Lesson Duration: 1 hour 30 minutes

Overall Objective

Clients will be less anxious and more knowledgeable of the process of labour and childbirth.

Objectives

Clients will be able to:

1. Define the term labour.
2. List signs of the onset of labour.
3. Know when to report to the Labour Ward.
4. Describe briefly the different stages of labour.
5. Demonstrate childbirth exercise techniques utilized in labour and delivery.

Resources

• Music (to be played during the exercises) - optional.
• Video: Labour and Delivery (if available).
• VCR.
• Television.
• Flip Chart of Labour Process (including female anatomy).
• Cervical Dilation/Effacement Chart or Diagram.
• Doll and Pelvis (if available).
• Model of Cervical Dilatation (if available).
• Diagram/Picture of Cross-section of Womb.
• Pencils for clients.
• Writing pads or paper for clients.
• Handouts:
  1. Getting Ready to Have Your Baby (includes items to take to hospital for mother and baby).
  2. Know the Signs of Preterm Labour.
  3. Caesarian Birth.
     

Introduction

A true story
A pregnant woman was at home having labour pains. When she felt that she was in established labour she asked her husband to take her to hospital.
The husband jumped up, grabbed the suitcase and got into the car, leaving his wife behind, inside the house. After she did not appear outside the house fast enough, her husband shouted to her “Are you coming? Mind I leave you!”

Body

Read vocabulary list

Labour begins with certain signs. These include:

• The passing of the mucus plug from the neck of the womb. This may be clear or mixed with a little blood and is called a “show.”
• Contractions (labour pains) coming at least every 5 minutes and lasting up to 40 seconds or more.
• Bursting of the water bag.
  

There are other possible signs of labour, which may begin days or weeks before true labour is established and there is no need to go to hospital at this time.
These include:

• Lightening, also called “Engagement,” is when the presenting part of the baby has secured itself into the upper opening (inlet) of the pelvic bones and is in its beginning position for the passage through the pelvis. This may be noticed by the mother as “dropping.”
• Irregular or regular contractions that last for less than 40 seconds.
  

If the water bag bursts at any time without other signs of labour being present you are to go to the hospital, as this can result in infection or other complications for the baby.*

Once contractions are established you should report to hospital taking:

• Your overnight bag/suitcase with the items for yourself and your baby.
• Your Antenatal Passport and identification.

The presence of your partner is most valuable at this time as he provides support and is able to coach you with your Childbirth Relaxation-Concentration and Breathing Exercises.

On admission to hospital certain procedures are carried out on the Labour Ward where you will be admitted. These include:

• Admission history, where you will be asked about all signs and symptoms that caused you to come to hospital.
• A complete physical examination, which includes special examination of the abdomen to determine the position of the foetus. The foetal heart is also listened to.
• The time, duration and frequency of your contractions (labour pains) will be checked.
• Your temperature, pulse and blood pressure will also be checked.
• A vaginal examination will be carried out.
• A urine test will be done.
• The pubic area will be shaved if you have not done this at home. This helps to keep the genital area clean.
• An enema might also be ordered to empty the bowels, so that this does not interfere with delivery.
• You will not be allowed to eat or drink once you are in labour.
• Sometimes it may be necessary for you to have intravenous fluids (life water) to ensure that you have sufficient energy.

Following the admission procedure you will be placed in a room in the Labour Ward until it is time for the delivery of the baby, when you will be moved to a delivery room.

Throughout labour your pulse, blood pressure, the time, frequency and duration of contractions, as well as the foetal heart rate will be checked frequently.

Nurse/Midwives and Doctors will care for you during labour.

You can use your Childbirth Relaxation-Concentration and Breathing Exercises during labour. Your coach or Midwife can assist you.

During labour the neck of the womb softens, shortens, and gradually opens with each contraction until it is fully open. This occurs at 10 centimetres (full dilatation). The foetus is also forced down through the pelvis during contractions.

Labour is described in 3 stages:

First Stage:
Lasts from the beginning of regular contractions to full dilatation of the cervix. In first-time mothers this may last up to 15 hours. In multigravid women the duration may be up to 8 hours.

During this stage medication to relieve pain is given as prescribed.

Contractions are of moderate strength, lasting approximately 45-60 seconds and are less than 5 minutes apart until the cervix is about 7 centimetres dilated. Nearing the end of the first stage the strength and timing of contractions increase to approximately 60-90 seconds every 2 to 3 minutes until the cervix is fully open.

