What happens in labour

The stages of labour

Labour is not linear. It speeds up, slows down and doubles back, and nobody can tell you how yours will go. This is the general shape labour tends to move through, not a timetable to keep to. Most of what surprises women in labour is normal.

• Early labour (Latenzphase). Contractions come and go, stop for a while, then start again. This part can last hours or days, and it is the one most people underestimate. Eat, drink, and sleep if you can. Run a bath, watch something undemanding. Going in to your birth place very early tends to mean a longer labour on the ward, and more chance of being offered something to move it along.
• The first stage (Eröffnungsphase). Contractions find a rhythm, get longer and stronger, and the cervix opens. This is usually the longest stage. Moving helps: walking, leaning, swaying, hands and knees, a birth ball, warm water. Whoever is with you can take care of the room and the timing, so that you only have to labour.
• Transition (Übergangsphase). The last of the opening, and often the loudest. Many women shake, feel sick, or say they cannot do it any more. That sentence is the one I am always glad to hear as a doula, because it usually means your baby is close. Transition is short next to what came before it, and it is the part I find most exciting to be in the room for. What helps here is the room staying quiet, dark and steady, and someone telling you what is happening.
• The rest phase (Ruhephase). After the cervix opens and before the urge to push, labour often pauses. Contractions slow down and some women sleep. Midwives have a name for it, and if you and your baby are both well there is usually no reason to hurry it along. It is worth knowing about in advance, because it is easy to mistake for something going wrong.
• Pushing (Austreibungsphase). The urge builds and your body pushes with you, often in waves with rests in between. Upright, kneeling, on all fours, on your side: whichever position works for you is the right one, and you can change it as often as you like.
• The placenta (Nachgeburt). A short third stage after your baby is born, usually with your baby already on your chest. Keeping the room warm, dim and quiet, with your baby skin to skin, keeps your own oxytocin high, and oxytocin is the hormone that helps the placenta come away and your womb contract down. That first hour together is doing something physical, not only sentimental. You can ask to wait for the cord to stop pulsing, and you can ask whether the injection that speeds this stage up is being offered or assumed.

What helps with labour pain

None of us can know what lies ahead on the day. You can still prepare for the intensity of birth, and part of that is knowing what is on offer where you are booked.

• Warm water. A bath or a birth pool. It offers great relief in early labour, and some women stay in the water for the pushing phase too. Ask in advance whether your birth place has a pool and whether it can be used for the birth itself.
• Movement and position. Upright and leaning forward is usually easier than lying flat on your back. Your pelvis moves and opens as your baby comes down through it, and lying on your back limits that, so labour in that position tends to be harder work. Change position whenever you want to.
• Heat, massage and counter-pressure on your lower back. Firm pressure there through a contraction is one of the main things a doula does with her hands. Worth whoever is with you practising it beforehand, because it is hard to explain in the moment.
• Your breath and your voice. Low, open sounds, and nobody in the room minds noise. Three breaths worth practising:
  • A long, slow breath for early labour. In through your nose, out for longer through a soft open mouth.
  • A steady, counted breath for strong contractions. The same count from the start of a contraction to the end of it. Whoever is with you can breathe it with you.
  • An open, downward breath for pushing. Chin down, jaw loose, the breath going down with your baby rather than held in your chest.
• A TENS machine, which you can start at home and keep using in the car. The one thing here you have to arrange yourself, so it has a section of its own overleaf.
• Gas (Lachgas), where it is available. You hold the mask yourself and it wears off within a minute or two. Not every German birth place offers it, so ask.
• An epidural (PDA), in hospital. The strongest pain relief there is, placed by an anaesthetist through a fine tube in your back. It is a medical procedure and it changes how the rest of your labour is managed: research links epidurals with a longer pushing stage and more assisted births, and you will usually have continuous monitoring and less freedom to move. Midwives and doulas often work with water, movement, massage, aromatherapy and acupuncture first, partly for that reason. It stays your decision, at any point in your labour.

Using a TENS machine

What it is. A small battery-powered unit with sticky pads that go either side of your spine, on your lower back. It sends small electrical pulses through the skin. You set the strength with a dial, and there is a boost button you press as each contraction builds. It is the one form of pain relief you can start at home, keep using in the car, and stay completely mobile with.

When to start. Early, while contractions are still mild, and turn it up as they get stronger. It works best when your body has had time to respond, so switching it on for the first time in strong labour is not much use.

How it helps. The pulses give your nerves something else to register, and are thought to encourage your body’s own endorphins. The evidence on how much pain it takes away is mixed. Many women say it takes the edge off early labour and gives them something to do with each contraction. It does not stop you doing anything else.

Getting the most from it. Buy or hire one in advance. Few German birth places have them, and nobody will find you one on the day. Ask whoever is with you to practise putting the pads on before labour, so it goes on quickly. Take spare batteries. Keep the boost button in your own hand. Take it off and dry your back before you get into a bath or a pool.

BRAIN · five questions before you agree to anything

If something is suggested and you are not sure, go through these first. They are for thinking, not for saying out loud, and there is time for them more often than a busy room makes it feel.

• B · Benefits. What are the benefits of doing this now?
• R · Risks. What are the risks, for me and for my baby?
• A · Alternatives. What else could we try first?
• I · Intuition. What is my body telling me?
• N · Nothing. What happens if we wait and do nothing for now?

In a genuine emergency there is no time, and you will be told so. Everything else can wait for a question.

When to set off, and who to call

• Call the labour ward (Kreiß­saal) where you are registered, at any hour: when contractions are strong and regular, when your waters break, if there is bleeding, or if anything worries you. The number is in your Mutterpass once you have registered. For a birth house or a home birth, call your midwife.
• They will ask how often the contractions come, how long they last, and how you sound while you talk through one. You can call more than once.
• Go in sooner if you have had a very fast birth before, if you are less than 37 weeks, if your waters are green or brown, if there is bleeding, or if your baby is moving less than usual.