The Agony And Ecstasy Of Childbirth
I can summarize my memories of childbirth as follows:
- Come on, it is time for you to come out now!
- Hallelujah, finally the time has arrived.
- Unbearable back pain that was driving me crazy (so I had an epidural).
- Push, come on PUSH! What the hell do you think I am doing? I am red in the face and exhausted – don’t mess with me!
- Dignity! What is that! Here I am exposed to all and sundry in the labor room with no control over anything! Everyone is more concerned about what is going on down there – I am sure they will recognize that before recognizing my face!
- Just get this baby out of me! Why can’t he have the baby? I am never having another one!
- Finally, the exhaustion, pain and suffering are overshadowed by the wonder of holding your newborn for the first time.
- Motherhood – all is forgiven and forgotten……..until the next time!
During pregnancy, you spend approximately 280 days going through body changes, emotional turmoil, hormonal changes and are subjected to all sorts of ailments until you get to the point where you just want baby to be born. But you still have to go through hours of labor before that happens! Modesty disappears with everyone watching that part of your anatomy! Your pain threshold is tested to the maximum and you go through a range of emotions that even surprise you!
Yet, when you hold your newborn, all of this fades into a distant memory and soon you are ready to go through the whole process again and maybe again and again……! Are we suckers for punishment or is childbirth a labor of love?
Being a first time mom, as you near your due date, it can be a time of anticipation but feeling anxious as well. At this point you are keen to get baby out as you are pretty uncomfortable, but at the same time, nervous about the unknown factors in labor and childbirth. Each twinge makes you wonder if labor has started.
Just as each pregnancy is unique, each labor and delivery is too! It certainly is not what you see on television either – swift, on time for a commercial break and full of drama.
Both of my children took their time before eventually being born, but my younger sister had to rush to hospital immediately at the first sign of any contractions and only just made it in time for the delivery of her children!
It is impossible to predict when you will go into labor, how long your labor will be and if you will need medical assistance or medical intervention. But you can prepare yourself mentally by knowing what to expect.
What Are The Early Signs Of Labor?
Preparation for labor starts with the cervix softening and thinning (also called effacement or ripening).
Usually your cervix is about 3.5 cm long (measured at 24 weeks of pregnancy) and during labor it will become completely effaced, ready for delivery. Effacement is measured in percentages: 3.5 cm would be 0% and fully effaced would be 100%. At your prenatal visits, your doctor will establish whether this has started by doing a vaginal examination.
In addition, the cervix starts to dilate or open.
Some dilatation may occur before contractions start. It is not uncommon for the cervix to be 2 to 3 cm (just less than 1 inch or just over 1 inch) dilated days before labor actually starts. Again, this can be confirmed by a vaginal examination at your prenatal visit.
As the cervix starts to dilate, the mucus plug will be released in the form of a bloody or brownish discharge.
This may be the first sign that you notice.
Water breaking: sometimes this happens before labor has started. This means that the amniotic sac that has been the protective covering for your baby inside the womb has ruptured (hence the name “ruptured membrane”) and the amniotic fluid then leaks out through the vagina.
It may happen in a gush or a slow leak. Most women will then go into labor within 24 hours.
If you are uncertain whether you are leaking amniotic fluid or just had a bladder leak, put a sanitary pad on and check regularly (it also smells differently). If there is a consistent leakage, contact your midwife or doctor.
Labor pains or contractions – how do you know if these are real? Labor pains generally start slowly and you may either feel mild contractions or slight backache – this is the confusing stage – is it a false alarm or not?
To tell if you are really having labor pains, time:
- How often you are getting the contractions and
- How long they last for.
If they are getting longer in duration, stronger in intensity (rising like a wave to reach a crescendo, then subsiding) and more frequent (less time in between contractions), contact your midwife or doctor.
Sometimes it is hard to tell if you are in labor, especially with your first pregnancy, so expect false alarms and do not feel embarrassed if nothing happens. Your body is doing what it needs to do and labor will eventually make itself crystal clear, but for now it may just be giving you a heads up on what is about to happen. Treat it as a practice run for the real one around the corner.
What To Expect During The Three Stages Of Labor
The First Stage Of Labor
- Latent Phase
- Active Phase
- Transition Phase
During The latent Phase:
- Your contractions begin, each one lasting about 30 to 60 seconds with gaps of 5 to 20 minutes in-between each contraction.
- Over several hours, your contractions progressively become stronger, develop a more regular pattern and become more frequent with less time in-between each contraction.
- Your cervix starts effacing and dilating to about 4 cm.
This is usually the longest phase of labor (can be 12 hours or longer) and the one that is least uncomfortable, so it is a good time to relax, adjust to the news that you are actually in labor and to get ready for the next phase. Drink plenty of fluids, eat small snacks, take a nap, make those important phone calls to family and friends, check that your hospital bag is ready, take a relaxing shower, listen to music, focus on some light activities or ask your partner for a good shoulder massage.
As you are most likely to still be at home during this time, keep your support group near you, especially as the contractions become stronger, to help you with your breathing techniques.
You will most likely head for the birthing center when you enter the active phase, but your midwife or doula will be able to advice you when to go. Traditionally, the 5-1-1 rule has been used: when contractions occur at 5 minute intervals, last for a full minute and have been like that for about an hour.
The Active Phase
- During this phase your cervix effaces and dilates to 8 to 9 cm.
This is when the hard work begins as your contractions become longer (1 to 2 minutes), stronger and more frequent (3 minutes apart), which does not leave you much breathing space in between. You may feel intense pain in your back or abdomen during each contraction.
Due to the rapid progress during this phase, finding a comfortable position and focusing on your breathing and relaxation techniques may become more difficult. You may want to try walking or changing positions often.
