What you need to know before giving birth

In this blog post, I will give you a thorough description of the different stages of childbirth, to give you an idea of what you can expect from yourself and from your doctor/midwife in a completely normal, uncomplicated childbirth. Among others, you can find answers to the following questions:

• Does the birth always start with the water breaking?
• How do contractions feel? And what does it mean when you are 10 centimetres open?
• When do you call the midwife/doctor? And what will he or she do?
• How can a partner support you during childbirth?

What is childbirth?

A birth that is categorized as “normal” begins somewhere between week 37+0 and week 42+0. This is called a birth to term. It is furthermore defined by the baby coming out head first (vertex position), an uncomplicated pregnancy, spontaneous onset, normal progression and without any surgical, medical, or pharmaceutical intervention.

If you are curious about your baby's development during pregnancy, we can recommend you to follow the link and read our blog post about the subject.

During birth, your uterus creates contractions, which will mature and open the cervix and eventually push out the baby along with amniotic membrane, amniotic fluid, and the placenta.

The first stage of labour

The birth consists of 3 stages that can be divided into 5 phases, which I will elaborate on here:

Phase 1: Early labour

Early labour is the first phase of childbirth. For some women, this phase is short and for others, it can last for many hours - sometimes days. Both ways are completely normal and are unfortunately not something we can control ourselves. Early labour begins with the first real and regular contractions and continues until the cervix is ​​approximately four centimetres open.

Only about 10% of all births start with the water breaking and contractions beginning afterwards. It is a pregnancy myth that all childbirth starts with the water breaking, which means that most of all births begin with contractions, after which the water will break at some point during the birth or at the very end. In the early labour phase, most women experience a large amount of clear/pink mucus from the vagina, which originates from the mucus plug. This is a collection of mucus which is located in the cervix and works as a protective seal against outside coming bacteria. The mucus can appear several weeks before labour without it necessarily meaning that the birth is underway – this is perfectly normal. You may also, during this phase, experience small signs of bleeding. This occurs when the cervix begins to dilate, and small blood vessels rupture – this is also completely normal.

Your contractions will typically be mild (but painful) and the breaks between the contractions may be long and irregular. In early labour, you are usually at home in familiar and quiet surroundings, where you can use pain relief such as hot water, massage, or a heating pad on the lower back or front. This part of the birth is something you can prepare for during your pregnancy, read how to do this in our blog post about preparing for a baby.

Examinations during the early labour

When the contractions become more intense, more painful and show themselves regularly 3–5 minutes apart (from one contraction starts to the next contraction starts), it is time to contact your midwife or doctor to get a check-up. The midwife will either come to your home or, you will be invited to the delivery ward for an examination including:

• Checking your baby’s heartbeat
• Determining your contractions – duration and intervals
• An external examination of your belly to clarify the position of the baby, the baby’s size, the tension of the uterus and how far the baby’s head has descended into your pelvis
• Measuring your blood pressure
• Examining a urine sample
• An internal examination is also performed by the midwife/doctor, who will insert two fingers into your vagina to examine how much your cervix has dilated. During the internal examination, she/he also notices whether the amniotic membranes are intact and how the baby's head is rotated. This is to get an indication of how far you are in the labour process. The internal examination might be uncomfortable and that is all right. Tell your midwife how you are feeling, and she will do it slowly and at your tempo.

Sometimes a CTG is performed. This is an external examination, where two meters are placed on your belly to measure the baby's heartbeat and at the same time register your contractions. The purpose of a CTG is to make sure that the baby responds well to the contractions.

If your cervix is ​​about four centimetres open you and you have regular contractions, will probably be invited to stay at the delivery ward as you will now be in active labour. If you are still in early labour and everything else is uncomplicated you can go home and wait for heavier and more frequent contractions.

If you experience heavy bleeding, less movement from the baby or if the water breaks at home, always call your midwife or doctor.

