This is a moment that will mark you forever. It consists of different phases: reception, labour, phase during which the cervix dilates, birth and delivery.
The medical team is thus ready to receive you. Their professionalism will reassure you. You will feel it from the moment you arrive on the ward. Let’s start by finding out who it is composed of :
- A doctor on duty 24/24
- An anaesthetist on duty
- Midwives based on the number of planned deliveries
- HSA (hospital service agents)
- A paediatrician (on duty or on-site)
- Paediatric nurses
The engine of labour is the contraction. This is a kind of cramp that pushes baby onto the cervix. It begins at home and continues in hospital where you are monitored. The midwives thus want to ensure that baby is responding correctly to the contractions.
Opening of the cervix
Initially, the top of the head rests on the cervix which gradually opens.
To assess progress, the midwives measure the dilation. 1 cm is still the beginning of labour. 10 cm is complete dilation. On average, the dilation progresses by one cm per hour, i.e. around 10 to 12 hours between the first contractions and the birth of baby.
Now for some mechanics. Baby is not naturally in the axis of the pelvis. It is therefore important to find the position that brings him to this axis. A little stroll, pelvic tilts or a few exercises on a ball can help you achieve it. The antenatal classes will have undoubtedly helped you to learn these techniques.
We are not all equal when it comes to pain. Mothers in the childbirth phase each feel it in their own way. It is very useful to learn how to manage it: take a bath at the beginning of labour, control your emotions and focus on your breathing…
Medically, you can be offered some solutions :
- Nubain: this is a morphine derivative used at the beginning of labour.
- Epidural: this can be performed between 3 to 8 cm in dilation. It anaesthetises the lower body, from the top of the uterus to the feet. The patient retains her sensations but does not feel pain. This is a medical procedure you must be prepare yourself for: it is mandatory to make an appointment for an anaesthesia consultation in the eighth month.
- Spinal anaesthesia: this technique enables fast and reliable anaesthesia, effective for about 2 hours. is therefore indicated for a brief and impromptu Intervention such as a caesarean section.
- Nitrous oxide: this is a gas that you can inhale at any time to relieve you in a punctual way.
The ideal position is the one that allows you to feel good. There are 3 most common positions :
- On the stirrups. Remember to perform the pelvic tilt to facilitate pushing as much as possible.
- On your side. Less common, but it is an attractive alternative because it enables better articulation of the push axis.
- On all fours. This position usually responds to a specific investment on the part of the future mum as it excludes the use of an epidural and any unnatural methods.
The second phase of labour begins with the big push and ends with expulsion or release. It extends for 20 to 30 minutes. This is a protocol estimation found in the majority of cases. Beyond that, the obstetricians intervene and provide assistance for the expulsion: suction or forceps for example.
The big push
After clearing the cervix, baby arrives in the vagina and then progresses to the perineum. When he presses on the perineum the big push begins for mum. There are 2 major push techniques learned during the antenatal classes:holding your breath with full, blocked lungs, or holding your breath until the end of expiration.
At this stage, mum stop pushing. The head is about to come out. This is the most delicate moment, fortunately greatly facilitated by the peculiarities of the baby’s skull. Here the midwife gives you valuable assistance in guiding baby. Once the shoulders have passed, the expulsion of the rest of the body is only a formality. After a few seconds, breathing occurs by reflex of the lungs: baby is born.
At birth, the skull bones of your baby are not yet fused. His head can become deformed in order to pass through a space narrower than itself.
The first reflex: cut the umbilical cord. This is a symbolic act which can be performed by dad.
Then the midwives carry out the Apgar test to assess baby’s health. The criteria are: skin colour, heart rate, breathing, muscle tone and reflexes. A score of zero to two is attributed to each factor: the Apgar score is the sum of these five scores thus calculated. Most newborns get a total between seven and ten. Below that, a further examination is usually conducted.
Baby is usually measured, weighed, bathed… and gently placed in your arms.
The contractions start again about ¼ hour after birth. The placenta detaches. You are asked to make a final push to expel it: the delivery.
The midwife then keeps an eye on you for two hours in the delivery room to be sure that you and your baby are well. Use this time to get to know him: skin-to-skin contact on your stomach, your chest, by your eyes, breastfeeding, etc. Your partner can also participate.