| First stage of labour
Labour is by definition the presence of regular uterine contractions, leading to the progressive effacement and dilation of the cervix and ultimately to the delivery of the baby. The diagnosis is usually self-diagnosis, made by the mother on the basis of painful and regular contractions and other factors such as a show of mucus or blood and rupture of the membranes.
Labour is a time of intense physical activity, stress and pain and the care that a woman receives during her labour should help her to cope with this as well as minimise any potential risks to herself and her child. It is important for the mother to prepare herself not only physically, but also with knowledge to give her confidence and courage to deal with the changes to her body. Every woman experiences labour differently, however, there are common changes that occur throughout the stages and phases of labour.
First stage
The process often starts out slowly with short, infrequent contractions of the uterus. Over a period of hours or days, the contractions become stronger and come closer together.
| |
Effacement/early labour |
Dilation/active labour |
Transition |
| Description |
-
Thinning out (effacement) and opening (dilation) of the cervix
-
Dilated 0-4 cm
-
Baby’s
head starts to descend behind the pubic bones
|
-
Dilated 4-8 cm
-
Membranes may rupture or be ruptured by the doctor
-
Further descent of the baby’s head behind the pubic bones
|
- The cervix finishes dilating and begins making the transition from
opening to pushing.
-
Dilated 8-10 cm
- The
baby’s head starts to press on the pelvic floor and an urge to bear
down is experienced
|
| There is often referred pain as pain that may be felt
in the abdomen, back, hips or even the inner thigh. Pain will only be felt
during a contraction and will build in intensity as the contraction does. |
| Contractions are: |
-
Mild
- 20 – 40 seconds long
- From
5-10 minutes apart
|
- Stronger
- 40 - 60 seconds long, 2-5 minutes apart
|
- Very powerful and efficient, thus this phase may be quite short
- 40-60 seconds long
- From 1-3 minutes apart
|
| Appropriate techniques to employ |
- Relaxation
- Slow abdominal breathing
|
- Relaxation
- Slow chest breathing
|
- Pattern/candle breathing (pant-blow)
|
| Mother's reaction |
- Elation
- Excitement
- Apprehension
|
- Growing serious
- Increased need to concentrate
- Restlessness
- Desire for companionship and increased dependency
|
- Possible urge to push
- Restless
- Hard to concentrate
- Nausea or vomiting
- Hiccups or burping
|
| Mother should do the following: |
- Time the contractions
- Call her doctor or caregiver
- Conserve energy
- Pack the last of her hospital bag if a hospital delivery is planned
and prepare the last minute things for the baby
|
- Go to hospital
- Consciously relax
- Concentrate on her breathing
- Empty her baldder regualarly
- Find the most comfortable position. Changing positions, walking,
rocking or moving will help labour progress
|
- Try to relax
- Keep eyes open during a contraction
- Rest between contractions
- DO NOT PUSH
|
| Father/birth partner can do the following to help: |
- Help partner relax and check her breathing
- keep the environment pleasant and calm - possibly encourage her to
listen to some classical music
- Assess the situation and be supportive
- Time the contractions
- Put a pillow and blanket in the car for partner
|
- Drive slowly to the hospital
- Check in while the partner is being prepped
- Check the relaxation of the partner
- Help to find the most comfortable position
- Be supportive
- Locate emesis basin
- Give back pressure or rub the lower back if she needs it
|
- Alert nurse in charge of intensity in contractions
- Help partner to deal with the contraction
- Reassure partner that the end is near
- Help partner to relax between contractions
- Stay calm
- Pace her with her breathing
- BE ENCOURAGING
|
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