What to Expect When You’re (Imminently) Expecting: The Stages of Labour

After months of anticipation during a pregnancy, the first signs of labour can bring both relief and worry. There is relief in knowing the long wait will soon be over. But there may be worry about whether labour and delivery will progress without complication.

In this blog post I’ll explore the three stages of labour, outline what can be expected during each stage, and discuss how medical practitioners may respond if labour is not going according to plan.

The Three Stages of Labour

Although each pregnancy and birth experience is unique, all normal vaginal births are expected to progress through the same sequence of events. That being said, the length of each of the three stages of labour and the emotional and physical toll on an expectant parent may vary considerably.

Lasting from hours to days (and in some cases even weeks), the first stage of labour commences when the cervix begins to efface (thin) and dilate (open). A gelatinous collection of mucous (the mucous plug), is often expelled during this time and mild infrequent (and sometimes not noticeable) contractions begin. Early first stage labour, which continues until the cervix is about six centimetres dilated, can stop and start or progress directly into active labour.

In active labour, when the cervix dilates from six to ten centimetres, contractions become regular and more intense. The pace of cervical effacement and dilatation quickens (on average about one centimetre per hour in first births) and in a normal head-first birth, the baby’s head begins to move down the birth canal. A final sub-stage of the first stage of labour is called ’transition’ and it occurs as full cervical dilatation (10 centimetres) is achieved and contractions are about 60 to 90 seconds apart. For many, transition can be particularly intense and painful.

In the second stage of labour, the cervix is fully dilated and the urge to push with each contraction begins. With each push the baby will move further down the birth canal until it is delivered. The second stage can last anywhere between minutes to hours. Second stage labour usually takes longer in first pregnancies than subsequent pregnancies.

Once the baby is delivered, weaker contractions will occur during the third stage of labour as the placenta detaches from the uterine wall and is expelled. Although the afterbirth usually arrives within 30 minutes of the baby, the third stage of labour can last up to an hour.

Complications

At any stage of labour, complications can arise. For example, indications that labour may be commencing prematurely - prior to the 37th week of pregnancy - could prompt medical practitioners to look for ways to delay labour or administer medication to help improve fetal outcome.

If a pregnant person begins to experience regular contractions or tightening, period-type pains, an unusual backache, loss of the mucous plug, bleeding, or pre-labour rupture of membranes (water breaking) before 37 weeks of gestation, they should be assessed by a medical professional to determine next steps. Sometimes a medication may be administered in an attempt to delay labour, treat an infection, or support a premature baby by strengthening its lungs (steroid injections), or protecting its still developing brain (magnesium sulphate). In other cases, the cervix is stitched to prevent opening and early labour.

In term pregnancies, greater than 37 week gestation, once active labour begins medical practitioners will monitor for signs of failure to progress (FTP) to determine if intervention is needed to speed up vaginal delivery or to deliver the baby through an emergency Caesarean section.

FTP means active labour is abnormally long and/or something is preventing the usual sequence of events from occurring without intervention. Although the reason for FTP is sometimes unknown, potential causes include:

• Weak or infrequent uterine contractions
• Improper position of the baby (for example, breech birth)
• The inability of the baby to fit through the pregnant person’s pelvis due to its size or an obstruction (such as shoulder dystocia)

Certain risk factors can also make FTP more likely. These can include:

• Using medications to start labour
• Use of an epidural
• Premature rupture of membranes or problems with the amniotic sac
• FTP in a previous childbirth
• Pre-existing or gestational Diabetes
• Fertility treatments
• An abnormally large baby

FTP can lead to injury (or even death) for the pregnant person and/or their baby. Prolonged labour increases the risk of post-partum haemorrhage in the mother and a baby may show signs of distress or decompensation if labour lasts longer than it should. If a baby’s resources and energy reserves are depleted during an extended labour, they may suffer injury and neurological damage.

To speed delivery, medical practitioners may use medications such as oxytocin to increase contractions and/or artificially rupture amniotic membranes (manually ‘break’ the water). Continued failure to progress or signs of fetal distress may cause a practitioner to use assistive devices (such as forceps or a vacuum) to complete vaginal delivery. In some cases performing a caesarean section delivery may be the best course of action according to established standards of care.

During the third stage of labour complications can arise if the placenta does not detach as expected or the pregnant person experiences a post-partum haemorrhage. Interventions can include medical and surgical. Any unexpected bleeding or cramping in the hours, days or weeks following the birth should be discussed with a medical provider.

When Labour Ends

For the vast majority of new parents, the end of labour brings a mixture of joy and relief. If labour has not gone according to plan and someone suffers a serious injury as a result, the end of labour marks only the beginning of a period of recovery, sometimes grief and, hopefully, a journey toward healing. If you or a loved one experienced injury as a result of labour or delivery and believe a medical provider’s negligent actions or inaction caused or contributed to harm, you may be able to access compensation and damages for your losses. An experienced birth injury lawyer can help determine if you have an actionable claim.

To learn more about how Gluckstein Personal Injury Lawyers can assist you, contact us today.