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1st stage of labour

The main sign that you are in labour is the appearance of regular contractions. But before these begin, there may be other signs:

  • A ‘show’. The thick mucus plug at the opening of the cervix comes away. As the cervix gets softer in preparation for labour, the plug comes away. It may be pink and streaked with blood. It could still be a few days before labour begins, however.
  • Your waters break. The sac of amniotic fluid surrounding your baby bursts and comes out. It could either be a trickle or a gush. Often the waters don’t break until labour is well underway – and sometimes they don’t even break until the baby is about to be born. If, however, your waters break and contractions don’t start within a few hours, contact your midwife. An increased risk of infection can make it advisable to induce labour.

When you start feeling contractions, it means that your cervix is gradually softening and then opening (“dilating”) in order to allow the baby to pass through. In the early hours of labour, contractions can be quite like a tightening sensation around your abdomen. Each contraction feels like a wave, starting off gentle, getting more intense, and then tailing off again. They may feel a little like period pains. What differentiates them from Braxon-Hicks contractions is that they will be regular: perhaps every 30 minutes or every 15 minutes, or more frequently. Every woman’s body has an individual rhythm of labour, unique to her so it is not possible to give precise timings. As labour progresses, the interval between the contractions will get shorter and they will feel stronger.

Early Stages

In these early stages, you will probably still be able to walk about quite comfortably. While you are at this stage, there is no need to call the midwife or go into hospital – first stage labour can last for a very long time, particularly in a first pregnancy, so there is no point in rushing into hospital. It’s a good idea to stay at home for as long as possible – you will know how long the journey to hospital is and when you feel ready to make it. You will help the hormones which control labour to work well if you stay in an environment where you feel safe and happy, able to move about, eat and drink and be with family and friends if you wish. Your home is the best place to fulfill all these requirements.

As contractions become more frequent and last longer, they will also become more painful. You can help yourself by using relaxation and breathing techniques you learnt in ante-natal class or use a TENS machine to relieve the pain. Do what feels good but avoid sitting or lying back – lean forward when a contraction comes. If you are tired and want to sleep, lie on your side, not your back.

Hospital?

If you are giving birth in hospital, then phone the hospital when you feel ready to go in. The midwife will probably ask you how long and how frequent your contractions are – usually if the contractions are coming every five minutes and lasting for a minute or more, you will be advised to come in. If you have a contraction on the phone, the midwife may be able to judge from your voice and your breathing whether you are ready to come in. Similarly, if you are having a home birth, a good time to call your midwife is when your contractions are coming every five minutes. See “Home birth” for more information.

Remember to take your notes and your hospital bag with you when you go to hospital. Once there, you will probably be admitted to an assessment unit where the midwife will ask you how long you’ve been having contractions and how frequent they are. She will check your notes, take a urine sample, measure your blood pressure and check the position of the baby. She may also carry out an internal examination to judge how far dilated your cervix is. This doesn’t necessarily bear any relation to the severity and frequency of your contractions: sometimes a woman can reach full (10cm) dilation with fairly moderate contractions, while others can experience painful contractions for many hours without dilating very much. As a general rule, however, the contractions will become more intense once you are about 5cm dilated.

From there, you will either be taken to the antenatal ward or the delivery ward, depending on how far advanced your labour is. You can choose, if labour is not advanced, to go home again if you wish.

Remember...

While you’re still in the first stage, it’s a good idea to keep moving and walking around if you can. But you may also choose to use pain relief. See “Working with pain in labour” for information about the different kinds of pain relief on offer in labour, and refer to “Using water in labour and birth” for information about how water can help relieve pain in labour.

Sometimes if first stage labour is progressing very slowly, you may be offered a syntocinon drip to speed it up. You will need sit on a bed or chair while the drip is in place. Syntocinon, a synthetic version of the hormone oxytocin, can make the labour more painful and intense. You may decide to use extra pain relief , such as an epidural.

You can find out more in the NCT Guide to labour