The first period - Latent stage of Labour

The latent stage of labour is where your cervix starts to soften and open (dilate) so your baby can be born.You may begin to feel irregular contractions, but it can take many hours, or even days, before you're in established active labour. It's usually the longest stage of labour.

At this stage, your contractions may range from being slightly uncomfortable to more painful. There’s no set pattern to how many contractions you get or how long they last.

During the latent stage, it's a good idea to have something to eat and drink because you'll need energy for when labour is established.

If your latent stage of labour starts at night, try to stay comfortable and relaxed. Sleep if you can. If your latent stage of labour starts during the day, stay upright and gently active. This helps your baby move down into your pelvis and helps your cervix to dilate.

Breathing exercises, massage and having a warm bath or shower may help ease pain during this early stage of labour.

The second  period of birth- active phase of labour

Begins with the appearance of regular uterine contractions, and when the cervix is open 3-4 cm.  Contractions are felt like sensations of tension or pain that come from the uterus.

The active phase ends with the complete opening of the cervix, when the baby's head can pass. This period has a duration of 8-10 hours for pregnant women who give birth for the first time and of 6-8 hours for those who are giving birth repeatedly, it must not exceed 15 hours in total.

The third  period of birth -  the birth of your baby starts from the moment of the complete opening of the cervix and ends with the birth of the child. This period is short, lasting 1-2 hours for pregnant women who give birth for the first time and from a few minutes (5-10) to 1 hour for those who are in repeated birth. This period is the one that requires the greatest amount of energy, several times more than the energy used during labor.

It is important to know that when the baby descends through the birth canal and presses on the nerve endings, the contractions are accompanied by a pushing sensation - Women need to push to accompany the contractions of the uterus. This will help the baby to go out of the uterus.

The fourth period of birth - the period of delivery (expulsion)  of the placenta begins immediately after the birth of the baby and ends with the expulsion of the placenta and its appendages from the uterine cavity. This period is called delivery.

After the birth of the baby, some measures could be initiated, such as the intramuscular injection of oxytocin, necessary for the prevention of postpartum bleeding.

The duration of the delivery period is from 10 to 30 minutes, there are no differences between women who give birth for the first time or after repeated birth. The doctor will check the placenta to make sure that it is whole. Then the birth canal will be examined, to make sure that injuries are not present.

The pregnant woman will go to the maternity ward when:

• She has  contractions, which, when changing the activity or position of the body do not improve or do not cause the contractions to stop, every 5 minutes for 2 hours for the first pregnancy and for 1 hour for repeated birth;
• The amniotic fluid leaks from the vagina,  this occurs as a result of uterine contractions or stretching. In this case, it is advisable for the pregnant woman to reach the maternity hospital as soon as possible, even in the absence of contractions.
• The pregnancy will exceed the term of 41 weeks and the birth has not come;
• Noticed the appearance of the danger signs described like absence of fetal movements.

The contractions of the uterus are associated with strong pain sensations. The pregnant woman should  watch and note the frequency of contractions. It is advisable to go to the maternity ward when they are regular and of the same intensity (repeated at: 5 minutes, if it is for the first birth; 10-20 minutes, for repeated births).

Jana Diabelková  , Kvetoslava Rimárová, Adolescent Pregnancy Outcomes and Risk Factors, Int. J. Environ. Res. Public Health 2023, 20, 4113

A clear, open and trust-based communication between the attending physician and the patient aims to clarify all the aspects not yet understood by the expectant mother like:

• What are the signs of labor that she must identify
• When she must report to the hospital for birth
• What to expect after admission
• How to prepare for labor

The expectant mother should go to the hospital,

• When regular, increasingly frequent and intense painful uterine contractions occur.
• When she has liquid discharge (amniotic fluid has leaked) or bloody vaginal discharge occurs.
• Chronic illness of the mother,  preeclampsia, accompanied by a strong headache, with increased blood pressure (BP) values, blurred vision, ringing sounds in the ears.
• The fetus is too big - the capacity of the maternal pelvis is inadequate to allow the adaptation and engagement of the fetal skull, or another complication can be the blocking of a shoulder through the birth canal.
• Bloody vaginal discharge - which suggests a complication that requires urgent involvement in favor of cesarean surgery

The mother will be asked to stay in the hospital in case there is malposition of the fetus - Before labor begins, most children sit in a position that allows them to exit the birth canal head first. However, this does not always happen. Positions that require different conduct would be the child sitting in a chair, sitting face down or up, or lying in an oblique position.

Birth is a physiological process and an event considered normal. Preparation for birth is extremely important also from the perspective of pain perception and control. It is known that when the pregnant woman/teenager is informed about the presence of pain in labor, she feels it with a lower intensity, thus reducing the demand for pain relief through the use of various methods.

