Two of the most common questions asked by women towards the end of their pregnancy are: “How do I know when I am in labour?” and “When do I go to hospital?”
Labour is often difficult to diagnose in its early stages. We divide labour into three stages. The first stage is from the start of contractions, through to the time when the cervix is fully dilated. The second stage of labour is from the time of full dilatation to the time of delivery of the baby, and the third stage is from the delivery of the baby to the delivery of the placenta. The duration of these stages can vary greatly between different women, and also within the same women in different pregnancies.
The first stage of labour is the one that has the greatest variation in duration. From a medical point of view we consider the start of labour from the time a women comes into hospital and is in need of pain relief, but women may have laboured for many hours before they have arrived at hospital.
For some women the onset of labour is fairly quick and is often heralded by the rupture of membranes (or breaking of waters) but there are many women in who labour starts very slowly and extends over a period of two days. The labour may be spurious in the sense that it may stop and start many times over the course of two to three days before good labour is established. If this is happening to you, then you need to talk to your Obstetrician as an induction of labour with rupturing of waters may be indicated.
Women are often asked to ring the hospital when they feel they are in labour. The general advice given is that if your waters have ruptured you need to present immediately so that the progress of labour can be assessed and the wellbeing of the baby checked. If your contractions have been coming on slowly and your waters are intact, then you are generally asked to take some painkillers and wait at home until the contractions are 5 minutes apart. Women are advised to keep in touch with the hospital and ring as often as they require assessing the best time to present to hospital. If you are not happy with the advice you are given, then you should either ring your Obstetrician or present to the hospital for assessment anyway.
When labour starts. The first part of labour is mainly designed to soften the cervix and make it thin. Once the cervix is relatively thin then it will start to dilate. It will appear to some women in the initial stages of labour that they are making no progress, but as long as the baby is assessed to be well, then there is no need to interfere with a normal process. If there is ever any concern about the wellbeing of the baby then the process can be hastened by medical intervention.
Expectant mothers are often reminded to keep an open mind about the whole process as not all labours go to plan and the aim at the end of labour is to ensure the safe delivery of a healthy baby and also ensure the safety of the mother.