STAGES OF LABOUR

1st STAGE

| Latent Phase | Active Phase | How do you feel | What does the doctor do | | Do's and Don'ts |

It is the beginning of labour. It commences with the onset of true pain and uterine contractions, which bring about gradual opening up of the cervix. The opening of cervix is assessed in terms of “centimeters”
When the cervix is fully opened or dilated as it is medically referred to, it is approximately 10 cms in diameter.
This is so because the diameter of the foetal head (biparietal diameter) is approximately 9.5 cms at full term.

The first stage is divided into two parts:

1. Latent phase
   
2. Active Phase.
   

What do you feel / experience?
This is the beginning of the end part of your pregnancy. Very soon you will be the proud mother of an adorable little one. During this stage you may experience pain in the abdomen and back. This may even go on to the thigh and leg. Initially it may start off with a vague backache or lower abdominal pain (like menstrual pain). Gradually it will increase in intensity, duration and frequency. 
You will be able to appreciate the hardening of the uterus.The movements of the foetus may also be slightly reduced during labour.The pain may initially come once in ½ - 1 hour lasting for few seconds and by the end of this stage it will peak and you may experience a contraction every 2 – 3 minutes and the contraction itself may last for ½  - 1 minute. With the onset of pain you will have show   .  
Sometime during the first stage of labour, the bag of waters may burst releasing watery fluid. This is normal.
This water is usually clear. If it is yellow, brown or green, then it suggests that your baby may be having some problem inside and it is an indicator to immediately inform your doctor. 
If the bag of waters burst before onset of labour pain, it is wise to report immediately to your doctor so that steps for early delivery can be taken to avoid infection setting in.
 In case the bag of waters does not burst by itself, your Doctor may do so when you are in the active phase   .  This tells him/her about the colour of amniotic fluid and also accelerates the labour pain.

What Does Your Doctor Do?
Once you have been admitted and all the routine procedure like shaving, enema, etc. have been done, you may be assigned a room or may be kept in the labour ward (depending upon the hospital protocol and your doctor’s judgement).

Subsequently, your doctor and the nurse will be constantly and closely monitor you. Monitoring is done to follow the course of labour (whether you are progressing normally) and to find out the status of the foetus during labour. An obstetrician is always worried (sometimes more than you) till the delivery takes place as he/she is in charge of two lives during labour. She / he can relax only after the delivery has been conducted.

Your doctor / nurse will be monitoring the following things:

•  Your general condition, pulse rate, B.P and other parameters.
•  Your labour pains – whether they are adequately in need or need any external support to increase their intensity (with the help of tablets / I.V.drugs).
•  The heart rate of your baby-- whether it is normal/abnormal. This is checked by using a stethoscope or a Doppler machine. These 2 parameters may be checked every ½ hour or even more frequently as per your conditions.
• Internal examination: Your doctor may do an internal examination as required, though not as frequently, as he/she checks you pulse, blood pressure and your baby’s heart rate. Internal examination (P.V. – Per vagium) is done to assess the progress of labour.If your bag of waters is not burst, the doctor may do so if your cervix is dilated to about 3 – 5 cms. This procedure is absolutely pain less. You may feel some warm fluid trickling down your vulva and buttocks and nothing more than that. If you are moving around, then you may need to wear sanitary pads to prevent soiling/ leaking.
• If necessary and if facilities are available, you may be attached to a monitor / instruments to record your baby’s heart rate. This may be done intermittently or continuously.
  If necessary, an IV line may be taken to administer IV fluids or other medications.

Medication commonly given may be:

• Analgesics to prevent / decrease pain.
• To increase uterine contraction.
• To facilitate dilatation of the cervix.
• Specific medicines as indicated by your medical / obstetrical status.
• Medicines to reduce acidity and vomiting.
•  Pain relief during labour / Painless labour      
  If consent is given, you may be subjected to some form of therapy to reduce pain felt during labour. 

Your Role – Do's & Dont's

Few things which you may find comforting and relaxing are:

• Take a warm bath just before leaving for the hospital.
• Walk around in the hospital as much as possible.
• Keep yourself adequately hydrated.
• Use relaxation, breathing techniques, etc. to reduce pain.
• Ask your companion to massage your abdomen and back.
• Use a damp cloth to wipe your face and body. It is very refreshing.
• Relax between contraction and don’t push unless told to.
• Think about the wonderful baby that you are going to have soon. Its worth all the trouble and discomfort that you are going thru.