Pain control during labour can be alleviated by: birth preparation, non-pharmacological remedies, epidural analgesia or other regional techniques, and even general anesthesia. It is well known that there are several non-pharmacological options: the mother in labour can take a vertical position and walk, the use of massage and acupressure techniques favour emotional support during birth

The need of the mother in labour to move is very important because :

• favours the progression of birth,
• reduces the perception of increased contractions,
• facilitates the descent of the baby through the birth canal, etc.

Analgesia

The advantages of analgesia during labour are:

• minimization of negative emotions and fear of the mother in labour;
• ensuring a good analgesic effect and full comfort for the mother in labour and fetus;-
• preserving the consciousness of the mother in labour and the ability to participate in the birth process actively;
• lack of negative action on lactation and the physiological evolution of the period after birth.

Epidural analgesia is a form of anesthesia obtained by injecting a local anesthetic in the lower region of the spine, blocking the transmission of pain impulses caused by uterine contraction during labor. It is performed by the anesthesiologist, under sterile conditions, performed with the consent of the pregnant woman.

There are many reasons why obstetricians encourage you to have a partner during birth. You will need someone to be with you, comfort you and help you during the birth. This person can be the child's father, mother, sister or a good friend. Step-by-step encouragement can help you cope better with contractions and have a more pleasant experience. There is scientific evidence that has shown that ongoing support from a loved one (not medical staff) leads to:

• Shorter births
• Less pain
• Less need for sedatives and drugs to hasten labor
• Fewer emergency C-sections
• Fewer cases of fetal distress

The close person in childbirth helps the woman to relax, to feel safe, which leads to an increase in the amount of hormones-endorphins. These hormones lead to less pain during childbirth.

During childbirth, the woman expects from her support person:

• Confidence
• Encouragement
• Support
• Appreciation
• Sharing of responsibilities

The role of the support person during birth:

• Hold a cold cloth to the woman's forehead during contractions.
• Stays involved in the birth process.
• Provides emotional support, showing empathy, understanding and compassion
• Facilitates communication between the pregnant woman and the medical staff who assist in labor and birth, so that future parents can make informed decisions about them

A caesarean section is an operation in which the baby is delivered through an incision made in the abdomen and uterus.

The cut is usually made on the abdomen, just below the underwear line. A caesarean section is a major operation, so it is only done if it is the safest option for the mother and the baby.

C-section is a major surgery, but it is also a very safe surgery. An anesthesia will be done initially. Often this is an epidural or spinal anaesthesia. This makes the belly and lower body numb and painless, but the mother remains awake and will feel some movement and pulling during the operation. If you have a general anaesthesia, the mother will be asleep during the operation. Often, you can choose to stay awake or asleep during the operation.

What happens in the operating room:

• A screen (made of fabric) is placed over your body so you cannot see what is being done - the doctors and nurses will let you know what is happening.
• Usually an incision about 10-20 cm long will be made in the lower abdomen and uterus so that the baby can be delivered.
• The operation takes about 40-50 minutes.

Recovery after a caesarean section

Recovery from a C-section usually takes longer than recovery from a vaginal birth. After the operation, an IV (infusion) and a urine catheter (a tube into the bladder) will be connected. Both are usually removed when the mother is able to move. Abdominal pain will be present for the first few days with painkillers to help you with this. The average hospital stay after a C-section is about 3-4 days, compared to an average of 2 days for a vaginal birth.

The belly wound will eventually form a scar. This may be obvious at first but it may fade over time and will often be hidden by pubic hair.

The risks of a caesarean section

C-section is a very safe procedure, but complications can still occur. These complications could include

• infection of the wound or the uterus
• excessive bleeding
• damage to nearby organs such as the bladder or ureters (tubular structures connecting the kidneys and bladder)

After a c-section, it is recommended to wait at least 18 months to have another pregnancy( to make sure that the uterus has enough time to recover and form a proper scar).

Having 3 c sections is the maximum recommended by WHO. Otherwise it can be dangerous for the mother.

After c section, women can have a normal vaginal delivery: VBAC : Vaginal birth after c- section,  but the mother should wait two years between the 2 deliveries.

It is important to do what is good for you and maintain maximum freedom of movement.

Childbirth is a natural process. Walking, frequently changing positions and not just lying in bed are the best actions for mothers and babies during all the labour and childbirth. Labour will be easier if the mother moves her pelvis slightly and is active. There is no fixed way to do this, which means trying what works best for the mother.

Walking around the room with resting periods while leaning against the wall, dancing, and leaning on knees and elbows are effective. Walking with your birth support person is a great way to deal with labour pains in the early stages of labour. Try to stay as mobile as possible even when the pain is getting worse.

There are also different positions for giving birth, such as lying on your back, kneeling or sitting. Position during birth doesn't make much difference. Mothers should choose a position that works for them.