Stage 1 of Labour
Stage 1 of labour is the longest, lasting from the start of regular contractions and the opening of the cervix until the cervix is dilated to 10 cm (fully dilated). It is then that the baby's head is able to pass through it. Though long, this stage is not relentless as, in between contractions, you will have the opportunity to move around and chat to your partner if you wish.
Before labour begins, the cervix is like a small, thick tube with a dimple in it, which nestles at the top and to the back of your vagina. The cervix moves forward, softens and thins and then gradually start to open. Putting a finger into a cervix that is 1 cm dilated feels a bit like putting a finger in a nostril! As the cervix gets thinner and more stretchy, it feels more like a hole in a lump of bubble gum. Because of the amount of stretching and softening that needs to take place, the longest part of labour can often be the dilation of the cervix to 4-5 cm.
Signs of labour
There are a number of signs, but experiencing any of them does not necessarily mean that you will go into labour immediately.
A show is the jelly-like; blood-streaked 'plug' of mucus that has been preventing infection from getting into your uterus. It often comes away from the cervix at the beginning of labour, although it can still be a few weeks before labour begins. There is no need to tell anyone about this. It is your own sign that there is a good chance of labour starting within the next few days - but it is not a guarantee!
In early labour, these tightenings of your uterus feel similar to period pains. You may also get backache. Although these niggling aches and pains can go on for days before labour becomes established, it does not mean that they are without effect. As well as having to move forward, your cervix also has to soften, become thinner and dilate, which often happens in the days before labour starts in earnest.
Once you are having regular contractions that are lasting for longer than 30 seconds and are spaced only 5 minutes apart (10 minutes apart if this is not your first baby), or you are struggling to cope with the pains, contact your midwife or labour ward. If you are capable of talking through a contraction, it is too early to go to the labour ward.
The breaking of your waters (amniotic fluid) usually happens during labour with the force of a contraction, but it can also happen before labour begins. If it does, contact your midwife or labour ward, who can confirm whether labour has started if you are unsure. A midwife will also listen to your baby's heartbeat and probably take a swab from your vagina to check for infection in case you do not go into labour soon afterwards.
Once their waters have broken, most women find that their contractions start within 24 hours. If you do not go into labour, the midwife will tell you how to check for signs and symptoms of infection, for example, by looking for changes in the colour and the smell of the amniotic fluid.
This can occur shortly before labour begins and can be regarded as nature'clearing you out'before the birth. Again, there is no need to rush to the labour ward. It may be some time before the contractions really start.
Once you are getting strong, regular contractions, your midwife can do a vaginal examination to establish just how far into labour you are. Most women lie in a semi-upright position on the bed, while the midwife gently examines them using two gloved fingers. She can feel how far your cervix is dilated and also confirm the exact position of your baby.
The midwife will check and record on your notes things such as your blood pressure, pulse and temperature, and ask you questions about the time you felt labour begin.
Most women's waters break during labour because of the force of the contractions. However, even if your waters do break before labour starts, it will probably be with a trickle rather than a gush. Many women are not even sure that their waters have broken because it feels more like a dribble of urine. In this case, it is advisable to wear a sanitary towel and see whether it continues. If your waters do break, tell your midwife so that she can check you and your baby before labour begins. If you are worried that your waters might break while you are out and about, wearing a sanitary towel when you go out may give you more confidence.
It is now considered best to leave the membranes (bag of waters) to break by themselves. Once the waters break, the baby's head, which was being cushioned by the amniotic fluid, drops further down into the cervix, which can cause stronger contractions. If your membranes are left alone, you may find that both you and your baby can cope better without such direct pressure on your cervix.
However, there are times when it might be advisable to break the waters, for example, if labour is induced or needs speeding up, or if monitoring indicates the baby is becoming distressed.
Monitoring the baby
Some babies show signs of distress during labour and for this reason your baby's heartbeat should be monitored. There are various ways of doing this.
Dopplers and pinnards
During pregnancy your midwife will have listened to your baby's heartbeat using a hand-held instrument, such as a Doppler or a pinnard. A pinnard is a type of ear trumpet that she places on your abdomen and through which she can hear your baby's heartbeat. Many women prefer the Doppler because the sound is amplified so that they can hear the heartbeat as well. If your pregnancy has been straightforward and no problems are anticipated during the birth, research suggests that this is the best way of monitoring the baby's heartbeat during labour.
If your baby opens her bowels inside you (passes meconium), which can be a sign of distress, or if you are given certain medications, for example, an epidural or oxytocic drugs, it is safer to have continual monitoring of the baby's heartbeat.
This instrument consists of two transducers which are held in place on your abdomen by elastic belts and connected to a monitor. The monitor provides a print-out of the baby's heartbeat and also the uterine contractions. The monitor can be moved about so, unless you have an epidural, which restricts your movement, you can still stay upright or get out of bed. If everything is going smoothly, there is no need for continual monitoring. However, there are many instances where continuous monitoring is necessary, for example, premature labour, use of oxytocin or an epidural, or signs of distress in the baby.
Fetal scalp electrode (FSE)
Sometimes there are problems picking up an accurate and continuous reading of the heartbeat with the abdominal transducers, often because of the baby's position. In this case it may be necessary to use an FSE.The midwife or obstetrician will carry out a vaginal examination to determine the position of your baby and then attach a small metal clip to your baby's scalp. This is linked by a lead to the CTG (see above).
Many women experience a period of transition between stages 1 and 2 of labour. This can present itself in different ways. For some women it is a period of rest: the contractions ease off, while nature prepares you for the exertion of birthing your baby in stage 2. Other women start to lose heart, feel unable to cope and stop thinking positively. Midwives often recognize this transition period and know that, with encouragement, it will pass. Some women vomit during this stage, which is another positive sign that they are approaching stage 2 of labour. Other women begin to get an urge to 'bear down', although the cervix may not yet be fully dilated. It is hard to fight the urge to push but you should be encouraged to'breathe through it' and to turn onto your knees with your bottom in the air, which will help to take the pressure off the cervix.