waiting 3The ‘Latent phase’ of labour

Labour and childbirth are as individual as the women who experience them. Every labour is different and where this is your first baby, it is likely to feel rather like embarking on an unfamiliar journey to an unknown destination. The term ‘labour’ is an apt description because giving birth is hard work and normally takes quite a long time.

 

The stages of labour

There are three stages of labour that you are likely to hear your midwife or doctor refer to:

The first stage of labour – This is defined as the onset of regular uterine (womb) contractions accompanied by effacement (shortening) and dilatation (opening up) of the cervix (neck of the womb) until it has reached 10cm ie is ‘fully dilated’.

The second stage of labour – This commences when the cervix is fully dilated and involves the ‘pushing stage’ where the baby passes down through the birth canal (vagina) and is born

The third stage of labour – This is when the placenta and membranes (afterbirth) come away from the wall of the uterus (womb) and are delivered.

 

Cervical effacement

Before labour begins the cervix is long, has a ‘firm’ consistency and the cervical os (opening) is closed. When labour starts the uterine contractions draw the cervix up so that it becomes thinner, softer and flatter. This is called cervical effacement and can also occur even before labour has properly started. A good analogy is to imagine your cervix is like the knitted cuff of a jumper… As you put your hand through the cuff, it shortens, thins out and opens up. This is the same process that takes place when you are in the first stage of labour.

Where there are changes to the cervix it is very common for women to have a ‘show’ – This is the ‘pinkish’ or blood-stained mucousy discharge (mucus plug) that comes away from inside the cervical canal.

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Braxton Hicks contractions

‘Braxton Hicks’ are the painless uterine tightenings that women frequently experience throughout their pregnancy. However, in the latent phase of labour, some women become more aware of their Braxton Hicks contractions because they feel stronger and occur more frequently – this is the body getting ready for labour – rather like doing stretching/warming up exercises before you hit the gym!

 

The latent phase of labour

A large number of women, particularly those expecting their first baby, experience signs and symptoms which make them feel as if they are in strong (established) labour when in fact, they are actually only in the very earliest part of labour. This is referred to as the latent phase of labour and it is the very early part of the first stage of labour. Being in the latent phase can be a very anxious, unsettling and exhausting time for women and their partners. Women frequently feel confused and unsure about what is happening to their body and the uterine contractions can be so painful that they interrupt sleep, affecting both the woman and her partner.

Women’s experience of the latent phase will vary considerably. Some women will have a relatively short latent phase, while others may find that theirs last for anything between four and 24 hours. In other cases, women can remain in the latent phase for several days or even weeks.

Cervical effacement takes place during the latent phase of labour and the cervix dilates a little – typically to around 3cm. Uterine contractions in the latent phase are often variable in their strength, frequency and duration which results in little, if any, cervical change. These contractions may also be felt as backache or period-type cramps. Some contractions can feel slightly uncomfortable while others are a lot more painful and need to be ‘breathed through’. The contractions may come at regular intervals for a few hours, only to then peter out or stop entirely. Typically, the contractions only last for 30-40 seconds and often continue for several hours without becoming stronger, longer or closer together. This is perfectly typical of the latent phase and is nothing to be concerned about – this is perfectly normal.

 

Active (established) labour

Women are described as being in ‘active’ or ‘established’ labour when they are experiencing regular, painful uterine contractions along with cervical effacement and dilatation. Active labour is very different – contractions become stronger, longer and closer together until they are two to three minutes apart and last for a good minute; the cervix reaches full dilatation and the baby is born.

NB. Both the latent and active phases take place during the first stage of labour.

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Is there anything I can do?

Studies have found that relaxation is associated with a reduction in the intensity of pain during the latent phase of labour – there are a range of DIY measures that can aid relaxation and ease pain/discomfort:

  • If your contractions have stopped altogether, make the most of it and ensure you get as much rest and sleep as you can!
  • Eat and drink normally – contracting muscles need energy to function properly, so eating foods that are high in slow-breakdown carbohydrates eg granola bars, bread, rice and pasta, as well as, drinking Isotonic (energy drinks), water and fruit juice can help to build up your body’s energy supplies
  • Backache and cramps can be eased by taking a relaxing soak in a warm bath or having a warm shower
  • Comfort measures can soothe pain and discomfort – a warmed ‘wheatie bag’/hot water bottle can ease lower backache
  • Taking pain relief such as, Paracetamol and Codeine can be effective – Codeine settles the uterus and can make you feel slightly sleepy, which makes it much easier to rest
  • Try not to become anxious – remaining relaxed is more conducive to the onset of active labour. Use relaxation techniques eg ask your partner to give you a foot or shoulder massage; find comfortable positions and support yourself with cushions and pillows; sit on a birth ball, use breathing techniques
  • Watch a favourite ‘chick flick’ or ‘feel good’ movie
  • It can be easy to start ‘clock watching’ and wonder when you’re going to start active labour. Activities that distract can be very helpful – gentle household chores or light gardening can help the hours pass more swiftly!
  • Keeping active eg going for a gentle walk can help, but don’t overdo things – remember you are going to need all your energy for labour and the birth
  • TENS (Transcutaneous electrical nerve stimulation) can help to ease backache and appears to work better when it is started early in labour
  • Love-making may be the last thing on your mind; however, it encourages the body to produce Oxytocin. This is the hormone that makes the uterus contract
  • The continuous presence of a birth partner of your choice who provides support, reassurance and encouragement has been found to be very beneficial. See also our article, ‘Who can support me during labour?’

 

Contacting your midwife/maternity unit

There are some circumstances where you should always contact your midwife or the hospital. These are where your membranes have ruptured or you think they may have ruptured (the waters have broken); where you experience any vaginal bleeding; have abdominal pain, or if your baby isn’t moving as much as they normally do. In these circumstances the maternity staff will always advise you to come into the maternity unit/hospital to be checked. This will usually include the following observations:

a) Checking your temperature, pulse, blood pressure & respiratory rate

b) Palpating your abdomen to confirm which way your baby is lying

c) Listening to your baby’s heart rate (see also our article on ‘Monitoring your baby’s heart rate in labour’)

d) Performing a vaginal examination, with your consent, to assess whether your cervix is dilating and labour has begun.

Where your midwife examines you and finds that your cervix is not dilating, they will explain that labour hasn’t yet started (and providing there are no concerns about you or your baby’s wellbeing) are likely to suggest that you return home. This can be a huge disappointment and very upsetting; particularly where you are experiencing painful contractions that don’t appear to be having any effect. However, if you are in too much pain to go home, your midwife may suggest that you have Pethidine.

 

Pethidine

Pethidine is the drug most commonly used for pain relief during labour. It is usually given by injection into the muscle of the buttock or the top of the leg. It takes around 20 minutes to take effect from the time of administration and the effects tend to last for at least two hours. Pethidine often makes women feel dizzy and nauseous so is usually given with an anti-sickness drug. Pethidine also tends to make women feel very sleepy so is very good in aiding rest and relaxation. Women often wake up a few hours later in established labour.

Although a long latent phase can be distressing, confusing and tiring, it is also perfectly normal and should not harm either you or your baby. You will require rest and it is important that you receive support from your family at this time. You can also phone the midwife/maternity unit/Birth Unit at any time for their advice and reassurance, or where you have any concerns about what is happening.

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