Active Labour

Earlier this year I blogged about the Latent Phase of Labour  how to cope with it and how to recognise when it transitions into active labour. This is “part two” - from the onset of strong and regular contractions to a baby’s birth. It describes a straightforward, unmedicated birth. I’ll discuss complications in labour in another blog.

Recognising active Labour

Active labour commences when contractions last a minute, and come, on average, 3 every 10 minutes. These are the contractions that help the cervix to open up beyond 4 or 5 cms.

They feel different to the latent phase tightenings, higher in the abdomen and significantly stronger. They continue whether sitting, standing or lying down and “stop you in your tracks”. There is little option to talk or walk through a contraction - the main focus is on the breathing technique.

There may be a ‘show’ when the mucus plug in the cervix is released - this can be during the latent or active phase - not a word for the faint hearted but most midwives say "it looks like snot", it can be clear and streaked with blood or sometimes brown with old blood. If the sac surrounding baby bursts there can be a trickle or gush of fluid - if this happens tell your midwife.

Once there is no cervix left around the baby’s head the womb is fully dilated. This part of active labour can take up to 12-14 hours, sometimes longer. During this phase women should eat and drink as they see fit - though many don’t feel like eating much, and honey, energy drinks and glucose sweets are useful when the womb is working hard.

Top tip: Practise breath awareness techniques daily

How does Labour work?

Birthing your baby is a normal physiological process. It is something women and babies are designed to do. We have the equipment: a womb and vagina, a pelvis and hormones that drive labour and help us to make the necessary changes emotionally and psychologically to adapt to motherhood. Women and babies know how to birth. Watch this amazing video of a physiological water birth at home

Mother and baby work together during labour. The baby is positioned in a way that exerts pressure on the cervix, helping it to open.  Correctly positioned his or her head will be tucked down, with chin to chest, and the baby moves and twists it’s way through the pelvis. Pressure from the baby’s head also stimulates oxytocin.

Top Tip- Give oxytocin the right environment!

Oxytocin is “a birth essential” - it’s known as the ‘shy’ hormone and thrives on natural or low light, quiet, privacy, warmth and calm while fear, stress and anxiety create adrenaline which disrupts oxytocin levels.  Oxytocin and other hormones play a role in regulating pain, release of milk and in helping the womb “close” after birth - they’ll be the subject of another blog

In the first stage of labour, Oxytocin causes the womb to contract, shortening and pulling the muscle fibres to the top of the womb, building up a thick layer at the top in order to push the baby downwards, with great strength and power, along the birth canal. At the same time the cervix, that’s the lower part of the womb that protrudes into the top of the vagina and is normally positioned towards the back, is brought forward to a more central position. Some of the softening and thinning has been done in latent labour and now the cervix is being pulled upwards away from the baby’s head.

During this opening up stage, take up the most comfortable position but try not to remain in the same position for too long, more than 30 minutes or so. Moving and using upright positions reduces the need for pain relief, shortens labour and reduces interventions.  

When the cervix is fully dilated, many women feels the urge to go to the toilet - this sensation is caused by baby’s head pressing against the back passage sending signals the brain interprets as “something needing to be expelled”! At this point  breathing patterns change involuntarily and an urge to push or bear down is present. This is the onset of the second stage of Labour which for mums who have already had a baby can last for just few minutes otherwise this stage can last for 2-3 hours.

Often women feel the need for reassurance at this point. Sitting on the toilet not only offers a sense of security and privacy during this stage but can help the baby’s descent. Other women are happy to continue pushing where they are, be it in the pool, on a floor mat or leaning over the back of the bed. There’s no right or wrong, just be comfortable and happy the baby is coming soon.

It helps to understand how the vagina is formed and how it can accommodate the passing of a whole baby! It’s not just a hole. It is a tube of layers of tissue in folds and muscle, rich with elastic fibres.  When the baby enters the vagina it’s head stretches the tissue and it unfolds like an accordion, increasing the available space. At this point I often suggest women should visualise a flower opening - it’s a helpful distraction and it can help release any tension held in the vagina allowing the baby’s head to descend more easily

 

Giving birth to your baby

Personally, I love this part of labour. It feels great to have such power surging through your body and you can just let it happen. Holding back hurts! Let go, open up and the sensation can feel incredible.

Birthing women having an unmedicated and undisturbed birth can be more in tune with their bodies. They move in ways that create more comfort and ease, alternating between rest and activity help their babies find the best positions for birth.

Adopting upright positions opens up the pelvis increasing space for the baby to manoeuvre into the best position and because of the shape of the birth canal, uses gravity. Pushing up is always going to be harder than pushing down!

The baby’s head will gently descend stretching the vagina and the perineum. The perineum is the area between the vagina and the anus. You may feel the baby easing back and forth- this is normal. It’s better to have a slower birth as it reduces the possibility of tearing. Applying a  warm compress to this area can ease the stinging and help reduces tears.

Top tip: Movement and upright positions helps the baby get into a better position, uses gravity and can make birth more comfortable and shorter.

It’s a good idea to breathe gently, avoiding strong pushes as your baby’s head is born. Once the baby’s head is born the rest of the baby will be born with the following contraction. Hooray!

The baby will be dried then put skin to skin with you. This is the third stage. At this point the baby’s cord, which is still attached to the placenta, continues to pump blood containing vital nutrients, stem cells and oxygen to the baby. This is a very important time as the baby will receive up to a third of his or her blood volume. Once the cord has finished pumping it can be clamped and cut - this can take several minutes.

When the placenta has finished it’s work your womb will contract again, although you might not feel it. This helps the placenta and the bag of membranes attached to it, to release and you can push them out fairly easily- they’re soft and squishy. It sometimes helps to move around a little on the bed or perhaps sit on the toilet to push it out.  

This information does not substitute care from your midwife or doctor and should not be relied upon as personal medical advice.

Molly O Brien is a midwife with over 20 years of experience - she runs a free antenatal class, "moving for an easier birth" classes and hypnobirthing courses at Treat. She is an associate lecturer at the UEA and teaches biomechanics of birth and emergency training to midwives around the world