By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health), Freelance Medical Writer. Medical review by The DLHA Team
A black woman lying in bed and in labour attending by a midwife.
In the African context, childbirth is one of the significant events in the life of any family. This is because of the high premium that is placed on childbearing.
Labour is a process that marks the beginning of the end of pregnancy. It is a journey that is marked with both pain and joy. Pain because of the discomfort that comes with the process and joy because of the expected results. All pregnancies are expected to end with labour, although, in certain circumstances, the delivery may happen via caesarean section (surgery) even before labour starts.
Whether you’re a first-time parent or have been through it before, understanding the basics of labour can help you feel more prepared and confident as you go through the journey..
Successful labour demands a balance (interplay) of three ‘P’ factors:
The labour process requires close monitoring of these factors to enable a successful outcome.
This article aims to educate and empower African women and men with information about the labour process so that they can jointly advocate for the best outcome during the delivery process.
Labour is the onset of intermittent, progressively increasing, painful contractions of the uterus (womb) that is associated with the thinning out and dilatation of the cervix (mouth of the womb) and leads up to the expulsion of the baby and placenta. [1, 2]
It is a natural process whose trigger is not yet completely understood. It usually starts around the 37th week of pregnancy. On occasions, it may start before 37 weeks, in which case it is termed preterm labour.
Labour can also be induced artificially if there are conditions in the mother or baby that demand delivery before the natural onset of labour. [3]
There are three main stages of labour. [4, 5]
These are:
The first stage of labour is the period from the beginning of labour to when the cervix is fully (10cm) dilated.
It is divided into two phases:
The latent phase is the early part of labour. It is marked by contractions, which may be irregular, this is associated with thinning out and dilatation of the cervix. The cervix is not dilated more than 4cm. This phase can last for hours or even days. During this phase, your doctor may admit you for a while for observation after which you may be allowed to go home if there is no progress.
This is the main part of labour that ends up with delivery. The cervix is completely thinned out during this period and is dilated to between 5cm and 10 cm (full dilatation) The contractions are usually more regular and longer lasting in this period. They may also be more painful. Your doctor will admit you during this period for closer monitoring.
The second stage of labour is the period from full cervical dilatation to the delivery of the baby.
The third stage of labour is the period from the delivery of the baby to the delivery of the placenta.
The preparation for labour starts during the antenatal period. It involves:
This provides you with information on
Birth Preparedness and Complication Readiness
This involves making plans for delivery to ensure a smooth process.
Depending on the healthcare facility where you will deliver, you may be asked to include this in a birth plan.
The information on your birth plan will include:
Your doctor will also further advise you on how to prepare for labour. This is called birth preparedness and complication readiness. It is a preparation strategy for normal birth and potential emergency complications. [6]
It involves:
Related: How to Boost Positive Childbirth Experience in African Women
Though the exact time of labour is difficult to predict, labour is mostly likely to occur after 37 weeks of pregnancy. If you see any of these signs, you should visit your health facility for assessment. [7]
This active phase of the first stage of labour lasts about 12 hours in first births and 10 hours in subsequent births.
When you enter the active phase of labour i.e when your cervix is dilated up to 5cm, your doctor will admit you into the labour ward, after taking your history and examining you. They will cross-check your records for any special birth plan.
Your blood will be drawn to check your blood percentage. They will also cross-match your blood with that of a potential donor if you are at high risk of blood loss. Depending on your specific circumstances, other tests may also be done.
An intravenous (I.V.) line may also be inserted to allow the administration of fluids.
You may either be allowed to lie down on your left side or to periodically move around as the labour progresses.
Depending on the local circumstances, you may be allowed to have a companion during the labour process.
The active phase of labour needs close monitoring of both you and your baby.
The major factors that are monitored at intervals include:
Your doctor will do periodic vaginal examinations to assess:
Your doctor/midwife will monitor these factors during the labour process. They are recorded on the Labour Care Guide or Partograph. This would help them to make critical decisions along the way.
Some interventions that may be done in this stage of labour include:
Related: Oxytocic Drugs in Pregnancy and Labour: An Explainer for Africans
The second stage may last up to 3 hours in first births and 2 hours in subsequent births. In most cases, it lasts a few minutes.
Your midwife will help you find a comfortable position to give birth in. When the baby has descended to the outlet of your pelvis (close to the opening of the vagina), the midwife will encourage you to push during contractions. With repeated pushes the baby would be delivered, while the midwife guides the baby and guards the vaginal opening in the process.
If there is a need, a small cut may be given on the skin and muscles around the vagina (episiotomy) to increase the passage for the baby
In some cases when delivery is delayed or the baby’s heart rate becomes abnormal, a vacuum or forceps will be used to deliver the baby.
The third stage usually takes a few minutes but may last up to 30 minutes. It is the period from the delivery of the baby to the delivery of the placenta.
Immediately after the delivery of the baby, your midwife will give you an oxytocin injection to help the placenta separate.
The placenta will be delivered by a gentle thug on the placenta with counter traction on the abdomen (controlled cord traction)
The use of oxytocin and controlled cord traction is termed the active management of the third stage of labour. [8] It helps to prevent postpartum haemorrhage.
The healthcare team during labour includes the following:
These professionals work together to ensure a safe and positive birthing experience. You should cooperate with them and stick to instructions to ensure a successful labour. Do not hold back from asking questions when in need of answers to your concerns.
After birth, you will be made comfortable. Your baby will also be cleaned and handed over to you so that you can bond and start breastfeeding.
The baby will given the following immunisations; BCG, Polio and Hepatitis B.
You will be observed in the labour ward for an hour before being transferred to the ward where monitoring continues.
You will be admitted in the hospital for at least 24 hours. This allows for more monitoring and breastfeeding and child care support.
While most labour progresses normally, at times problems may arise in the different stages of labour
These include:
Your labour ward care team will put in measures to prevent and manage these problems.
Related: Why African women die more from birth-related bleeding
Labour is a natural process, but it requires careful monitoring and the support of a skilled healthcare team to ensure the safety of both mother and baby. It is good for you and your partner to gain knowledge about the stages of labour, preparation, and potential complications. This would help you to better handle the birthing process with confidence and informed decision-making.
1. John Hopkins Medicine. Labour [Internet, n.d.]. Cited 2024 Aug 13. Available from here.
2. Hutchison J, Mahdy H, Hutchison J. Stages of labour. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [Last updated Jan.30, 2023]. Cited 2024 Aug 12. Available from here.
3. Vrees RA. Induction of labour. [Internet]. Medscape. 2023 Dec 8 [cited 2024 Aug 13]; Available from here.
4. WHO recommendations: Intrapartum care for a positive childbirth experience [Internet]. 7Feb. 2018. [Cited 2024 Jul 16]. Available from here.
5. Hilton SH. Normal labour and delivery. Medscape. [Internet]. Updated 2024 Feb. 23. [Cited 2024 Aug 13]; Available from here.
6. Acharya AS, Kaur R, Prasuna JG, Rasheed N. Making pregnancy safer - birth preparedness and complication readiness study among antenatal women attendees of a primary health centre, Delhi. Indian J Community Med. 2015;40(2):127–34. doi: 10.4103/0970-0218.153881. Available from here.
7. NHS, UK. Signs that labour has begun. [Internet]. Last updated 2023 Nov. 9. [Cited 2024 Aug 12]. Available from here.
8. Smith JR. Management of the third stage of labour. [Internet]. Medscape Updated 2024 June 3. [Cited 2024 Aug 13]; Available from here.
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Published: August 28, 2024
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