The birth of the baby will be triggered off by hormonal changes, probably started by the fetus. This is known as ‘going into labor’, because giving birth is indeed very hard labour, usually accompanied by discomfort and some pain. If the expectant mother has been well prepared for the birth she will understand what is happening and will be able to use the relaxation techniques which she has practised during pregnancy. This will make the birth easier, as it is fear and tension that tighten the muscles and create more pain.
The baby will be lying in a head down position (vertex presentation), ready for birth (Figure A).
Any abnormal presentation should have been corrected by this stage, but some babies do manage to get into awkward positions such as breech presentations (Figures B and C) or transverse presentation (Figure D), and a Caesarean section may be necessary.
The onset of labour is usually quite slow and gives the expectant mother time to make final preparations and get her to hospital. Labour usually starts in one of the following ways:
- The expectant mother may have a ‘show’. This means that the plug of blood-stained mucus that fills the neck of the cervix is passed through the vagina.
- The ‘waters may break’. The bag of fluid in which the baby is floating may rupture as labour begins and the pregnant woman will get a rush of ‘water’ from the vagina.
- The expectant mother will start getting regular contractions. They may be mild at first, like a little backache, but these ‘pains’ will increase and become more regular. Visit us Preparing to give birth.
If any of these symptoms occur the expectant mother should contact her doctor and the hospital, or the midwife if it is to be a home confinement. If the confinement is to be in hospital, she will be admitted in preparation for the birth.
Sometimes the expectant mother will find she has had false labour pains and she will have to return home for a bit longer. Throughout pregnancy the uterine muscles contract in readiness for labour. These are false contractions (Braxton Hicks’ contractions) and can be mistaken for the real thing towards the end of pregnancy.
When the expectant mother who is having a hospital confinement is admitted for the birth she will:
- Report to the admission desk where she will give her name and hospital number, so that her pregnancy and medical record can be found.
- be taken to the obstetric department to be seen by the midwife. She will change into a hospital gown, her temperature and blood pressure will be taken, her abdomen felt and the foetal heart-beat listened to, and she will perhaps be given a suppository to empty the bowels ready for the delivery.
- Possibly have a bath (or a shower if the waters have broken).
- have a vaginal examination to see how advanced the birth is, and then go to the first stage labour ward.
For a home confinement the attending midwife will carry out these preliminary procedures in preparation for the first stage of labour.