Coping with the early stages of labour

Here you can find out more about how recognise the start of your labour, understand the progress through labour and get some advice and tips to help you through the early phase – sometimes referred to as the latent phase – of labour.
You may know that labour is divided into three parts:

• The first part of your labour is when the neck of the womb (cervix) opens over a
  period of time, to 10cms
• The second part of your labour is when the baby moves down through the vagina
  and is born
• The third part is when the afterbirth (placenta) is delivered.

Remember that every woman’s labour is different and sometimes it can take some time. This is perfectly normal.

If you think that you are in the early stages of labour, the main thing to remember is to stay calm and relaxed.

What is the latent (early) phase of labour?

Before labour starts, the neck of the womb (cervix) is long, firm and closed.

Even before labour begins, the cervix can be drawn up and get thinner.

The ‘latent’ phase of labour is the very first part of your labour – the early part of first stage. During the ‘latent’ phase the neck of the womb thins and opens up to about three to four cm.

The next part of labour is called the ‘active’ phase. This is when labour has become established.
Both the ‘latent’ and the ‘active’ phases take place during the first stage of labour.
Eventually, at the end of the first stage, the cervix has opened to 10cm and is described as being ‘fully dilated’.

Before labour starts, the neck of the womb is long and firm. During the latent phase, the muscles of the uterus (womb) contract and make the cervix become flat and soft, at the same time as opening it to three to four centimetres. This flattening is called ‘cervical effacement’ or thinning.
The latent phase can last several days or weeks before active labour starts. Some women can feel backache or cramps during this phase.

Some women have bouts of contractions lasting a few hours which then stop and start up again the next day. This is normal.
‘Braxton Hicks’ contractions occur all through pregnancy. They are the tightening of the muscle of the uterus and last for about 30 seconds. They are usually painless.
During the latent phase Braxton Hicks contractions may become more noticeable and more frequent, lasting between 35 and 45 seconds. However some women may not notice anything happening at all.

Remember, the latent phase of labour can last a long time, especially if it’s your first baby.

Things you can do to help yourself before labour starts

Remember your body already knows how to give birth. When you understand what helps or hinders the natural process you can create the right environment around you.

Here are some tips to help you prepare:

• Communicate with your midwife during pregnancy – make sure that you find as much information as you can from her
• Attend antenatal classes and active birth workshops
• Some women use the internet – try the National Childbirth Trust website
• The Pregnancy Book is a complete guide to keeping healthy in pregnancy,
  labour and childbirth and the first weeks with your baby.
• You can write a birth plan so we can understand your needs and feelings about
  labour
• Aim to visualise a positive outcome to your labour, such as holding your baby in
  your arms
• Think positively about the strength and reliability of your body

It helps if you avoid stimulating the ‘rational’ part of your brain during labour. This can override the ‘primitive’ part which produces endorphins (your own natural pain relievers) and oxytocin (the hormone which is produced when you go into labour).
There are lots of ways to increase production of endorphins. These include practicing relaxation and calm breathing, listening to music that makes you feel happy, keeping the lights low, having cuddles and words of encouragement. All these help at every stage of labour.

What do I do if I think I may be in labour?

If you think that you might have started in labour, please ring the hospital you are booked for:
Scunthorpe Central Delivery Suite (CDS): 03033 302270
Grimsby / Blueberry Team: 03033 304789
Grimsby / Holly Team: 03033 304790
Grimsby / Honeysuckle Team: 03033 304794
Grimsby / Jasmine Team: 03033 304787
When the midwife has assessed you, she will give you a clearer picture of what is happening.

If you are ‘assessed’ (checked over) in hospital, and are in the latent phase of labour, she may suggest you return home until you reach the ‘active phase’ of the first stage.

If you are booked for a home birth, the community midwife will assess you at home.

What signs can I expect to tell me that labour has begun?

The show

As the cervix begins to flatten and open, the mucus which has been protecting the entrance to your womb comes away.

Many women experience what is known as a ‘bloody show’ from the vagina. The mucus will be tinged pink or brown from blood – this is normal. Having a ‘show’ means that your body is starting to get ready for labour – but the actual birth is very likely to be some time away. Some women have a ‘show’ several days before labour starts.
If there is bright red blood you should phone CDS at Scunthorpe / the team you are booked under at Grimsby.

