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All your pregnancy questions answered

How to prepare for labour

Labour

• Enema and shaving

When you go into labour and are admitted at the hospital you will probably receive an enema as well as have your private parts shaved [you could in fact do the shaving at home before you are admitted if that is more comfortable for you].

• Admission test

You may have an 'admission test' which is a short NST [electronic fetal heart monitoring] done at the time of admission which will tell your doctor if your baby is receiving enough oxygen. It is a type of screening test to pick up any potential problems early. If this test is okay then your baby will probably be alright for a few hours of labour. If this test shows a problem then your baby is receiving less oxygen already and may not be able to tolerate labour and may need to be delivered by caesarian section

• The stages of labour

Your labour is divided into 3 stages:

1. The first stage-is from the onset of labour contractions till the cervix is fully dilated which is about 10cm dilatation of the cervix. The cervix is the 'mouth' of the uterus which is closed during pregnancy and has to dilate [open] to about 10cm for the baby to come out. This is further divided into a 'latent' phase which is from onset of contractions till about 3cm dilatation and an 'active' phase which is from 3cm to full dilatation of 10cm.

2. The second stage-is from full dilatation of the cervix till complete delivery of the baby

3. The third stage-is the delivery of the placenta [afterbirth]

• How does a normal labour progress?

The latent phase till 3cm dilatation may be of very variable duration and is not very important in deciding the outcome of your labour. However once you cross 3cm dilation with active contractions your cervix should dilate at the rate of at least 1.2cm/hour for primigravid patients [1st delivery] and 1.5cm/hour for multigravid patients [2nd and more deliveries]. This progress is charted on a graph called a  partogram and if you do not dilate at the required rates some intervention needs to be taken. If the dilatation is tardy and the contractions are of poor strength then labour needs to be augmented with drugs [Pitocin/Syntocinon/Prostaglandins] to improve the contractions. If the dilatation is slow in spite of good contractions then your doctor will seriously consider an operative delivery such as a caesarian section. During this first stage of labour you need not 'push' or bear down. You need only to take deep breaths during the contractions.

It is when you enter active labour that you may elect to take an epidural for what is frequently known as a painless labour.

When you are fully dilated [10cm] you have entered the second stage of labour which may last upto 2 hours for a primi or 1 hour for a multi. This is when you should with every contraction take a deep breath and 'push' as hard as you can. If your second stage is long or you or your baby are exhausted at this time your doctor may decide to apply a forceps or a vacuum to assist in the actual delivery of the baby.

An episiotomy may be given just before the head is delivered. This is an angular cut near the vagina to help to increase the space available for the head to come out. This is almost always given for 1st deliveries and sometimes for subsequent deliveries too. It also reduce the chances of severe tears to the vagina and rectum.

After your baby has been delivered your doctor will cut the umbilical cord and hand over the baby to the nurse or paediatrician for cleaning and suction of the mouth and the nose. Within about 10-30 minutes you will expel the placenta and that would be the end of your delivery

• After your delivery

If an episiotomy has been given it will be stitched usually with dissolvable stitching material and you will be cleaned up. Some drugs are usually given to prevent excessive bleeding and you will probably be kept in the labour room for about an hour to observe for bleeding. You will be handed your baby as soon as the paediatrician has finished and you may start to nurse the baby as soon as it is comfortable for you.