After nine months of pregnancy, the big moment is nigh...but what actually happens during childbirth?
Dilation of the cervix
As you approach the pushing stage of labour, contractions will occur at a rate of about one every 3 to 4 minutes. Your cervix starts off long and hard like the end of your nose and as your labour progresses, it softens and thins out (like a polo neck jumper rolling up) to feel soft like your lips, this is called effacement. Gradually, your cervix will also open up (dilate) until it has all disappeared and you are 10cm dilated and your baby is nearly ready to be born. This dilation phase lasts for about 8 hours if it’s your first baby.
Pushing
Once baby has moved down into your pelvis, contractions will occur every 2 minutes. Baby is engaged in the pelvic bone, with the head downwards, and will continue to move downwards, head first, with the head curled in towards the chest and turned slightly to the side. As baby continues to move through the pelvis, the head changes position to straighten out and the face is turned towards the floor. You will soon feel the uncontrollable urge to push, this is when you should start pushing. Listen to your midwife, she will guide you. Your baby presses on the perineum and starts the pushing reflex alone to speed up the delivery. Wait for the midwife to tell you to push, and breathe deeply when she asks you to. Once baby’s head appears, you will push again to deliver the rest of the body.
Delivery of the placenta
There are two ways to deliver the placenta:
Active Management - This is when your midwife injects a hormone drug (syntometrine or syntocinon) into your leg following the delivery of your baby. This will cause your uterus to contract and your placenta to be expelled. Your midwife will gently pull on the cord until your placenta and membranes are delivered. This is quicker than normal expectant management, taking only 5 minutes. If you have had any intervention in your labour this may be recommended as you may not bleed as heavily initially. You should discuss the delivery of the placenta with your midwife before the birth of your baby so that you are aware of any side effects of the drug prior to when you are in labour. You can then put your wishes into your birth plan.
Expectant or Physiological third stage - This can take up to two hours but usually occurs 10 to 20 minutes after the birth, when contractions will resume so that you can deliver the placenta. Once it’s out, your midwife will check that it is complete and that nothing has been left behind, which could lead to an infection. A physiological third stage may be recommended if you have not had any intervention during your labour and everything has been straightforward. You may bleed a little heavier at birth than if you had Active Management, but blood loss in the postnatal period is sometimes found to be less.
