Most women deliver in semi-recumbent position while some women prefer the "all fours" or squatting positions.
Labour is traditionally divided into three stages:
The length of labour varies for different women. The average active phase of labour lasts for 8–12 hours in your first pregnancy. Labour is often shorter for subsequent pregnancies.
Stage 1 — latent phase
Duration: variable, from a few hours to a few days.
This is often the least painful stage of the labour. During this phase, you may experience very non-specific symptoms such as a mild backache, abdominal cramps, bloody show or passing of the mucous plug. Ambulation can help by distracting you from these symptoms and hasten this phase. You may start to prepare to head for the hospital once the contractions increase or if your water bag bursts.
Stage 1 — active phase
Duration: 8–12 hours (about 1 cm per hour of dilatation).
During this phase, the contractions increase in intensity and frequency, lasting for up to 45 seconds at times. By this time, you should have been in the hospital for an internal vaginal examination to assess the extent of cervical dilatation. You would have been admitted into the delivery suite for the management of this phase of labour.
It is a common practice to manage your labour actively. This entails artificially rupturing your membranes and getting you started on an intravenous medication known as oxytocin to maximize your contractions. Studies have shown that this shortens the labouring process and thus avoids the problems associated with a prolonged labour, such as infections and postdelivery bleeding.
Furthermore, the rupture of the membranes enables your doctor to assess the colour of the liquor to see if meconium (motion) has been passed out by your baby, which may indicate that your baby is under stress. Be assured that there is nothing unnatural about this as it merely serves to assist your natural delivery process. Furthermore, it does not increase your chance of having a cesarean section.
You will also be offered a variety of pain relief options.
Read more: Labour Pain Relief
Stage 2 — delivery of your baby
Duration: 30–120 minutes (this may be longer if the clinical situation allows, especially if epidural anesthesia is used).
This is the stage where you are required to work the hardest to help push your baby out. Your doctor and/or the midwives will be beside you to help guide you through this. You may notice an urge to bear down owing to the pressure of the baby’s head on your perineum and back passage. This may be accompanied by the passage of faeces but do not be embarrassed. To aid the delivery, your legs may be raised up to allow more room within your birth canal. It is also here that an episiotomy may be made for the delivery.
Read more: Pushing and delivery: Is an episiotomy needed?
At times, your obstetrician may even need to assist you by using either a vacuum, forceps device or even fundal pressure to help deliver the baby’s head.
Read more: Vacuum and Forceps delivery
Stage 3 — delivery of the placenta
Duration: 5–30 minutes.
Once the baby is delivered, your uterus will continue to squeeze out the placenta so that it separates from the wall of the uterus.
This separation process is usually accompanied by a sudden gush of blood from your vagina. Prior to this, the baby’s cord blood will be collected. You can help at this stage by remaining patient while your episiotomy or vaginal tear is being repaired.
In almost all the cases, we do actively manage your third stage of labour. This includes administering an intramuscular injection of an oxytocic after the delivery of your baby, followed by the delivery of the placenta through a controlled cord traction technique. Again, this has been found to reduce the incidence of post-delivery bleeding.
Rarely, separation does not occur and this results in a retained placenta. In addition to causing discomfort, it can also give rise to increased bleeding. Under these circumstances, it may be wise to have your doctor remove it manually by inserting his hand into your womb through the vagina under a general or regional anesthesia (manual removal of placenta).
Some patients may opt to claim back the placenta for personal or religious reasons. For others, the hospital would dispose of it in an appropriate manner.
Possible immediate problems following vaginal delivery
Immediately after a seemingly uneventful vaginal delivery, some common problems may arise in the immediate postnatal period. These include:
Do the different birthing positions like on all fours, squatting and birth stools help in the delivery?
Unfortunately, there have not been conclusive studies to look into the advantages and risks of the different birthing positions. Thus, it is important to discuss your birth plan and communicate your desired birthing position with your obstetrician so that preparation can be made when you are admitted to the delivery suite. This discussion should commence before you reach term (i.e. 37 weeks of pregnancy).
This concept of delivery involves the labouring mother sitting in a warm tub of water in an attempt to reduce the pain and discomforts of labour in a more “natural” way. Some women who had opted for this have found it a more satisfying method of delivery.
However, there are certain disadvantages associated with it. Some of the hospitals are not equipped with the facilities to support such a birth. Monitoring of the baby’s condition becomes difficult with the mum submerged in the water. Infections may also occur as the water is contaminated with urine and faeces. Owing to the warmth of the water, blood loss may be greater after the delivery of the placenta. Great care must be practised to remove the baby from the water immediately after the delivery to reduce other complications.
You should speak to your obstetrician in greater detail if you have any queries over this.
Frequently asked questions (FAQs)
Q: What is engagement? When do primips/multips usually engage?
Engagement is the movement of your baby’s head into the pelvis. It occurs at the end of your pregnancy. Your baby is considered engaged when the head has descended below the pelvic bone. In primips (first time mothers), engagement typically occurs before labour. In multips (those who have delivered before), the baby may not engage until the start of labour. During engagement, your abdomen may seem smaller as the baby enters your birth canal. You may also feel some aches or heaviness in your pelvic joints and perineum as well.
Q: When does a baby’s head usually turn down? If the head is down, will it turn again?
In most pregnancies, babies are born head first. This means that most would have turned to a head down position by 37 weeks. In only 3% to 4% of cases, the babies are found to be breech at time of delivery. After 37 weeks, if the baby is still not in a head down position, it is very unlikely that the baby would turn spontaneously.
In some cases, there may be frequent changing of fetal lie and presentation after 36 weeks. This is termed as an unstable lie.
Common causes of unstable lie include:
In such situations, your obstetrician will need to assess you properly and decide on the best mode of delivery.
By Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John,
KK Women's and Children's Hospital
The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.