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STAGES OF LABOUR

1st STAGE

| Latent Phase | Active Phase | How do you feel | What does the doctor do | | Do's and Don'ts |

It is the beginning of labour. It commences with the onset of true pain and uterine contractions, which bring about gradual opening up of the cervix. The opening of cervix is assessed in terms of “centimeters”
When the cervix is fully opened or dilated as it is medically referred to, it is approximately 10 cms in diameter.
This is so because the diameter of the foetal head (biparietal diameter) is approximately 9.5 cms at full term.

The first stage is divided into two parts:

  1. Latent phase
  2. Active Phase.

What do you feel / experience?
This is the beginning of the end part of your pregnancy. Very soon you will be the proud mother of an adorable little one. During this stage you may experience pain in the abdomen and back. This may even go on to the thigh and leg. Initially it may start off with a vague backache or lower abdominal pain (like menstrual pain). Gradually it will increase in intensity, duration and frequency. 
You will be able to appreciate the hardening of the uterus.The movements of the foetus may also be slightly reduced during labour.The pain may initially come once in ˝ - 1 hour lasting for few seconds and by the end of this stage it will peak and you may experience a contraction every 2 – 3 minutes and the contraction itself may last for ˝  - 1 minute. With the onset of pain you will have show   .  
Sometime during the first stage of labour, the bag of waters may burst releasing watery fluid. This is normal.
This water is usually clear. If it is yellow, brown or green, then it suggests that your baby may be having some problem inside and it is an indicator to immediately inform your doctor. 
If the bag of waters burst before onset of labour pain, it is wise to report immediately to your doctor so that steps for early delivery can be taken to avoid infection setting in.
 In case the bag of waters does not burst by itself, your Doctor may do so when you are in the active phase   .  This tells him/her about the colour of amniotic fluid and also accelerates the labour pain.


What Does Your Doctor Do?
Once you have been admitted and all the routine procedure like shaving, enema, etc. have been done, you may be assigned a room or may be kept in the labour ward (depending upon the hospital protocol and your doctor’s judgement).

Subsequently, your doctor and the nurse will be constantly and closely monitor you. Monitoring is done to follow the course of labour (whether you are progressing normally) and to find out the status of the foetus during labour. An obstetrician is always worried (sometimes more than you) till the delivery takes place as he/she is in charge of two lives during labour. She / he can relax only after the delivery has been conducted.

Your doctor / nurse will be monitoring the following things:

  •  Your general condition, pulse rate, B.P and other parameters.
  •  Your labour pains – whether they are adequately in need or need any external support to increase their intensity (with the help of tablets / I.V.drugs).
  •  The heart rate of your baby-- whether it is normal/abnormal. This is checked by using a stethoscope or a Doppler machine. These 2 parameters may be checked every ˝ hour or even more frequently as per your conditions.
  • Internal examination: Your doctor may do an internal examination as required, though not as frequently, as he/she checks you pulse, blood pressure and your baby’s heart rate. Internal examination (P.V. – Per vagium) is done to assess the progress of labour.If your bag of waters is not burst, the doctor may do so if your cervix is dilated to about 3 – 5 cms. This procedure is absolutely pain less. You may feel some warm fluid trickling down your vulva and buttocks and nothing more than that. If you are moving around, then you may need to wear sanitary pads to prevent soiling/ leaking.
  • If necessary and if facilities are available, you may be attached to a monitor / instruments to record your baby’s heart rate. This may be done intermittently or continuously.
    If necessary, an IV line may be taken to administer IV fluids or other medications.

Medication commonly given may be:

  • Analgesics to prevent / decrease pain.
  • To increase uterine contraction.
  • To facilitate dilatation of the cervix.
  • Specific medicines as indicated by your medical / obstetrical status.
  • Medicines to reduce acidity and vomiting.
  •  Pain relief during labour / Painless labour      
    If consent is given, you may be subjected to some form of therapy to reduce pain felt during labour. 


Your Role – Do's & Dont's

  • During this stage you can be either ambulatory or lie in bed at rest. Abulation helps to take your mind off the discomfort and gravity aids in proper dropping down of the foetal head.

  • As far as the pain is concerned you may try a variety of methods like relaxation, deep breathing etc. or request your doctor for labour analgesia. More details on techniques of the pain relief     during labour.

  • During labour it is preferable to be on a liquid diet. One thing you can do is to have a light snack before you leave from home for the hospital.

  • During labour you must have adequate fluids to prevent dehydration.

  • In case you are asked to be fasting by your doctor (in anticipation of some problem during labour or for surgery) an I.V. drip will be started to take care of your nutrition and hydration.

  • It is a good idea to keep some hard boiled sweets to suck on during labour to counter you thirst, though ice chips are the best for this purpose.

  • Pass urine frequently as a full bladder may impede labour. Only rarely you will require catheterisation to empty your bladder.

  • You can time your contraction and if you are on a foetal monitor, you can monitor the foetal heart rate yourself. The normal range is between 110 – 160 beats/minutes.

  • Keeps your spouse / partner with you as long as allowed to by the doctor. It is a great physical as well as moral support to have someone besides you during labour. The partner / spouse can massage you, distract you and provide comfort and reassurance. This can be a great help in calming you down and actually enjoying your labour.

  •  During the first stage remember not to push / strain during any time. Always make a conscious effort and tell yourself to relax in between your contration. Pushing during this stage will not help in anyway. Infact it can lead in formation of a swelling on your baby’s scalp (although, quite harmless, called “the caput”) and also predisposes you to prolapse of the uterus in later years.

  •  Your 1st stage will last for an average of 8 – 10 hours from onset of labour. So remember that you will not deliver as soon as you are in the hospital. Be patient. Don’t forget to add to your labour list, things like a walkman, cards, cassettes, story books, etc. to help you kill time.

 


Few things which you may find comforting and relaxing are:

  • Take a warm bath just before leaving for the hospital.
  • Walk around in the hospital as much as possible.
  • Keep yourself adequately hydrated.
  • Use relaxation, breathing techniques, etc. to reduce pain.
  • Ask your companion to massage your abdomen and back.
  • Use a damp cloth to wipe your face and body. It is very refreshing.
  • Relax between contraction and don’t push unless told to.
  • Think about the wonderful baby that you are going to have soon. Its worth all the trouble and discomfort that you are going thru.

                                                       


Recommended:  book
"The new parent"
by author Martha
UTILITY

 

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