The first stage

The dilation of the cervix

Contractions at the start of labour help to soften the cervix, then the cervix will gradually open to about 4in (10cm). This is wide enough to let the baby out and is called fully dilated.

Sometimes the process of softening can take many hours before what midwives refer to as established labour. This is when your cervix has opened (dilated) to at least 1in (3cm). If you go into hospital before labour is established, you may be asked if you would prefer to go home again for a while, rather than spending many extra hours in hospital.

You may be able to have drinks and light snacks in established labour, but you will usually not want to eat anything else.

Once labour is established, the midwife will check again from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between six and 12 hours. It is often quicker for later ones.

Towards the end of the first stage, you may feel that you want to push as each contraction comes. At this point, if the midwife isn’t already with you, ring for her. The midwife will tell you to try not to push until your cervix is fully open and the baby’s head can be seen.

To help yourself get over the urge to push, try blowing out slowly and gently or, if the urge is too strong, in little puffs. Some people find this easier lying on their sides, or on their elbows and knees, to reduce the pressure of the baby’s head on the cervix. You can be up and moving about if you feel like it too.

As the contractions get stronger and more painful, you can put into practice the relaxation and breathing exercises you learned during pregnancy. Your birth partner can help by doing them with you and by rubbing your back to relieve the pain if that helps.

Foetal heart monitoring

Every baby’s heart is monitored throughout labour. The midwife is watching for any marked change in the heart rate, which could be a sign that the baby is distressed and that action should be taken to speed up delivery.

There are different ways of monitoring the baby’s heartbeat:

• Your midwife may listen to the baby’s heart intermittently with a hand-held ultrasound monitor (often called a Sonicaid). This method allows you to be free to move around in labour if you wish. The heartbeat and contractions may also be followed electronically through a monitor linked to a machine called a CTG. The monitor will be strapped to your tummy on a belt.
• Sometimes it may be suggested that a clip is put on the baby’s head so that its heart can be monitored more exactly. The clip is put on during a vaginal examination, and the waters are broken if they have not already done so. Ask your midwife or doctor to explain why they feel the clip is necessary for your baby.

Throughout labour the heartbeat will be followed by a bleep from the machine and a print-out. You cannot easily move around. Some machines use tiny transmitters which allow you to be more mobile. Ask if these are available.

Speeding up labour

If your labour is slow, your doctor may recommend acceleration to get things moving. You should be given a clear explanation of why this is proposed. To start with, your waters will be broken (if this has not already happened) during a vaginal examination. This is often enough to get things moving. If not, you may be offered a drip containing a hormone which will encourage contractions. If you have a drip, the hormone will be fed into a vein in your arm.