What Really Happens During Labour
Are you nearing the end of your During pregnancy with no idea what to expect come d-day? You’re not alone. HP uncovers what goes on behind the delivery room doors that might surprise you.
WORDS CHRISTEL GERALYN GOMES
If your due date is looming, you’re likely to be wondering about what really happens in the delivery room. First time mums are often in for a few surprises – here’s the inside scoop on what goes down.
It’s Messier than You Expect
Think blood, sweat, amniotic fluid, tears, pee and placenta accompanied by a fair bit of screaming. At some point it’s even likely that you no longer care who sees you naked. Doctors will tell you that no matter how much you think you’ve read beforehand, the delivery process regularly surprises new mums.
The Doctor Won’t See You Yet – You Might Be Sent Home
It pays to know which stage of labour you’re in and when to check yourself into the hospital. If you’re still in early labour, getting to active labour can last anywhere between a few hours to a few days, so it’s no surprise if you get sent home to wait it out.
Dr Kelly Loi, obstetrician and gynaecologist at the Health & Fertility Centre for Women, at Paragon Medical, explains that early labour, “is when the cervix gradually effaces (thins out) and dilates to 3cm. The duration varies very much amongst different women.” Given that it might be quite a while before you’re ready to push, you’re better off resting in the comfort of your own home till you begin active labour.
“Active labour is when the cervix begins to dilate more rapidly from 3cm to fully dilated at 10cm. The duration of active labour is usually eight to 12 hours,” says Dr Loi.
During active labour, “cervical dilatation is more constant at about 1cm per hour,” says Dr Tony Tan, specialist in Obstetrics & Gynaecology and consultant, Raffles Women’s Centre. “Usually, I ask my patients to come to the labour ward when the contractions are once every five minutes (or earlier if they had past history of a quick delivery), when the amniotic fluid is already leaking, or if there is decreased foetal movement,” he says.
You’re Likely to Poop on The Table
Yes, you read right. In fact, it happens often and to most people, so you might want to mentally prepare the hubby beforehand. According to Dr Tan, there is a high chance of this happening “unless the rectum has been emptied before the labour process.” It can happen once, or more than once, and is most common when the baby crowns. Unfortunately, it might also be slightly outside of your control. He explains, “During pushing at the second stage of labour, the instruction often given is to push down like one is going to pass motion. You can imagine how poop may thus be passed out during the second stage of labour.”
dr kelly loi
Obstetrician & Gynaecologist
BA (1st Class Hons, Oxford),
MA (Oxford), BM BCh (Oxford),
DFFP (London), MRCOG (London),
FAMS (Singapore)
Health & Fertility Centre For Women
290 Orchard Road
#18-06 Paragon Medical Suites.
Tel: 6235 5066
www.healthfertility.com.sg

     
EPIDURALS COME WITH CATHETERS
An epidural pretty much blocks off the nerves to the lower half of your body. If you opt for one, it comes with a lot of liquid that’s necessary so your blood pressure doesn’t go haywire. But you should also know that once given, you can’t get up to pee. Dr Tan tells us that it is then protocol to have either an indwelling urinary cathether inserted (a slim tube put through the urethra into the bladder) or an intermittent bladder emptying through in-out catheterization. Sound painful? The epidural will ensure that you pretty much feel nothing, and it will be removed before you start pushing.
WHERE'S BABY'S HEART-RATE?
Usually baby’s heart-rate is monitored externally by electrodes placed on your belly. Sometimes, the doctor might need to use a more direct method – a foetal scalp electrode. “It is done when the heart beat is not easily detected through the usual abdominal sensors and there is a concern that the baby may be ‘stressed’,” says Dr Loi.
A wire is inserted through your cervix and screwed a couple of millimeters into Baby’s scalp skin and it will cause a small wound on the head. This may sound scary but you can be assured that it is relatively safe – instances of bleeding or infection are extremely rare.
“The monitor that is attached to the baby’s scalp is less commonly used nowadays,” says Dr Tan. However, it may be necessary, “if there is difficulty in obtaining good heart rate tracing through an external monitor, especially if the mother is wriggling around in pain or if the foetus is very active,” he adds.
HOW MUCH PAIN CAN YOU EXPECT?
In short, there’s no way to tell. Some women are lucky enough to experience a mild labour. Others face excruciating pain. But almost everyone forgets the pain as soon as the baby arrives.
According to Dr Tan, “The pain of labour is like very severe menstrual cramps, and has often been described as the most painful experience in the lifetime of a woman. Obviously, there is a spectrum of pain intensity and some may find it bearable with various distraction techniques, or with some medications.”
Dr Loi says, “Pain levels perceived appear to be influenced by a variety of factors including previous childbirth experience as well as fear and anxiety. Being prepared for the childbirth process may help to decrease this fear and anxiety, and influence a woman’s perception and response to pain. It is therefore useful for a woman to prepare as much as possible for what labour may entail. Knowledge of the process and options for pain relief will make a woman feel more ‘in- control’ and less fearful, empowering her to make the necessary decisions. Ways to prepare for labour include talking to your doctor about what to expect, reading books on childbirth, and attending antenatal classes and talks.”
     
Dads Suffer too!
You may be surprised to see the soft side of your partner surface during your delivery. According to Dr Tan, he’s witnessed husbands sympathising with their wives pain “to the extent of offering their arms for their wives to bite.” So be rest assured, as much pain as you are in, your hubby is likely to be suffering by proxy too. “They sometimes do feel helpless when the pain becomes unbearable for their wives,” says Dr Tan.
Baby’s Out? You’re Not Done Yet!
The baby is not the only thing you’ll be delivering that day. You’ll still need to deliver the placenta. Fortunately, you won’t need to do any more pushing.
“Placenta can be delivered passively after waiting for the placenta to separate from the uterus, usually within 30 minutes; or delivered actively by pulling on the placenta in a controlled fashion,” says Dr Tan.
Dr Loi adds that the pulling by the obstetrician is called ‘controlled cord traction’. “In addition, contractions may be further stimulated with the help of injections.” The delivery of the placenta is important to prevent infection or excessive bleeding after delivery.
     
You Can See the Placenta if You Like
If you’re curious, you can go ahead and ask to see your placenta – after all, it was your baby’s first home. Wondering what it’ll look like? Dr Loi tells us that it averages 9 inches in length and about 1 inch in thickness, “with the center being the thickest, and the edges being the thinnest. It typically weighs approximately 500 grams and has a dark reddishblue colour.”
Dr Tan on the other hand finds that “raw beef” pretty much summarises what it looks like.