As the contractions increase in frequency and intensity, you will need your support to help you focus on breathing through the contractions and relaxing in between.
Pain relief options may be provided during this phase.
The active phase lasts longer for first time mothers-to-be (average of around 5 hours) than for subsequent births (average around 2 hours).
The Transition Phase
This is the most challenging phase for you and your support team as your contractions will be very long, strong, painful and frequent. Thankfully it is a short phase, lasting up to 2 hours. During this phase:
- Your cervix will dilate fully (10 cm) and
- You may experience nausea, vomiting, uncontrollable shaking, hot flashes, irritability, intense emotions and the urge to push.
Once you feel the urge to push (feels like you want to go to the toilet) tell your midwife, but don’t push until you are given the all clear to do so, as you can cause damage to your cervix if you push to soon. Hang in there – you have almost completed the labor marathon.
The Second Stage Of Labor
Your baby’s head “crowns” when the crown of baby’s head reaches the vaginal opening and does not slip back after each contraction, it stays visible and you can feel your baby’s head with your hand.
As your baby’s head crowns, your perineum (the area between the vaginal opening and the anus) is stretched to the maximum and your doctor will then decide whether you need an episiotomy, a small incision in the perineal area, to assist the delivery of your baby and prevent the perineal area from tearing. An episiotomy is only done if needed and is not a routine procedure.
Once your baby’s head is out, baby’s nose and mouth may be suctioned before you continue to push to deliver baby’s shoulders and body.
As you are pushing, it is not uncommon to pass a stool at the same time. Do not panic, as the staff will be very used to this. It is inevitable as baby is pushing on your rectum and you are trying to push baby out, so, sometimes, both happen. If you have a full bladder, you may even pee during childbirth.
Childbirth is definitely not a glamorous occasion, but who cares! Once your baby is born and you hold him/her in your arms, that precious moment makes everything else fade into insignificance.
Stage three of Labor
Once your baby is born, the uterus starts to contract and shrink in size and this causes the placenta to separate from the wall of the uterus.
This stage can be actively managed with the help of drugs or without (expectant management or physiological third stage).
In active management you will receive an injection of oxytocin in your thigh within a minute of delivering your baby. This injection stimulates the uterus to contract and speeds up the separation of the placenta from the uterus.
While your midwife or doctor gently pulls on the cord, supporting your uterus with a hand against your lower abdomen, you may be asked to push (nothing like before – just a gentle one) to help in delivering the placenta. I remember being told to cough.
In expectant management, no drugs are administered and the placenta is allowed to separate and deliver spontaneously. This may take up to an hour. Breastfeeding your baby may help the uterus to contract.
It would be best to discuss your options with your midwife or doctor, keeping in mind that this may change depending on whether you will require medical intervention during labor.
The biggest risk during the third stage of labor is postpartum hemorrhage (PPH), losing more than 500 ml (16.9 ounces) immediately after delivery. It may be caused by some of the placental tissue still remaining in the uterus (retained products), the uterus not contracting properly (uterine atony), a bleeding disorder or trauma.
Therefore care is taken to deliver the placenta and attached membranes, making sure the uterus is well contracted and checking the placenta to make sure there is no missing bits.
The First Few Minutes After Your Baby Is Born
If all is well, your baby will be lifted onto your abdomen, while your placenta is being delivered. You may be able to breastfeed your newborn within an hour of birth.
If you need stitches, this will be done under local anesthetic.
Your baby will be checked medically, his/her identification tags put on and a wrap placed over him/her.
The midwife or nurses will also check your pulse, blood pressure, the firmness of your uterus (how well it has contracted), assess whether your blood loss has settled and whether you have been able to pass urine.
If all the checks are satisfactory, you will be transferred to the postnatal ward for some private time with your partner and newborn baby.
Postpartum – What To Expect
If you are feeling exhausted, battered and bruised, that is OK. You have just been through a long hard traumatic experience both physically and emotionally. Your body has taken a beating and your emotions are all over the place. Allow yourself some time to recover. Rest and sleep as much as you can.
Many first-time parents are a little apprehensive about picking up and holding their tiny baby, but you will be shown how to do so and once you have, it is like a huge relief! After that, it becomes instinctive.
In the first week, your breasts may feel huge, lumpy and sore as your milk comes in. Feeding your baby often, wearing a good supporting bra and warm showers may help.
One thing you can expect is to have fairly heavy bleeding (like a heavy period) for 3 to 10 days, after which it starts slowing down and will eventually stop around 3 to 6 weeks after delivery (earlier if you are breastfeeding). As it slows down, the bleeding (also called lochia) will change to a pinkish discharge and then a brownish one.
If you notice any blood clots or continued heavy bleeding (soaking a pad within an hour) or an unpleasant odor, contact your doctor.
Another problem to avoid is constipation. Your bowels may take a few days to get back to their normal pattern, so drink lots of fluids, eat plenty of high fiber foods and try to get active by walking around. If you do not have a bowel motion within 2 to 3 days, a mild laxative may be needed.
If you needed stitches in the perineum, you may feel sore and uncomfortable after the local anesthetic has worn off. Ask for painkillers if you need them. Salty baths may also help to soothe the area.
Many women feel a bit down a few days after giving birth, so if you find yourself crying or feeling miserable without any reason, you are not alone. Many women go through the “baby blues” and it does normally pass. However, if this feeling persists or gets worse, please contact your doctor as you may be suffering from postnatal depression (PND).
The long and eventful road to parenthood is exciting, full of anticipation, challenging and a unique experience that you will never forget. It brings out every emotion, turns your life upside down and you learn more about your body in those 9 months than ever before!
Yet it is but just a short step in the journey of being a parent. So keep those precious memories to be able to look back and remember how it all started.