When does it start? And more importantly, when does it end?

The questions, fears and worries around childbirth are considerably more than around the whole pregnancy.

When will labour start and when will it end?
Will I recognise the signs of labour even though I haven't given birth yet?
How long will it take?
Will I be able to manage the pain or will I need an epidural?
Will they hook me up to a fetal monitor?
What if labour doesn't progress?
What if I have such a fast labour that we don't get to the hospital in time?

In this article we will try to give you answers to these and many other questions.

You can rest assured.
The fears and doubts that come with impending labour are perfectly normal and understandable.
It doesn't matter at all if you are a first-time or a multiparous mother. Every birth is different and unique.

What are the 4 signs of labor and delivery

1. The passing of the mucus plug

A mucus plug is a transparent drop of mucus that closes the lower part of the cervix in pregnancy.

For more detailed information about the mucus plug, read our article:
Mucusplug in pregnancy: when does it form, what does it look like, how does it leave?

If you develop a bloody mucus discharge (pink or brownish-red), it means that the cervix is gradually starting to dilate. It may be a signal that labour is about to start.

The process of labour will usually start within 24 to 48 hours after the mucus plug comes off, but in many cases it can be several days or weeks.

Attention!
If the discharge suddenly turns bright red or heavy bleeding occurs, contact your doctor or seek the nearest medical attention immediately.

The only real sign of labour starting is frequent and regular uterine contractions.

2. Regular contractions

Contractions are uterine contractions that may be regular or irregular.

Childbirth usually starts with light contractions that resemble abdominal cramps during menstruation or digestive problems.
They are usually accompanied by frequent visits to the toilet.
Often the woman does not pay much attention to them. She only notices them when they become more pronounced.

How do I know if my contractions are regular?

• The length of the contraction is 40 to 60 seconds
• the interval between each contraction (the time from the start of one contraction to the start of the next) is 5 minutes
• each contraction is at regular intervals for 15-20 minutes
• during contractions the intensity of the perceived pain is constant (the pain does not diminish)
• changing the position of the parturient does not affect the contraction activity of the uterus

3. Amniotic fluid outflow

A proportion of births, approximately 15%, begin with amniotic fluid rupture. After amniotic fluid drainage, regular contractions usually occur within 12 to 24 hours and labour begins.

Only a small percentage of women experience a sudden amniotic fluid flow.
It is not uncommon for amniotic fluid to flow slowly, a little at a time.

In any case, it is necessary to go to the hospital after the amniotic fluid has drained.

Amniotic fluid is a whitish or slightly pink liquid.
If it is greenish or cloudy, do not delay leaving.

4. Maturity of the cervix

During labor, the cervix softens, shortens, and moves from a posterior position (pointing toward the coccyx) to a forward position (pointing toward the pubic bone).
It gradually thins and turns into a birth gate.

Your obstetrician will detect the fourth sign of an incipient labour when you are admitted to the delivery room.
He or she will assess the obstetric findings by vaginal examination and inform you of the next expected course of action.

The condition of the cervix is assessed in the following characteristics:

• length
• dilation (opening of the cervical canal)
• orientation (towards the coccyx, in the middle, forward - towards the pubic bone)
• consistency (firm/soft)
• cervico-corporeal angle (this is an assessment of the steepness of the narrowing at the internal cervical gate)
• urgency (this is the relationship of the lowest part of the fetus, most often the head, to the pelvic entrance)

The course of labour

1.

• begins with: the onset of the first regular contractions
• ends: opening of the cervix to 10 centimetres and complete disappearance of the birth gate
• duration: 10-12 hours in a primiparous woman, 6-8 hours in a multiparous woman

2. II. period of labour - expulsion

• begins: at the moment of complete disappearance of the birth canal, when the cervical rims fuse with the vaginal wall to form a single birth canal and the birth canal is ready for delivery
• ends: with the birth of the foetus
• duration: 30-40 minutes in a primiparous woman, 20-30 minutes in a multiparous woman

3. III. period of labour - postpartum period

• begins: with delivery of the fetus
• Ends with: delivery of the placenta and membranes
• duration: approx. 20 minutes

First period of labour: opening

Every woman who gives birth at term and without a caesarean section goes through the three phases of the first period of labour.

The first phase: early or latent

In this phase, the cervix gradually softens and opens to 3 centimetres.
This is the longest and fortunately least intense phase of labour.

It can last for a few hours, but can also last for days or weeks without stronger contractions.

Characteristic signs of uterine contractions in this phase:

• lasting 30 to 45 seconds, sometimes shorter
• they tend to be mild to moderate
• regular or irregular with intervals of 5 to 12 minutes
• the intervals between contractions become progressively shorter
• some women do not even notice them
• do not disappear after a change of position or, for example, after a shower

Sometimes towards the end of the opening phase of labour (when there are 5-minute intervals between contractions) it is time to be taken to the hospital.

The time of departure should also be adjusted to the distance of the hospital from where you are staying.

Remember!
You should leave for the hospital immediately if:

• amniotic fluid has drained, especially if it is cloudy or green
• you have a pale red discharge
• you can't feel the fetus moving

If you have no such problems, call your doctor or midwife if you are in any doubt.

