Latent early labour

00:00:13:23 - 00:00:30:14

Speaker 1

So this is a video about coping in early labor at home. We know from the evidence that the best place to be in early labor, for most people, is at home. So these are ways to cope with that, what's going on in your body and ways that you can make it as easy as possible. We've got several things that are going on in the body.

00:00:30:16 - 00:00:49:21

Speaker 1

I'm going to use a balloon to demonstrate what's happening. So the balloon represents the uterus. And there is a ping pong ball just at the base here, which is representing the baby's head, putting pressure on the cervix, which was presented here by the end of the balloon. The uterus is a large muscle and it's got lots of muscles intertwined going across and going down.

00:00:50:04 - 00:01:07:00

Speaker 1

And they're working together for the first time with your first baby to try and push your baby down onto the cervix and get the cervix to thin out when you're not in labor. Your cervix is tucked behind your baby's head it's quite thick and it's long and it will be closed tightly shut. This balloon is to try and demonstrate that.

00:01:08:01 - 00:01:47:09

Speaker 1

And when your body is starting to prepare for the process, of labor you might experience and Braxton Hicks contractions, which are tightenings of the muscles of the uterus. So when those are happening, as you can see, there's not a huge amount happening to the cervix it's staying long, it's staying thick and it's staying closed. What starts to happen when your body goes into the early stage of labor and the contractions are getting more powerful, is that the contraction is coming from the top of the uterus and as it squeezes down, your baby's head is pushed onto your cervix and the cervix starts to get a little thinner and it starts to shorten and the

00:01:47:09 - 00:02:21:09

Speaker 1

Contractions at this point are usually quite irregular. So they can vary in how long they are, they can vary in how powerful they are. And they can vary in how often they're coming. So you might find that you can have one every 5 minutes, one every 10 minutes, one every 20 minutes, and they can vary in how powerful they're coming from, really intense, where you can't speak through them at all to being quite mild and you can have a little chat but it's really, really variable for each person.

00:02:21:09 - 00:02:47:07

Speaker 1

So sometimes people will really not feel this early stage particularly and they'll feel like the contractions get regular and strong every single time. But for most people with their first baby, you're going to experience this for at least a few hours. And for some people it can last for quite a few days. So as you can see, the cervix is really starting to thin out now and it's starting to get a lot shorter.

00:02:48:09 - 00:02:58:18

Speaker 1

And as we said, this process can take quite a long time. So staying at home, staying relaxed and comfortable will help this process to happen as quickly as your body's ready to make it happen.

00:03:03:21 - 00:03:29:04

Speaker 1

OK, so we're getting to the point where the cervix is really thinned out and eventually it gets to as thin as a bit of paper. And we now need the more powerful contractions to start the cervix to dilate and then usually once we get to this point, we're heading towards about three or four centimetres dilated. So again, that can still be quite irregular at this point.

00:03:29:04 - 00:04:02:01

Speaker 1

Up to about four centimetres dilated. From that point on you'll find that they get more regular and frequent and strong so contractions and surges are both referring to the same process in labor where the uterus muscles are tightening and then releasing. The surge is used to try and make that more of a positive sensation of the power and intensity that might be experienced rather than thinking about it in a painful way. You can use whichever terminology you feel is most appropriate for you.

00:04:02:07 - 00:04:28:05

Speaker 1

And your midwife will try and use this term and that terminology with you as well generally speaking, Braxton contractions are practice contractions, so the uterus is warming up. It's getting ready to start the labor process for most people that experience them as a tightness so that the tummy goes really, really tight when you feel it a little like the tightness of a drum, if you would feel the top of a drum.

00:04:28:14 - 00:04:49:13

Speaker 1

But when that tightness occurs, it doesn't seem to be painful for most people. It can be quite a strong sensation that eases off after could be a few seconds, could be a few minutes, but it's not generally experienced to be a really, really strong, painful sensation. It's usually just an uncomfortable sensation. And they can come and go throughout the day.

00:04:49:13 - 00:05:15:06

Speaker 1

A lot of people experiencing them more strongly in the evenings, particularly as the pregnancy progresses towards the last few weeks and last few days. Before Labor begins, when your body starts to go into the early labor process, you'll find that you feel the sensation usually a bit differently. So the tightness will still occur, but it will probably be much stronger and you may feel it is more of a painful sensation than you have done compared to your Braxton hip contractions, and they will tend to build up.

00:05:15:06 - 00:05:39:17

Speaker 1

So though we talked to that they're going to get longer, they're going to get stronger, but in the early stages they can vary quite significantly in how long they last, how often they occur and how strongly you feel them when you get towards the labor. So what we call active labor or established labor, then you'll find that the contractions come in a really regular pattern.

00:05:39:17 - 00:06:03:15

Speaker 1

So every two or 3 minutes that last a really long time, around about 60 seconds and they're consistently strong. So rather than some of them being able to, you can talk through them, you can move about, you can do other things whilst having a contraction or surge. When you get into the active stage of labor, your body's going to make you stop focus and give every bit of attention to that contraction until it has gone off.

