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The First Stage

The First Signs of Labour

Every labour and birth is unique, and there is a very wide range of experiences to be had. You can’t predict exactly how or when your labour will start.

Look for these signs:

The show: this is the release of the mucus plug (the operculum), which seals the opening of the cervix. It might be a blob of pinkish jelly; or it could be a series of smaller pieces; the colour could be more red than pink. The plug ‘escapes’ because the cervix is just starting to stretch and soften – but it doesn’t mean anything has to happen now. It could mean labour will start anything between a couple of hours and a few days.
Rupture of the membranes or ‘breaking of the waters’: the membranes are the bag of waters, or amniotic sac, which hold the amniotic fluid surrounding the baby. When the membranes rupture, the amniotic fluid (known as liquor – pronounced ‘ly-kwor’) comes out. It can happen as a sudden gush of liquid, but more usually, it’s a slow trickle.

Call your midwife or the hospital if you know your waters have broken, and ask for advice. They may suggest you come in – there is a possible risk of infection if the waters break and the baby takes too long to be born. There’s also a risk if your baby’s head isn’t engaged in the pelvis, as the waters could bring the cord down as well. This could mean your baby might compress it – and that could mean a risk to your baby’s oxygen supply. Most women whose waters break go on to have perfectly normal labours, and fairly soon afterwards, too.

Contractions: count them and time them. If the contractions come closer together over a period of an hour or two, and last longer than 40 seconds, and get stronger, they’re likely to be labour contractions. Use our Timing Your Contractions sheet to assist you keep track of your developing labour.

Contractions

The uterus is a complex network of muscle fibres. The fibres contract and become shorter, to pull up the cervix and to increase the downward pressure at the top of the uterus. At the peak of the contraction, the muscle fibres are at their shortest…. and then they relax and the contraction dies away. However, with each contraction the muscles stay a bit shorter than they were. This leaves the cervix slightly more open than it was and the baby is a little further down.

Contractions are painful for most women. They feel like a gradual tightening over your tummy. Most women describe the feeling as similar to a period pain but much more intense. Some women feel the pain in their back, or running down their thighs.

Most women will tell you that you cannot talk or move during a ‘real’ contraction. This should give you some indication if you have started labour or you are still just preparing.

At the beginning of labour, contractions last about 40 seconds, once every 10 minutes. By the end, each contraction lasts longer than a minute, with a gap of no more than a minute between each one

What Happens During the First Stage of Labour

The first stage of labour is the longest for almost everyone, but its length is very variable. Anything between one hour and 20 hours is normal.

Labour begins as a response to hormonal triggers coming from the baby. The baby’s adrenal gland matures and starts to secrete the hormone cortisone. In response to this, the mother produces hormones called prostaglandins – and it’s these that stimulate the uterus to start contracting.

With each contraction:

The uterus pushes the baby down.
The cervix opens up and becomes thinner.

By the end of first stage, the cervix is fully open; enough to allow the baby to pass through and into the birth canal (the vagina). This is described as being 10 centimetres dilated or fully dilated.

Labour tends to speed up as it progresses. It normally takes far less time for the cervix to dilate its second five centimetres, compared to its first five.

Most women cope best with this stage of labour if they feel free to move into whatever position feels best. This might be:

Kneeling.
Leaning forwards on a floor cushion or your partner’s lap.
Leaning against a wall.
Resting on all fours.
And anything else that helps – different positions may work better for you at different times.

You may decide you would like to use some pain relief during this first stage. Most women recommend waiting a further 5-10 minutes after first asking for drugs before actually using them. Your adrenalin might just get you through the labour.

Your Baby During Labour

Foetal monitoring keeps a close watch on your baby’s health by measuring his heart rate.

The midwife may use a Pinard stethoscope, which looks like a sort of ear trumpet. She places it against your abdomen and listens to the baby’s heart.
You may be linked to an electronic foetal monitor which picks up and displays the baby’s heart rate as a number on a screen. Alternatively, a small electrode, clipped onto the baby’s scalp picks up the heartbeat, and the result is transmitted to the machine. The heartbeat is also printed out so it can be looked at and assessed over time. This form of monitoring can be continuous.
Telemetry sends the signal of the heart rate via radio waves to the receiver. You’re not actually attached to the monitor, so you’re free to move around as long as you stay within range of the monitor. Again it can be continuous.
A doppler machine uses ultrasound for monitoring. A small transmitter-receiver is placed on your abdomen to pick up the heartbeat.

The more comfortable and relaxed a mother feels during labour, the better her ability to cope with pain. She can find this security with loving support from a birth assistant. A partner is the natural choice, as he will probably be closely involved throughout the pregnancy, and eager to share the experience of his child’s birth. Most hospitals welcome fathers, friends, or relatives to support the mother.

Pre-Labour and Labour Partners Role