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By Livia Gamble
If you’re pregnant, that means labour and birth are approaching. Naturally, you’ll have lots of questions about what to expect.
Speaking to Tell Me Baby for our TMB TV series, Pregnancy, Birth & Beyond, Tylah, who is a midwife based in Sydney, answered some common questions women have about labour. Here’s what she said.
Labour is defined in three stages, but “it does seem like a bit of a write off,” says Tylah.
“So the first stage of labour is actually from zero to 10 centimetres – it’s the whole thing. Then you’ve got the second stage, which is when you’re fully dilated, and the third stage is birthing the placenta.”
But the first stage of labour is broken up into two phases: latent phase early labour and established labour.
“Established labour is from four centimetres and above, and in some cases now, we’re considering it could be from six centimetres above,” says Tylah. “So most of the work’s done in the first stage. Even though it feels like you’re at the beginning, a lot of the grunt work has been done.”
It can be very frustrating for a first-time mum to be told “you’ll know” when you’re in labour.
“I think that’s such a classic piece of advice that’s given, but it’s not helpful at all,” says Tylah.
“A lot of people describe the very early signs of labour as just feeling slightly different or a little bit off. Maybe a little bit sick, almost like just before you come down with an illness – you sort of know something’s coming, but you’re not quite sure.
“It generally starts as either period-like cramps or a bit of back pain. You can also find your emotions are more heightened. It’s a whole body experience in terms of things starting.”
Tylah says mindset is key when it comes to labour. “We live our lives in this logical mind, but you want to get back into that primitive mind.”
“You want to do things like continue to do the housework – you’re moving your body around preparing things.”
She says to think about activities you find comforting, like “watching TV, reading a book, having a bath or going for a walk – you’ve almost got to pretend it’s not happening, and that’s the best way to get it to happen. It’s a bit of a catch 22.”
Frustratingly, this is a common experience for first-time mums.
Tylah says, “When you go into labour at home, you’re in a comfortable environment, you feel safe, and all the right hormones are flowing. Your partner might be there. You might be having a bit of a cuddle or a kiss in bed, just feeling really safe. But when you get up, and you get into the car to go to the hospital – this is when the adrenaline starts kicking in, and you start getting in that logical mind again, causing a bit of havoc on your hormones.”
First of all, Tylah recommends staying home until your contractions are “coming hot and heavy”.
“A lot of first time mums teeter in between early and established labour, and sometimes all they have to do is let go to kick past that and move into established labour.
“If you’re at the hospital, it’s really taking control of that environment and knowing that you have the power to take control. You can ask for the light to be dimmed; you can play your favourite music; you can put up family pictures; you can diffuse like lavender or something that’s going to make you feel more comfortable to get that oxytocin going again.”
Watch Tylah’s full chat below.
“They don’t mean that they were in rip-roaring labour for three days with contractions coming every two minutes – no woman could really sustain that,” says Tylah.
“But what they do mean is their contractions started slowly. So you might get one an hour, then one, every half hour, then one, every 15 minutes. And at this time you can still sleep between them. You can still do what you need to do.”
Don’t let the centimetres ruin your zen – there’s still significant work going on in your cervix.
“To explain dilatation a little bit, everyone thinks it’s about the centimetres – one to ten and that’s it. They get very disheartened if they go to the hospital and hear they’re only two centimetres – that ruins their whole mindset.”
Before labour, the cervix is around 3.5 cm to 4 cm long. Once labour starts, the cervix softens and shortens.
“You might stay one centimetre the whole time, but you’ve shortened your cervix,” says Tylah. “And then all it has to do is sort of open and things go quite quickly from there.
“It’s realising that no work that your body is doing is a wasted effort. It all is part of the plan.”
“Some hospitals have different recommendations, so I’d say this is a great conversation to have early on in your appointments,” says Tylah. “Some [hospitals] want to know who could be possibly coming in so they can organise things from a bedding and staffing perspective. However, some hospitals are on top of that, and they would rather you call once you think this is it.”
“Unless you’re crowning, you can get an epidural,” says Tylah. “It might be discouraged if you’ve made it to nine or 10 centimetres, and you’re almost there – it’s almost a much easier process for you just to push that baby out.
“That being said, you should never be denied pain relief. Yes, someone might not recommend it, but you still have a right to that.”
“This is definitely a very circumstantial-based question, but I’ll start by answering it simply with yes. Ultimately it’s better to tear naturally. Evidence suggests that a tear is going to heal much better if you do tear naturally.
“That being said, an episiotomy is not to necessarily prevent a small natural tear – it’s if we’re concerned that you’re going to get a severe tear.
“If we think that tear is going to be altering to your lifestyle, then we’ll often divert the pressure through an episiotomy.”
Again, this is something you can talk about before birth with your midwife or doctor.
Tylah says, “You can go in with a preference saying, ‘I would really only want an episiotomy if it’s an emergency or if it’s really deemed necessary.'”
“There is some evidence to suggest that something like paracetamol can extend that early stage of labour, but I wouldn’t say it’s necessarily conclusive,” says Tylah.
“It’s a decision for you to make and something that maybe you want to take on and research yourself.”
“Transition is generally between seven centimetres and fully dilated. This is where women will often get that overwhelming sense of losing control where they’ll want to go home; they’ll take off their clothes, and they’ll yell. You’ll see that real primal and animalistic behaviour. But it’s also when we get really excited, as midwives, because we know baby’s about to come.”
As for when to start pushing, Tylah says “a lot of women describe it as that feeling of needing to poo.”
“Probably, 50% of women open their bowels in labour. And for us, it’s a completely normal experience. We don’t even think twice about it. It’s not you opening your bowels – it’s because baby’s head is pressing against everything. So it’s baby’s fault, and you can blame baby.
“What you’ll often find is a lot of first time mums don’t actually open their bowels in labour because the bowels will empty in early labour.
“It’s normally a second-time mum where it catches them by surprise, but it’s completely normal.”
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