How Long will It Last? All about labor (part 1)

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How long will my labor last?

This is hard to determine since every woman is different and every labor is different. Also, how long your labor lasts depends on when you start timing it since the start of labor can be a gradual build up that occurs over a fairly long period of time. Usually, labor is classified as being established when the contractions are regular and getting stronger and do not stop until the baby is born. This, coupled with the cervix opening, are indicators that labor has commenced. During the gradual build up of contractions, labor is sometimes described as being in the “latent” phase until it becomes more established. This latent phase may last for a period of around 6–8 hours in first-time mothers.

As a general rule, if this is your first baby, you should expect to labor for around 12–24 hours in total. If you have had a baby before, your labor may be a lot quicker, that's if there are no other complications, particularly if you have had a vaginal delivery in the last 2–3 years. In some cases, usually with second or subsequent babies, labors can last for only a few hours, or even minutes, and in these situations the mother may not to make it to the hospital. The best advice in all cases is to speak to your midwife or hospital if you think labor has started.

I like to know what to expect. What will happen when I first arrive at the hospital?

Hospital routines vary, but generally you will be shown to a room on the labor ward, and one of the nurses or midwives on duty will come to see you. As well as asking you about your labor so far, she will probably ask to check your temperature, pulse, and blood pressure, and listen to the baby's heartbeat. She will also feel your belly to assess contractions and the baby's position and how far the head has engaged or moved down in the pelvis . If your contractions are regular, an internal examination may sometimes be done to reveal how far your cervix has dilated and the stage of your labor. This information will give the nurse or midwife an insight into the well-being of both you and your baby, and will help you both decide on the next course of action. If your labor is in the very early stages, your midwife or doctor may suggest that you return home for a while or spend some walking. If your labor is well established, you will be admitted.

How will my progress be checked?

An experienced nurse or midwife can tell a lot about your labor just by looking at you and observing your behavior. For example, a woman who is chatting happily during each contraction is unlikely to be in well-established labor. A woman who is in established labor and starts to be restless and nauseous may be in the “transition ” phase, approaching the second stage of labor .

Another way in which your care provider will assess your progress is by feeling your belly to check the strength of the contractions, and also by feeling the position of the baby's head in your pelvis.

Internal examinations also reveal a lot about how your labor is progressing. By placing two fingers gently into the vagina, your caregiver can feel how far the cervix is thinning out (effacing) and opening (dilating), how the baby's head is moving downward, and what position the baby's head is in.

What is AROM, and is it routine?

AROM stands for “Artificial Rupture of Membranes.” This means that a doctor or midwife, using a plastic crochet-hook-like device with a long handle, tears a small hole in the amniotic membrane that surrounds the baby and contains the amniotic fluid and the fluid then passes out through the vagina. This procedure is also referred to as “breaking the water” and may be uncomfortable, but should not be painful. AROM can be used to try to induce, or speed up, labor . The idea is that the layer of membrane between the baby's head and the cervix is removed. This enables the head to press directly on the cervix, which in turn releases the hormones that stimulate contractions and start, or help to speed up, labor.

AROM should not be performed routinely. In a spontaneous labor that is progressing normally, there is no need, and the membranes will usually rupture on their own.

I'm worried about being confined to a bed and monitored. Is that essential?

If there are no complications or reasons for concern, your baby's heartbeat will usually be monitored using a handheld device much like the one used during your prenatal appointments to listen to your baby's heartbeat. Once your labor is well under way, your nurse or midwife will listen to your baby's heartbeat for about 30 seconds to one minute every 15 minutes or so, which means that you can move around as much as you like in between.

If you have had complications in pregnancy, or problems develop during your labor, the midwife may recommend that your baby's heartbeat be monitored continuously. This means that you will have two monitors strapped to your belly using elastic belts. One measures the baby's heartbeat and the other measures the frequency of the contractions. The monitors are attached to a machine that prints out information in the form of a graph. This allows the doctors and midwives to keep a close eye on your baby's well-being and how she is responding to the contractions.

External monitoring does make keeping active a little more difficult but by no means impossible. Leads can be moved out of the way and adjusted, and some maternity units have wireless monitoring. You can talk to your doctor or midwife about how this will be managed.

How long will the first stage of labor last?