Your waters breaking

Before active labour starts, your waters may break. During pregnancy, your baby is surrounded by amniotic fluid – the ‘waters’:

• For some women (about one in 10), the first sign that labour is going to start is that the waters begin to leak
• It is quite common for women to leak a small amount of urine at the end of pregnancy and it can be difficult to tell if your waters have broken or if it is urine
• If you are not sure if your waters have broken, put a sanitary pad on and lie down for about 30 minutes. If you have a definite gush of fluid when you stand up, it is a clear sign that your
  waters have broken and you should telephone your maternity team at Grimsby or CDS at Scunthorpe
• If not, then you can assume your waters haven’t broken

Contractions

In the latent phase of labour, contractions may start and stop. This is normal.
Contractions may continue for several hours but not become longer and stronger. They stay at about 30 – 40 seconds. This is normal too, in the latent phase.

Many women have a vaginal examination during the latent phase which finds, for example, the cervix is 1- 2 centimetres dilated. Their contractions may then stop for a few hours. This is a good time to rest and make sure you have something to eat.

When your body has built up some energy supplies, your contractions will start again. If you are in hospital when you have this examination, the midwife may suggest you go home and wait for contractions to get longer, stronger and closer together. Most women are more relaxed at home in the latent part of first stage and you can use this page to help you manage this part of labour.

Remember – a ‘start-stop’ pattern of contractions is common in the latent phase.

In the active phase, contractions should continue until the baby is born. When you are having regular contractions, that are getting LONGER STRONGER AND CLOSE TOGETHER, you are in the active part of labour. The midwife may also describe the active phase as ‘established labour’. In the active phase, contractions should continue until the baby is born

What can I do in the latent phase of labour?

It is not possible to say when active labour will begin. It could start in a couple of hours or in several days, so try to stay as relaxed as you can and distract yourself from focusing only on the contractions.
The midwife may recommend that you stay at home for as long as possible. This is because there is evidence that the further on in labour you are when you come in to hospital, the more likely you are to have a normal birth.

There are things you can do to help yourself, such as:

• Pottering around the house
• Taking a walk
• Watching a DVD / video
• Taking a warm bath or shower
• Having a nap
• Doing some relaxation
• Keeping your breathing quiet and fluid – ‘breathe in gently, sigh out slowly’
• Massage – ask your partner / labour supporter to do this for you
• Putting a hot water bottle on any areas that ache – your lower back, your tummy
  (under the bump) or between your thighs. Wrap it in a small towel first
• Trying a soft gel sports injury pack which you have cooled in the freezer – this
  can help with backache
• Keeping as mobile as you can, while remembering to save your energy for the
  active part of labour
• Taking paracetomol may be recommended by the midwife, it is not advisable to
  take anything else. Always ask advice if you are not sure
• Try out different positions and using a birthing ball to experiment with what helps
• Drinking plenty of fluids – water, sports drinks, apple juice are all good
• Eating little and often – carbohydrates (bread, pasta, rice, cereal) for slow –
  release energy plus sugary foods for quick-release energy
• You may find it helps to make love – kissing, cuddling and having an orgasm all cause your body to produce oxytocin. This is the hormone which is also produced in labour and which makes the uterus contract
• Some women who have hired a TENS machine, find it helpful to use during the latent phase.
• If you have already come into hospital, it may be useful to soak in the bath or use the birthing pool in the early stages to help you cope with the pain and discomfort.
• Experiment with positions that you find comfortable. Stay upright and mobile as there are advantages to staying off the bed and keeping upright in labour. This can mean standing, sitting, squatting, kneeling and walking around. You may find a birthing ball, a floor mat and a beanbag useful at this stage.

Choose a supportive birthing partner who can be with you through your labour.
Some women choose to have the support of two people. Your birth supporters can encourage and reassure you and help to tell your midwife what you would like.
Partners can help with things such as:

• Massage
• Keeping you active
• Getting you drinks
• Praising and encouraging you
• Giving you cuddles
• Keeping you company and even trying to make you laugh!

Most importantly – your birthing supporter/ partner should be someone who you can be totally relaxed and comfortable with

Moving into the active phase of labour

Remember that you help your labour to carry on smoothly by avoiding stimulating the ‘rational’ part of the brain. You need peace, quiet and a feeling of safety to help you relax and so increase the levels of your own natural pain relievers – ‘endorphins’.
During labour you can take measures such as avoiding:

• Bright lights
• People asking you questions which you have to think to answer
• People talking to you during contractions
• Feeling as if people are watching or judging you

By having privacy, quiet, being in a darkened room and feeling safe, your ‘rational’ brain can be less stimulated and can allow your body to help you to begin your labour. Listening to music you have chosen can also help.

Remember – labour is a journey, and the early part of first stage can take a long time. This is normal. Quick labours are not always the easiest to cope with.

If at any time you are worried, not sure if you are in labour or are concerned about your baby’s movements slowing down please ring the team you are booked with. There is someone available 24 hours a day, seven days a week to answer your queries.