Phase 2: Active labour

Active labour happens when the contractions intensify. For many women, this is the hardest phase during childbirth. In this phase, the cervix opens from 4 to 10 cm so that the baby's head can rotate through the birth canal. The contractions last about 60 to 90 seconds and come 2 to 3 minutes apart. As the contractions become more intense, it is a good idea to concentrate on your breathing. During childbirth, breathing is one of your most important tools to find the strength to deal with the pain – there are various breathing techniques that can be used during childbirth.

If you have not prepared any breathing technique in advance, my advice is to breathe in deeply through your nose and exhale slowly through your mouth throughout the whole contraction. Try to relax your body, especially your forehead, hands, and shoulders. If the body tenses up during contractions, it can aggravate the pain and can eventually drag out the birth. It is super important to stay focused on calm breathing and to keep the body completely relaxed - even though it can be extremely difficult!

Some women also use visualization during labour, to get their mind away from the pain. Among other things, you can imagine a flower opening, a walk on the beach in the hot sand or something completely different – you decide what works for you. It can be a good idea to prepare yourself for breathing, relaxation, and visualization before giving birth, so you know what to do and how to deal with the labour pain. Remember, the midwife or the doctor is there to help you through this.

Phase 3: The transition phase

The transition phase starts when your cervix is completely open (10 centimetres) and lasts until the baby's head is in place on the pelvic floor and you need to start pushing. In this phase, the baby's head moves down through the birth canal. At the same time, it must rotate correctly. This can take anywhere from a few minutes to several hours. Some women experience that the pain changes character or decreases a little bit in this phase, which is completely normal. This is due to the body having to gather strength before it really kicks off in the second stage of labour.

In general, movement and an upright position during childbirth is a good things. It helps the baby to rotate properly and can relieve some of the pain. You may also experience an incipient urge to push as the baby's head moves further and further down through the birth canal. Do not actively push yet, as it may eventually prolong the second stage and exhaust both you and the baby.

The second stage of labour:

Phase 4: Childbirth (Giving birth to your child)

This phase begins when your cervix is ​​fully dilated, and the baby's head is on the pelvic floor. You are now ready to push. Many women experience a huge need to push and have trouble holding back. For some women, it may seem like a great feeling to finally be able to do something active during labour - even if it hurts. This stage can last from a few minutes up to two hours. For a first-time mother, pushing for about an hour is normal.

It can require a special technique to push in the right way using all your power. It may feel like the child is being born out of the rectum – but this is quite normal. As if you are sitting on the toilet trying to get rid of something very large. It may sound silly but that is how it is. Do not worry about anything else coming out - your midwife/doctor is used to it. This is totally normal and not something you can control. On the contrary, it can be an obstacle if you are scared and holding back because the baby must be born, and it is important not to drag out this stage too much.

Your midwife will guide you in how to push, when to push and finally when to gasp. It is very important that you and your midwife have a good collaboration at this stage. When the midwife tells you to gasp, it means that you are close to giving birth to your baby's head. This is called "crowning" and is also referred to as "the ring of fire" - which kind of says it all. The baby's head is on its way out and it feels like you’re burning. In other words, the violent unfolding of the perineum just hurts a lot!

You gasp when the midwife tells you to, and she might apply warm cloths against your perineum and guide you so that the baby's head is born slowly. This is done to ensure that you burst as little as possible and that the baby is born as gently as possible. When the head is born, the hardest work is done, and the rest of the body is born either in the same contraction or in the next with a single push. It is a huge moment when the child is born, and the pain disappears. Depending on the hospital procedure, the baby will either be placed directly on your chest, skin to skin, where it will be wiped off and covered with a blanket, or the hospital staff will take your baby away to be checked up on, wiped off and wrapped in a blanket.

The third stage of labour:

Phase 5: Giving birth to the placenta

After giving birth to your child, the afterbirth follows, and it is time for the placenta to be born. For most women, giving birth to the placenta is completely uncomplicated and painless. Many women describe the birth of the placenta as a hot lump coming out followed by great relief. The midwife may ask you to push or cough, after which the placenta will be quickly released.