How will you feel?
The most common symptoms at this stage of labour are:

• Back pain (persistent or only during contractions)
• cramps similar to menstruation
• nausea
• diarrhoea
• feeling of heat in the abdomen
• mucus discharge

Don't be alarmed, it doesn't mean you'll have all the symptoms.
Maybe just one or two.

You may feel a wide range of emotions, from excitement to uncertainty, fearfulness to feelings of happiness and relaxation.

Table.

If you will be experiencing the first stage of labour already in the maternity unit for various (above) reasons, most of the interventions listed in the table can be implemented there.
However, consideration must be given to the running and specifications of the unit, so communication with staff is paramount.

Second phase: active

At this stage, you are probably already in the maternity ward.

The intervals between contractions are getting shorter are 3-4 minutes.
The contractions themselves are getting longer.
By this time, the cervix is already open to about 7 centimeters.
There is less time to rest between contractions.

It may be that you did not feel the first stage, but the cervix has already gradually opened.

How will you feel?
The most common symptoms at this stage include discomfort related to the increased strength of the contractions:

• Strong contractions won't let you talk much
• Back pain will increase
• You will be tired
• Your amniotic fluid will drain spontaneously. If it doesn't, your doctor will perform an amniotomy - which is most often a completely painless procedure
• You may be restless and have trouble relaxing
• Or you may be so focused on having the baby that you can't notice anything else
• Your confidence will drop and you will feel that the birth will never end
• Or maybe just the opposite, you'll be excited and hopeful that the happy moment is coming

Table.

Third stage: transitional

This is the most challenging part of labour, by the end of which the cervix is fully open.
Then it's time to push.

Characteristic signs of uterine contractions in this stage:

• they become increasingly intense
• the intervals between them last 2 to 3 minutes
• contractions last up to 60 seconds
• the peak of the contraction lasts almost the entire duration of the contraction
• some parturients experience several peaks during one contraction
• you may feel that the contraction never ends and you cannot relax between contractions

How will you feel?

• you may feel strong pressure in your lower back or perineum area
• pressure on the anus with or without the urge to push
• there may be a feeling of warmth and wetness or, conversely, a feeling of coldness and shivering
• the bloody discharge becomes more intense
• your legs may feel cold, in many cases they start shaking uncontrollably
• nausea, drowsiness or vomiting are not exceptions
• you may have trouble relaxing

Table.

During the first period of labour you will still be expecting:

• Travel to the hospital
• the obstetric reception
• a consultation with the staff about your birth plan
• administration of cleansing fluids - with your consent
• administration of an infusion to ensure hydration
• vaginal examination to monitor the progress of labour - performed every two to three hours
• in the event of inadequate labour (if at any time during labour the cervical findings do not change within 3 hours), on medical indication, uterine function needs to be supported by an infusion of a solution containing the hormone oxytocin - not routinely administered, reasons will be explained to you
• insertion of an intravenous cannula - not routinely performed
• amniotomy
• administration of epidural analgesia at your request - if the cervix is open to 3 to 4 cm and the uterus is regular - this is determined by the obstetrician
• termination of labour by caesarean section (non-progressive labour, threat to the life and health of the baby or you)

Second period of labour: expulsion

From this point on, your active participation in the birth will be needed.

Now that the cervix is completely open, you need to push the baby into the world through the birth canal.

This process takes half an hour to an hour.
It can take as little as ten minutes or as long as two hours.

How will you feel?

• At this stage, you will have difficulty detecting the onset of contractions.
• you feel an uncontrollable urge to push
• you feel a burst of new energy or, on the contrary, exhaustion
• you may feel strong pressure on your anus
• the contractions are distinct with an obvious enlargement of the uterus during contraction
• the bloody discharge intensifies
• there is a tightening of the vagina as the head moves
• feeling of slippery wetness as the head emerges
• Mental relief as you can start to push

Table.

During the second period of labour, you still have to:

• the mother may not be able to exert enough pressure to deliver the baby
• if the baby is at risk of inadequate oxygen supply during labour, the labour should be stopped quickly
• the doctor may decide to end the labour with one of the obstetric operations, either forceps or vacuum extractor (bell), in order to protect the life and health of the baby
• in the event of a sudden threat to the life and health of the baby or the mother during the delivery, the delivery must be terminated by caesarean section

Caesarean section is a method that is reserved only for exceptional cases. It can in no way serve as a method of facilitating childbirth.

The third period of labour: delivery of the placenta

The third period of labour lasts about 20 minutes.
At this stage of labour, the placenta, which has provided the baby's vital functions until birth, leaves.

A few minutes after birth, mild, painless contractions may occur.
During these, the placenta detaches from the uterine walls and moves into the vagina, where it can be pushed out.

After the placenta is delivered, the birth canal is checked, postpartum injuries are treated and an episiotomy is sutured.

How will you feel?

• You will feel tired after the delivery is over
• you may feel a surge of new energy
• you will be thirsty and hungry
• some women will get shivering
• every woman who gives birth has a bloody vaginal discharge (lochia) like a heavy period
• the immediate emotional reaction after childbirth is relaxation
• impatience during delivery of the placenta and during treatment of postpartum injuries is common
• some women feel a strong attachment to their partner and a strong emotional attachment to the baby
• others tend to be more oblivious and resentful, especially after a difficult and prolonged labour

Tips for you:

The first signs of pregnancy. How to recognize them?

Who is the midwife? And what is her job?
Have you been overwhelmed by nervousness and stress?