The first stage of labor lasts until the cervix is fully open, or “dilated ” . Women tend to time their labor from the first contractions, but midwives and other health-care professionals don't start to time a labor until it is “established,” once contractions are coming regularly, roughly once every three or four minutes, and lasting for about 45 seconds to one minute, and the cervix is around 3 cm dilated. Due to the difference in how labors are timed, you may hear about labors that lasted 50 hours and others that lasted two! On average, for first-time mothers labor lasts around 12–16 hours. If it continues after this time, the midwife or doctor may want to investigate why labor is not progressing.

Once labor is established, health-care professionals usually expect the cervix to open at an average rate of half a centimeter an hour. However, there are huge variations in this average, and a labor can still be progressing normally with a slower or faster rate of dilation. Your caregiver will keep you informed about how things are going during your labor, and don't be afraid to ask how things are progressing.

Q:	Is it best to stay upright in early labor?
A:	It is thought that keeping upright and mobile can help labor to progress and make the pain easier to manage. This is because in an upright position the baby's head can press down onto the cervix and in turn stimulate it to dilate, and also gravity helps the baby to move down through the pelvis.

I'm having a trial of labor—how long will I be allowed to be in labor for?

A trial of labor is something that is done if, for example, a woman has had problems in pregnancy or has had a previous cesarean. This allows a woman to be in labor long enough to determine if a vaginal birth may be possible. It is hard to say how long you will be allowed to labor for, as the length of time depends on how your labor is progressing and the opinion of the medical staff caring for you.

Your labor will be closely monitored, with your doctor or midwife regularly assessing its progress to check that the cervix is dilating as expected and that the baby is moving down through the pelvis. You may be offered continuous monitoring of the baby's heartbeat and medical assistance would be close in the event of a cesarean being needed.

When will I be fully dilated?

“Fully dilated” means that your cervix is fully open (10 cm) so that your baby can move down the vagina and be born. When your labor begins, your cervix is either closed, or only one or two centimeters open. The contractions of the uterus gradually open it further until it is completely open. Once this happens, you are in the second stage of labor, which lasts until the birth. The point at which your cervix is fully dilated can occur quite quickly after the onset of strong, regular contractions, or can take many hours.

What is meant by “transition” and why do people say it's the worst part?

Transition describes the period of time between the end of the first stage of labor and the onset of the second, or pushing, stage. Contractions are usually at their strongest and most frequent at this point. It can last from a few minutes to over an hour, and in some cases may not happen at all. The transition period is often characterized by a woman feeling exhausted, fed up, unable to cope, shaky, or nauseous. In movies and books, this is often the time when a woman swears and gets a bit mad with her partner! It is usually around this time that the first feelings that you need to push begin.

If you experience any of the unpleasant symptoms of transition, it helps to focus on the fact that your baby will soon be born. Try to keep your breathing slow and regular, and focus on your partner and caregiver for additional support.

When can I start pushing?

Ideally, you can start pushing as soon as you feel the urge to, assuming that your cervix is fully open. The urge to push is usually stimulated by the baby moving down the birth canal, which happens once the cervix is fully open. You may experience a sensation of needing to open your bowels and may actually pass some stools or urine, since the baby is pushing on the back passage. This is a very common occurrence in labor (see I'm scared that I will poop in labor).

If both you and the baby are well, you will be encouraged to follow the natural urge to push. Sometimes, you can feel an urge to push before the cervix is fully open. If this is the case, it is important to resist this feeling as much as possible, because pushing at this stage can cause the cervix to swell, which makes it more difficult for it to dilate. Some women find that kneeling on all fours with their head and shoulders lower than their hips is a good position for this stage of labor.

What is “crowning” and should I continue to push during this part of the labor?

This term refers to the part of birth when the widest part of the baby's head—known as the crown—eases out of the opening of your vagina. Your doctor or midwife will encourage you not to push at this stage so that the baby's head can be born in a slow and controlled way, which can help to prevent serious tears to your vagina and perineum (the muscle and tissue around the outside area of your vagina and anus). Although stopping pushing can be hard, you could try short panting breaths or slow steady breaths to help you achieve this.

Although many women are worried about the possibility of tearing during the delivery of their baby, it can be reassuring to remind yourself that midwives are very experienced and practiced at guiding women and helping them to avoid tears whenever possible.

I'm scared that I will poop in labor, how will I feel if this happens?

You are not alone—lots of women are very nervous at the idea of passing stool while they are in labor. It may not be what you want to hear, but in fact a large number of women do defecate, usually during the second, or pushing, stage of labor. This is totally natural and happens as the baby's head comes down the vagina and pushes against the rectum, where feces are stored. The feces are then forced out of the anus and this is totally beyond your control. It is unlikely that you will be aware of what is happening at this stage—the overwhelming sensations of birth will be more powerful! Midwives and doctors are very used to this, and will simply wipe it away without a second thought. Also, sterile cloths will be placed around so it will be easily cleared away.