Afterwards, the midwife will probably hold a hand on your abdomen to check if the uterus has contracted properly and make sure that you are not bleeding too much. You may get an injection with medication that causes your uterus to contract so that the bleeding decreases.

Next, the midwife will check if you have ruptured and need stitches. Most of the women who need stitches have uncomplicated ruptures which the midwife quietly stitches in the delivery room while you hold your baby in your arms. It is perfectly normal to rupture when giving birth. Up to 80 % of all first-time mothers rupture to some degree, but it is far from all that needs stitches. If the rupture is large and involves the rectal muscle, it requires the supervision of a doctor, and you may be transferred to a surgical room so that the doctor has proper conditions to be able to stitch the rupture. Only about 4% of all women get a major rupture which includes the rectal muscle when giving birth.

How does a contraction feel? And what is it?

Contractions are a rhythmic tightening and release of the muscles surrounding your uterus during labour. They soften, mature, and open the cervix and eventually help push out the baby. The uterus is like an inflated balloon – it is large, tense and has a small “tap” at the bottom which is the cervix. It aims to keep the baby safe and protected in the uterus during pregnancy. When the uterus makes contractions, the neck of the small tap will pull upwards, and the tap (the cervix) will begin to open. It is the uterine muscles that make the contractions and allow the cervix to open. See the picture above, which is an illustration of the cervix dilating during labour.

When the uterus contracts at the beginning of labour, it might feel like severe menstrual cramps located over the pubic bone or in the lower back. The pain can move depending on how far you are in labour. The contractions will get stronger and stronger the further you get into labour, and they will get longer and more intense. At some point, you cannot concentrate on anything other than the pain and getting through it. Then, breathing will be your most important tool. It can be difficult to describe how a contraction feels, as it can feel different from woman to woman, but common to most is that it hurts a lot.

Pain relief during childbirth

There are different types of pain relief you can receive during childbirth. You can choose between natural and medical forms of pain relief. It may be a good idea to familiarize yourself with the types of pain relief your midwife or the hospital offers before giving birth and consider what you might like. You can see a list of different forms of pain relief below.

Non-medical pain relief

• Breathing
• Massaging and slight touching
• Visualization
• Water (bath or shower)
• Heat (from ex. a heating pad)
• Ginger or chilli paste
• Movement
• Acupressure or acupuncture
• Sterile water papules

Medical pain relief

• Paracetamol
• Morphine (Only in early labour)
• Laughing gas
• Epidural
• Pudendal block (Works well against the early need for pushing or for stitching afterwards)

What can my partner do?

In many ways, it can be difficult to be the partner to a woman giving birth. Seeing your partner in pain for many hours or maybe days without being able to take away the pain can be extremely hard and make you feel powerless. Some women need their partner very close, and others would rather cope with the contractions themselves. Both are perfectly okay.

During labour, the partner’s job is to fulfil every need you have, whether it is massage, cold cloths, something to drink or a hand to squeeze. Again, it is a good idea to talk about your expectations before childbirth.

Advice for the partner during childbirth

• First of all, it is a good idea to discuss your partner’s expectations or hopes before the actual birth. They might change along the way, but aligning your expectations gives you a starting point.
• Make sure she has everything she needs – whether it is something to eat or drink, a massage, a hand, etc.
• Tell her that she is doing well, and how strong and tough she is. Help keep her spirits up when it gets difficult.
• Remind yourself that the most important thing is, that you, as a partner, support your girlfriend/wife.
• Remember that you are in this together and that you are both important during the birth of your child. You are not causing any inconvenience, you do not stand in the way, and you have just as much right to be there as your girlfriend/wife who is giving birth.

If you found this article interesting, we can recommend you read our blog post about miscarriage or our blog post about the first weeks after giving birth.