Am I in a labour? Signs to look out for

Lilian Karanja, a Lamaze instructor at Aga Khan University Hospital discusses labour and how a pregnant woman can be empowered to know when she is due —a bid to avoid the roadside deliveries that expose many a mother to numerous risks.

What is labour?
This is the process that culminates in the birth of the baby, placenta and membranes.

Signs experienced when a pregnant woman nears birth:

Nesting: It happens that at the last moments before labour, a pregnant woman wants to do her shopping, have her hair done, if planning to move houses, this is when she does it. It is a natural occurrence that even happens to animals, a sign of preparation.

Burst of energy: For most women, late pregnancy brings a lot of fatigue but this time a pregnant woman will certainly realize she has lots of energy. She wants to do laundry, and tasks she has not carried out in a while: her days will be characterized by a new burst of energy.

Lightening: (relief experienced in the last stages of pregnancy when the baby’s head sinks into the pelvis) After 36 weeks, it is expected that a baby’s head is down towards the pelvis while the buttocks are up. The head then slowly starts to get into the pelvis. For most first time mothers it happens during pregnancy and for mothers who have previously delivered it will happen when they are in labour.

Loose bowel movement or diarrhoea: A woman may think she ate something bad but it is her body clearing up the rectum.

How to tell
A woman will get contractions, whereby the walls of the uterus become tight and hard fora couple of seconds and then relax. What the mother feels is the baby from inside pushing in all directions. Pregnant women are advised not to wait to feel pain to conclude that they are in labour. Pain is individual and it is not a guarantee that it happens. There are instances whereby a woman experiences false contractions and may think she is in labour which is not the case. Here are signs to know whether it is false labour. The false contractions can happen two to four weeks before the true labour starts.

True labour
o Contractions
o Begin irregularly
o Becomes regular and predictable
o Progressive o Enhanced by activity
o Lower back sweeps round to abdomen in a wave
o Cervix dilates

False labour
o Contractions
o Begin and remain irregular
o Do not progress
o Begin on abdomen and remain confined to abdomen and groin
o Disappear/Diminish with activity
o Cervix does not dilate

The first stage of labour is divided into three substages

Early labour:
The woman gets mild contractions that may last between 25 to 45 seconds. The break between each is about five to 30 minutes. At this stage the cervix dilates to about 3cm. Early labour lasts between 4 to 8 hours. Emotionally, the woman is excited, energetic, apprehensive and talkative.

Active phase
The mild contractions start becoming intense (40-60 seconds long), coming close together. The cervix opens a further (3-7cm) with this phase lasting between 4 to 6 hours. Emotionally, the apprehension increases and the mother gets more focused on the task of labour. She is less talkative. Physically, she will experience nausea, vomiting, urinary frequency, thirst and backache.

Transition
This is the last phase of stage one and now the baby is about to be born. Contractions are intense and seem continuous, coming every 60-90 seconds, accompanied by multiple peaks. High pelvic pressure, shaking and trembling are part of what the woman is experiencing. She is heavily perspiring and sensitive to touch; she is also having nausea. The cervix dilates 7-10cm. This phase lasts 30 minutes to two hours. Emotionally, the woman is irritable, feeling out of control, and is filled with fear. A desire to quit can easily set in then.

Stage two
Now the woman has an urge to push. She will have a lull in the uterine cavity. Nature gives women a break after the contractions and the transition. She will get a break during which her body restores and gives her more energy. After a while the contractions come back. If the cervix is already 10cm dilated, the mother to be, in a comfortable position is encouraged to start pushing.
Once the baby comes out, he is put on mum’s abdomen. The cord is tied, and cut in two different spots, after which the baby is wrapped and given to the mother to breastfeed if he does not require any medical attention.
Now that baby has arrived, the placenta has to be removed. The mother is allowed to breastfeed and as she does so, her body produces a hormone, (oxytocin) which helps the uterus to contract. The placenta is soon removed. Emotionally, the mother feels in control and happy. The whole process is tiring to both the mother and the baby so they need to rest for a period of two hours.

Other possible signs which may or may not escalate into labour include:

o Nagging backache accompanied by restlessness
o Menstrual-like cramps
o Soft bowel movements.

As the contractions come closer together and last longer and also keep a rhythm, the woman will realize that she is discharging some brownish, reddish discharge (show) which is a sign to confirm that she is in labour.

The discharge will keep coming because the cervix is becoming softer and starting to open up.

This is the first stage of labour.

Pregnant women are advised not to wait to feel pain to conclude that they are in labour.

END: PG18/44-45