The 3 Stages of Labour Explained
Labour, the process which results in the delivery of the baby and the expulsion of the placenta, can occur at any time during pregnancy. Typically, it is identified when a pregnant woman displays signs of labour which can include the rupture of membranes (i.e. water breaking), the discharge of blood-tinged mucous from the vagina (i.e. bloody show), and regular uterine contractions of increasing intensity.
A woman experiencing any of the aforementioned signs should immediately go to the hospital to ensure that she has the appropriate care if she is indeed going into labour.
As labour progresses, a pregnant woman goes through the three stages of labour, which are quite simply and aptly named the first, second, and third stages, respectively. These stages, which are quite different and have their own complications, are more fully described below.
First Stage of Labour
The first stage of labour is presumed to begin with the presentation of labour signs such as painful, regular, low-intensity uterine contractions and bloody show, and ends with the full dilation of the cervix (10 cm).
The first stage is further subdivided into the latent and active phases.
The latent phase presents with mildly painful and irregular uterine contractions that occur every 5 to 10 minutes with no significant distress to the mother. During this phase, which lasts 4 to 7 hours, the cervix dilates slowly: at a rate of 0.5 to 1 cm per hour for a total dilation of 3 to 4 cm. Additionally, the woman’s water may break toward the end of this phase.
The active phase, which lasts 3 to 6 hours, is indicated by strong and painful contractions that occur very frequently as well as rapid cervical dilation. A vaginal examination is performed at the end of this phase to assess and ensure that full cervical dilation, which occurs toward the end of this phase, has been attained. At this point in the process of labour, the woman may feel an urge to push. However, this is not advised as it may lead to lacerations inside the cervix.
For women who are having their first child (nullipara), the first stage lasts 8 to 12 hours, while for women who have given birth before (multipara), the stage is shorter and last 5 to 9 hours.
Management of the First Stage of Labour
Typically, a woman is admitted to the hospital during the first stage of labour, after which the doctor will likely receive her complete medical records includingthe past medical history and any complications in previous and/or current pregnancies. Then, a history is taken, symptoms are noted (i.e. rupture of membranes and bloody show), and blood tests are run. The woman’s vitals (blood pressure, temperature, and heart rate) are monitored every two hours.
Additionally, an abdominal examination is performed to assess the position of the baby and a cardiotocogram (CTG) is conducted every 15 minutes during the active phase to monitor the foetal heart rate (typically, 120 to 160 beats/minute). The frequency, regularity, and intensity of uterine contractions are also closely monitored with a sterile vaginal exam, which is performed every 4 hours to assess cervical dilation and foetal descent. During this time, the healthcare providers inform the woman about the progress of labour and discuss potential pain relief options.
Second Stage of Labour
The second stage of labour is the most painful stage of labour, which begins with full cervical dilation and ends with the delivery of the newborn baby. This stage is further subdivided into the early second stage and the late second stage.
The early second stage begins when the cervix is fully dilated and uterine contractions become more frequent and very painful. At this point, contractions are regular, occurring every 2 to 5 minutes with a duration of around 1 to 1.5 minutes.
These contractions help the foetus change position and descend deep into the pelvis of the mother. Typically, on reaching the pelvis, the foetus’ head rotatesto make room for himself or herself.
In the late second stage, which ends with the delivery of the baby, begins with crowning, the process by which part of the baby’s head slowly and visibly emerges from the birth canal. The woman is then compelled to push in order to completely release the head. During this period, mothers typically complain of rectal pain and/or having the desire to pass stool due to the pressure exerted by the foetal head.
After around 15 minutes of pushing, the anus opens, creating more space, and, with each contraction and push, more and more of the head begins to appear. At this point, the woman may push even when contractions are absent. Once the head is born, the shoulders, trunk, and legs quickly follow.
For women who are having their first child (nullipara), the second stage lasts 1 to 1.5 hours without the epidural and up to 3 hours with the epidural. For women who have given birth before (multipara), the second stage is shorter, lasting 25 minutes without the epidural and from 45 minutes to an hour with the epidural.
Management of the Second Stage of Labour
During this stage, the full cooperation of the mother is required (i.e. pushing when instructed). As this stage brings tremendous pain, the pain relief options that were discussed during the first stage should be administered. Furthermore, a partner or attendant should be with the mother during this period to provide both the emotional support and the encouragement needed to bear the pain, push, and relax, as needed.
Additionally, a few other techniques may be applied to bring about an easier and faster second stage. These include, propping up the bed at a 45 degree angle, making it easier to breath as well as push, and switching positions (i.e. squatting, kneeling, or sitting up) as needed.
Third Stage of Labour
As the bulk of the hard work is done during the second stage, the third and last stage of labour, which extends from the birth of the baby to the expulsion of the placenta, is typically much smoother and much less painful. The expulsion of the placenta occurs with the combined help of uterine contractions, which are decreasing in intensity, and the retraction of the uterus, which aids expulsion by reducing the size of placental tissues to a fourth of their size during pregnancy.
Typically, this stage is indicated by the following signs:
· A gush of blood
· Rounded or spherical appearance of the abdomen
· Lengthening of the umbilical cord
Management of the Third Stage of Labour
The healthcare providers typically wait 20 minutes for the aforementioned signs to appear as premature detachment of the placenta by pulling on the umbilical cord may lead to severe blood loss and, in extreme cases, rupture of the uterus. When the placenta is seen separated in the vagina, the uterus is massaged to create a contraction that aids in smoothly and painlessly expelling the placenta.
Additionally, in some cases, when the expulsion of the placenta is prolonged (i.e. takes more than 30 minutes), medical management, which has the benefits of reducing blood loss and shortening the third stage of labour, may be required. A form of medical management that is commonly seen is the injection of oxytocin to increase uterine contractions. However, oxytocin may also cause nausea and vomiting, side effects which are often seen with oxytocin use.
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