few hours or return home until the contractions pick up in intensity.
You will likely be admitted to the birthing unit on the Labour & Delivery floor when your cervix is more than 3-4 cm dilated with regular contractions.
During labour on the delivery floor, you will usually have fetal heart rate monitors on your belly for the doctors and nurses to watch how the baby is responding to the stages of labour. The cervical exam will be repeated every few hours to make sure that the labour process is moving along as expected.
What are the stages of labour?
This stage is the period of time where the cervix dilates to 10 centimeters. This is usually the longest stage of labour.
This stage is the period of time between when you are fully dilated until the baby is born. This time can be spent in a passive phase (resting) or active phase (pushing). For first time moms, this usually lasts between 30 minutes to 2 hours. For women who have had previous deliveries, this stage usually lasts between 5 minutes - 1 hour. Once the baby is born, you move onto Stage 3.
This stage is the period of time it takes for your placenta to be delivered, which can take up to 30 minutes. To help separate the placenta from the uterus, the doctor may provide a fundal (or uterine) massage through the stomach and gently apply traction to the umbilical cord. Once the placenta is delivered, you move onto Stage 4.
This stage is the 1-hour period after the placenta has been delivered. Doctors and nurses will monitor to make sure the bleeding from the uterus and vagina has slowed down, and make sure that your blood pressure and temperature remain stable.
You will usually remain in the labour and delivery unit for a few hours after the baby is born and will be transferred to the post-partum unit if everything is looking normal following this period.
Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.