Nearing the end of the first stage the patient feels frustrated, tired, and helpless and fears that contractions will get worse. She is short-of-patience and often demands that something be done or that the Midwife or Doctor “take” the baby.

The patient may experience uncontrollable shaking and trembling, leg cramps and excessive sweating. There is an increased amount of bloody show. Sometimes if not already burst, the water bag may
rupture. Nausea, vomiting and belching or hiccups may also occur.

During this phase the patient may have the urge to “bear down” before the cervix is fully dilated. It is most important not to bear down until advised to do so by the Midwife or Doctor.

Second Stage:
The patient may be moved to a delivery room for this stage.

This is from full dilation of the cervix to delivery of the baby. This stage usually lasts up to an hour in first time mothers and under half-an-hour in multigravid women.

Contractions are strong and lasting between 60-90 seconds and come every 2 to 3 minutes.

Some signs and symptoms that the patient is in second stage are:

• grunting.
• uncontrolled bearing down.
• increased bloody show.
• spontaneous rupture of membranes.
• uncontrolled bowel movement if the rectum is full.
• pins and needles sensation (progressing to numbness).

It is important to listen to the Midwife or Doctor’s instructions on when to “push” (bear down), to avoid a tear of the perineum, or to allow the Midwife or Doctor to check for the umbilical cord.

During delivery of the baby an episiotomy may be done.

Once the baby is delivered and is in good health the mother is allowed to hold the infant.

Third Stage:
This is the period between the birth of the baby to the delivery of the afterbirth, which lasts from about 1 to 20 minutes.

The Midwife or Doctor delivers the afterbirth. The patient is not required to push.

At the end of the third stage, the first hour following birth is sometimes referred to as the “Forth Stage.”

Forth Stage:
During this time the mother is observed to ensure that the uterus remains well contracted and that blood loss remains normal. Her blood pressure, pulse, respiration and temperature are also checked.

The mother is allowed to cuddle her baby. Try to breastfeed once all is well. The father is also given the opportunity to hold the baby. It may be necessary to request this.

The infant is examined by the Midwife to detect any abnormalities. The baby is also kept warm.

The patient is taken from the Delivery Room to a postnatal Ward/Room, following a bath and ensuring that all is well. The baby is taken to the Nursery and after receiving a bath, it is taken to the mother. Again, you may request your baby for breastfeeding or cuddling.

What has been discussed is normal labour and delivery. Should complications arise other medical intervention may be necessary, such as Induction of Labour, Forceps Delivery, Vacuum extraction or Caesarian Section.

Summary

The main sign that labour is established is regular contractions (labour pains) coming every 5 minutes and lasting 40 seconds or more. You might also see a show, and bursting of the water bag. Once these occur you must report to the Labour Ward. Remember however, that you must always go to hospital once your water bag bursts, even if you are not having contractions. Be sure to take your Antenatal Passport and identification with you.

Labour can be described as having 4 stages.

1. Contractions.
2. Delivery of baby.
3. Delivery of afterbirth.
4. First hour following birth of baby.

Tour of Maternity Ward

Vocabulary

Cervix

• The neck like, narrow end of the uterus opening into the vagina. Also called the “Neck of the Womb.”

Lightening

• Also known as “Engagement,” means that the head (usually) has positioned itself in the upper opening of the pelvic bones. May be noticed by the mother as “lightening” or “dropping”.

Primipara

• A woman whose present pregnancy will be her first birth.

Multigravida

• A woman who has been pregnant two or more times.

Show

• Reddish coloured mucous seen at beginning of labour, or is gradually discharged during labour.

S.R.O.M.

• Spontaneous Rupture of Membranes occurs when the “water bag” bursts on its own.

Labour

• The process by which the body starts to push the baby out of the womb and ends with the birth of the baby.

False Labour

• Regular or irregular contraction of the uterus which do not dilate the cervix. More noticeable in late pregnancy as the uterus is preparing itself for labour.

Contractions

• Also called “Labour Pains.” Tightening of the muscles of the uterus causing opening of the cervix and aiding in pushing the baby out.

Dilatation

• The gradual opening of cervix.

Centimeters

• Unit to measure dilatation of cervix. Used interchangeably with “fingers”. One “finger” equals one centimeter.

Perineum

• External tissues surrounding the anus and vagina.

Episiotomy

• Cut made into the perineum before delivery to prevent tearing or aid delivery.

Bear Down

• “Push”.

Delivery

• Expulsion of the baby along with the afterbirth.

Placenta

• “Afterbirth”.