Will I tear when the baby comes out?

Some women do sustain some degree of tearing during the birth of their baby. Unfortunately, it is impossible to tell whether you will tear or not until the actual delivery. Some tears only involve the skin and may not require any stitches. However, others can involve the skin as well as the muscle underneath and the vaginal canal, which will need stitches. Stitching will be performed by an experienced midwife or doctor after you have had a local anesthetic injection. There is some evidence to suggest that regularly massaging the perineum (the area between the vagina and anus) during late pregnancy may help avoid tearing . Allowing the baby's head to be born slowly can also help to prevent tears (see crowning).

What does a “skin-to-skin” birth mean?

“Skin-to-skin” is a phrase that means cuddling your naked baby against your bare skin. Many women want to have skin-to-skin contact with their baby right after the birth. This can help with bonding, the baby's temperature control, and the initiation of breast-feeding. As long as you and your baby are well, there should be no reason why this cannot be done—having your baby cleaned, weighed, and dressed can wait a moment. Most health professionals now recognize the importance of this early skin-to-skin contact, and will help you achieve this if that is what you wish. Communicate your thoughts and desires to your midwife or nursing staff as early as you can following admission to the labor area, so that the midwife can plan your birth to try and meet your wishes.

Q:	What happens in the third stage of labor?
A:	The third stage of labor lasts from after the birth of the baby until the placenta, or afterbirth, and membranes (the amniotic sac your baby has been growing inside) have been delivered. This stage can last for around 10–30 minutes, depending on whether your care provider waits for spontaneous expulsion or extracts it.

How does the placenta come out?

After the birth of your baby, the uterus starts to contract again and the placenta shears away from the wall of the uterus and passes out through the vagina. This will not feel the same as giving birth to the baby since the placenta is soft and much smaller! You may have had an injection to speed up this part of labor, and this is referred to as a “managed” third stage (see Syntometrine injection ). If this is the case, your doctor or midwife will apply gentle traction to the umbilical cord to guide the placenta and membranes out. If you are having a natural third stage, you won't need an injection, which may mean that this part of labor lasts a little longer, and the midwife will encourage you to deliver the placenta and membranes by pushing, and perhaps squatting over a bedpan. Your caregiver will advise you as to whether a natural or managed third stage, or a choice between the two, is most suitable for you.

What happens when you have an injection for the third stage of labor?

Sometimes, depending if your care provider believes in active management of third stage or favors a more natural approach, oxytocin (Pitocin) is injected into your arm or leg or by IV if you have one running. Such intervention has been shown to reduce blood loss from the mother but some care providers do not believe it is necessary unless there is a risk for hemorrhage or you have begun to bleed heavily.

What will happen once my baby has been safely delivered?

Once your baby has been born, if all is well, you will be encouraged to hold him and get to know him. The placenta and membranes will be delivered and the midwife or doctor will examine your vagina and perineum to see if you need stitches, which will be done under a local anesthetic. When you are ready, your baby will be checked over, banded with a plastic bracelet with your name and her date of birth, weighed, and dressed. If she hasn't been fed already, the nurse or midwife will help you with the first feeding. A light meal may be served and you'll be encouraged to drink plenty of fluids. If you and the baby are healthy and well, you may be able to go home within a few hours, sometimes straight from the labor ward, providing you have all the help you both need.

If you have a cesarean, you will be moved to a “recovery” room near for up to two hours to observe your breathing rate, pulse, and blood pressure. Your incision and vaginal blood loss will be checked as will your fluid levels, and the midwife will help you breast-feed your baby. You will then be moved to a postpartum ward. A typical stay after a vaginal birth is two days whereas for a cesarean, it would be 3–4 days.

It all sounds very “busy.” Will we be left alone at all once the baby is born?

Many couples look forward to having some time alone together after the baby's birth in order to start to get to know, and bond with, their baby in private. There shouldn't be a problem with this, as long as neither mom nor baby has any medical problems. The nurse will make sure you know how to call for assistance if you need it. If you are in a birthing room you may stay in the same room during your postpartum stay. Otherwise you will be taken to a postpartum ward about two hours after your baby's birth, if all is well. Or an early discharge home may be an option.