PREGNANCY

The stages of labour

Förlossningens olika faser - engelskaThe content concerns Östergötland

The baby is inside the uterus, about to be born through the vagina. The bottom of the uterus is shaped into a tip, which is called the cervix. The cervix leads down into the vagina. Towards the end of the pregnancy, the cervix becomes softer. When that happens, you may experience increased discharge. You may also see some thick mucus. This is sometimes called a “mucus plug”. Not everyone will see a mucus plug.

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In order for the baby to come out, the cervix has to be open. When the baby is coming, the cervix becomes shorter and thinner. When the cervix has dilated, the opening where the baby enters the vagina is usually around 10 centimetres in diameter.

Latent phase - Latensfasen

The first part of the labour is sometimes called the latent phase. During this phase, the body starts preparing for the more active stage of labour, when the baby is actually birthed. The latent phase can last up to twenty hours. Sometimes longer.

The delivery normally begins with contractions, i.e. when the uterus begins contracting. The contractions in the latent phase prepare the uterus for birthing the baby. They help the cervix to soften, become shorter and begin to dilate.

The first contractions usually feel like menstrual cramps. They normally start out being irregular. Sometimes, there is a long pause between contractions.

The delivery can also start with some light bleeding from the vagina. This is called a bloody show.

Try to relax

In the latent phase, you are usually still at home and can take it easy. It is good if you can try to relax and save your strength. You can take painkillers with paracetamol if you need to. Heat and massage can also help with the pain.

This stage can be hard, because you are in almost constant, light pain.

Contact the delivery ward

During the latent phase, it is time to call a delivery ward. This also lets them plan for your arrival. You can also receive advice and tips if needed.

You may need to go to the delivery ward if the latent phase lasts more than 24 hours. They can give you medical pain relief when you are giving birth. The pain relief can help you rest, so that you are not exhausted by the time the second stage begins.

The labour sometimes has to be induced. The midwife can burst the amniotic sac to make the waters break. You may also be put on a drip to induce labour.

The delivery sometimes starts with broken waters or heavy contractions

Sometimes, you hardly notice the latent phase. In that case, you have heavy contractions from the start, and when you arrive to the delivery ward, the cervix is already several centimetres open.

Some deliveries begin when the amniotic sac bursts and amniotic water comes out of the vagina.

The active phase - Öppningsskedet

The latent phase is followed by the active phase. This is the time when the cervix opens fully for the baby to enter the vagina. During the active phase, the contractions become stronger. They also get longer and come more regularly. When that happens, it can be time to go to the delivery ward. They can help you manage the pain. It can sometimes be hard to know when it is time to go to the delivery ward. You can always call the delivery ward for advice.

The first time usually takes the longest

The first time you give birth vaginally, the cervix usually dilates roughly half a centimetre per hour. But it can go both quicker and slower. The cervix usually dilates more rapidly if you have given birth before, perhaps one centimetre per hour.

Towards the end of the active phase, the baby’s head passes a place in the pelvis called the ischial spines. This is a narrow place for the baby’s head to pass through. You may therefore feel pressure against the pelvic bones. You may also feel nauseous. Some people vomit at this point.

After the ischial spines, the baby must pass down towards the pelvic floor. This requires more contractions, before it is time for the next stage of the birth.

The second stage of labour – pushing and giving birth - Utdrivningsskedet – att krysta

The second stage of labour consists of the actual birth. At this point, the baby has descended far enough into the pelvis that it is time to push it out through the vagina. You will normally feel the urge to bear down and push. When you have a contraction, you may feel like you need to empty your bowels.

Some will have the urge to push before the baby is far enough down. The midwife will tell you if this is the case. If it is, you have to try and breathe through the contractions without pushing. The midwife will help.

The first time you give birth vaginally, you will usually have to push for up to an hour before the baby is out. It can sometimes take even longer. If you have given birth before, you will rarely need to push for more than 30 minutes.

When you are pushing, you may feel that you want to get the baby out as fast as possible. But it is often a good thing if it takes a little time. This gives the vagina time to stretch properly and there is less risk of tearing.

The third stage – after the baby is born - Efterbördsskedet - när barnet är fött

The baby usually starts breathing and crying as soon as it comes out. Babies usually have a strange colour in the first few minutes, and the head can look a bit compressed. This is normal.

You can hold the baby right after giving birth, as long as it seems healthy. The midwife checks how the baby is doing, so this is nothing that you need to worry about. The midwife will wipe the baby dry and put a hat on their head. It is good for the baby to have skin-to-skin contact under a blanket for warmth.

Some babies need help to recover or to start breathing after the birth. The staff will then take the baby to a separate table, where they are helped by a midwife or paediatrician.

The uterus starts to shrink down

Once the baby is born, the placenta detaches from the uterine wall. This causes a bleeding from where it was located. At the same time, the uterus starts to shrink down. As the uterus contracts and shrinks down, the wound left by the placenta becomes smaller and the bleeding subsides.

The placenta must also come out. It is usually easy to push the placenta out, it is soft and malleable. The midwife will press on your abdomen to make sure that the placenta is detaching and that the uterus is shrinking down.

It is important for the uterus to shrink down as fast as possible. The midwife will usually give you a shot of oxytocin. Oxytocin is a hormone that causes the uterus to shrink and the bleeding to stop.

The midwife examines the placenta

When the placenta has been expelled, the midwife makes sure that it is intact and looks the way it should. The midwife also inspects the umbilical cord to count the blood vessels. They then examine your vagina, labia and perineum to see if there are any tears from the birth. You will often be given an anaesthetic before this examination.

It is common to lose up to a litre of blood during childbirth. It may sound like a lot, but your body is prepared for it. It has formed extra blood during the pregnancy.

The days following the birth - De första dygnen efter förlossningen

As soon as the baby is born, your body starts adapting to no longer being pregnant. There are hormones that affect you both physically and emotionally. After giving birth, it is normal to feel bruised and battered. You may experience muscle stiffness, tenderness and swelling in the pelvic area and sore breasts.

Afterpains

The uterus continues to contract. This is called afterpains. These are important to ensure that the uterus shrinks down properly. The afterpains are the strongest in the beginning, and particularly during breastfeeding. The afterpains may feel like menstrual cramps, if it is the first time you have given birth. If you have given birth before, the afterpains will usually be a little more painful.

Lochia

Lochia is a bloody discharge produced by the wound in your uterus. You may have lochia for up to eight weeks after the birth.

Emotions

Hormonal changes make you emotional in the first few days. You may feel sad and depressed. This usually passes after a few days. Some suffer post-partum depression after the birth.

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