The beginning of the delivery is usually indicated by contractions, however this can be false alarm. You may have felt it if you’re in the last months of your pregnancy: your uterus contracts. The further along you are the more this can happen. It is caused by hormones and is called a “hard stomach”. It can potentially be a disturbing feeling. However most women don’t even feel it.
Usually the delivery starts with contractions. Sometimes these can be painful from the start and with short intervals, but usually they are short in the beginning, irregular and not very painful. Often you can continue with what you are doing. These ‘pre-contractions’ prepare the cervix. To see if you are really going into labour, we follow your contractions and check the cervix through an internal examination. This gives us a good impression of the phase of your delivery. It can be hard to determine if you’ve really gone into labour in the very beginning. No need to worry: you will know for sure within a few hours! The beginning of the labour process can also be indicated when your water breaks. After this, strong contractions are also needed in order to open the cervix. These usually start within 24 hours.
The cervix is more stiff when it’s a woman’s first time going into labour and therefore opens up less easily than during the next pregnancy. The contractions make the cervix smoother and thinner. The speed of the delivery depends on the contractions. The delivery will be faster when these are stronger and become more frequent. The first centimeters of dilation are usually slower than the last. At 10 centimeters you are fully dilated and thus allowed to push.
When your water breaks
This usually happens after a number of contractions. This is a good thing, as the amniotic fluid protects the baby and aids in opening the cervix by exerting pressure. If your water hasn’t broken by itself, then we usually do this when you are fully dilated. However it can also be done earlier. For example when your contractions are becoming less strong or when your dilation is progressing insufficiently. This does not hurt. You will only feel some warm water. You will continue to make amniotic fluid so that the child is never ‘dry’. If you do not have strong contractions yet then you are not allowed to take a bath as this increases the chances of infections. The baby is in direct contact with the outside world. Your temperature is measured after your water breaks so that a possible infection is discovered in time.
Push contractions and birth
The dilation contractions will transition into push contractions once you are fully dilated and able to deliver the baby. We usually will have to do an internal examination to ensure that the dilation is complete. The baby’s head will have gone down due to the opening of the cervix. You will feel a need to push at the climax of the contraction. You cannot stop this need as it is an indication that the baby is ready to come out. The push contractions usually come within five minute intervals.
The end is in sight. Good pushing contractions already do a lot of the work and you can actively start pushing. During a contraction, use all your strength and push towards your vagina and anus as if you have to poo. You will not always feel where you’re pushing to in the beginning. However as the baby’s head goes down deeper, it becomes more clear how you can use a contraction to push.
You will feel stretching between your anus and vagina when the head is almost out. This may be a painful feeling. A cold or warm towel against your pelvis can help. We will indicate what you can do to prevent tearing. Once the head is out we will help the baby out further. Sometimes you can and may hold the baby yourself. You usually don’t have to push hard anymore then as the rest of the baby’s body will follow shortly thereafter. The baby is quickly placed on your (preferably naked) belly.
Your belly will start to calm down as you’re not experiencing any contractions anymore. However the uterus will contract to loosen the placenta and to ensure that you don’t loose too much blood. We may hold the naval cord tight to check if the placenta is loose. If this is the case, you could be asked to push again while midwife pushes on your belly. Usually then the placenta and naval cord are exerted. This may be a strange feeling but it does not really hurt. The uterus contracts and feels like a hard ball underneath your belly button. The placenta has to be removed while you’re anesthetized in the hospital if it doesn’t come out by itself within an hour after delivery.
Cutting the naval cord
The naval cord can be cut once you cannot feel the baby’s heartbeat through it anymore. If you want to breastfeed, then the baby is now placed at your breast. This is a natural method to contract the uterus and ensure that you loose any more blood.