00:06:04:03 - 00:06:30:05

Speaker 1

And that will take you having to breathe through it until it has released and as I about 60 seconds for most people if they've been in that pattern. So every two or 3 minutes lasting a minute and really powerful and strong every time for about an hour, that's usually a sign that that is going to be going into active labor with your first baby second babies can be quite different.

00:06:30:05 - 00:06:58:01

Speaker 1

They often go through the process of labor much more quickly. You can still have that early stage of labor lasting several hours, even a couple of days. But once it starts to change towards active labor, that can go much more quickly. So for people having their second, third, fourth babies will usually say maybe wait till they're about every four, 5 minutes and they're nice and strong, nice and long, but come in that bit earlier because things could progress much more quickly with a first baby for the majority of people.

00:06:58:01 - 00:07:21:14

Speaker 1

They'll need to be in that pattern for about an hour of every two or 3 minutes lasting a minute to really show that that labor is getting into the established part so we would usually say in the early part it's best to not really focus on timing them too much until the point where your partner is saying, I really think there's something going on here.

00:07:21:14 - 00:07:39:14

Speaker 1

I'd like to know how quickly they're coming. They seem to be quite frequent now and building up at that point, you can either just write them down, you can use apps on your phone, but it really doesn't matter as long as you have an idea that over an hour period how many contractions are coming in every 10 minutes, how long that they're lasting.

00:07:39:20 - 00:07:56:10

Speaker 1

And you could note down if your partner is able to talk through some or not others, or if all of them are taking all of her focus. And when you come in or whether you talk to the midwife on the phone first, you're going to be able to tell us the pattern for the last hour. And that will give us a good idea of what's been happening and where abouts your labor might be.

00:07:56:10 - 00:08:11:02

Speaker 1

And that will help us to be able to guide you. Is it time to come in or are you able to stay at home a little longer? We really would like to talk to you because we're going to gain a lot of information by how you're breathing and we can hear contractions over the phone. We'll get you to stay on the line with us.

00:08:11:09 - 00:08:21:09

Speaker 1

Your behavior, your reaction to them, whether you are able to talk to us, that's going to give us so much information that we can guide you then about what stage your labor might be and how we can help you to go forward.

00:08:26:11 - 00:08:52:07

Speaker 1

Babies like to descend into the pelvis on the side, and that's because the shape of the pelvis, if I show you here, fits with the baby going into the pelvis in this direction. And then as they get lower into the pelvis, which is caused by the contractions coming in, these early labor contractions are pushing, pushing your baby down deeper into the pelvis and getting their head to push down on the cervix and thin it and start to push it out of the way.

00:08:52:19 - 00:09:08:13

Speaker 1

And then as the labor progresses, we like the baby to turn around and come further down into the birth canal. If your baby is in a slightly more uncomfortable position, of being back to back, which you might have heard that term, and it's when the baby's back is on the mom's back, can I just show you the bones in the back here?

00:09:09:09 - 00:09:25:04

Speaker 1

You might experience a lot of your early labor and even into active labor in your back. For a lot of ladies, if the baby's in the ideal position with their back at the front, then you're going to feel the sensation of the interactions in the lower tummy, but you may still feel them in the hips and in the back as well.

00:09:25:09 - 00:09:44:02

Speaker 1

But if you've got it all in your back, it may be that your baby's in this back to back position. And as you can see, it's much harder for your baby to fit nice and snugly into the pelvis and nicely onto the cervix. So it's a slightly less ideal position. And we'll just we will encourage you to try and turn your baby round into that slightly better position just to make your labor as easy as possible.

00:09:44:07 - 00:10:02:01

Speaker 1

Ladies whose babies are in a back to back position in labor can find that the early stage particularly is quite prolonged because their body is really trying hard to get their baby to rotate and bring the background to the front. You can find that out in late pregnancy as well. So your midwife can feel your tummy and feel where abouts your baby's back is.

00:10:02:01 - 00:10:29:23

Speaker 1

And if we know that your baby's in back to back position in late pregnancy, we can guide you with some exercises to rotate your baby first and that will make the process easier. But if your baby is in a back to back position in labor, don't worry. There are things that you can do to encourage your baby to rotate and come down so you might find you've got several hours when the contractions are coming or going in that irregular pattern that we've described and then they go off for a few hours.

00:10:30:04 - 00:10:48:20

Speaker 1

If that happens, please don't worry, it's completely normal. And we would say just enjoy that rest period. Your body's usually just trying to signal to you, I'm not quite ready to take this to the next stage yet, so go to bed. Particularly on your left side is good because that helps your baby to get into the ideal position for carrying on the labor.

00:10:48:24 - 00:11:22:16

Speaker 1

And it will also help you just to be as comfortable as possible to get some sleep. When your body is ready, it will take it back to the next level of regular and strong contractions if your body's exhausted, it's not going to be able to do that. So it's really, really important to think about resting first. You can be upright and mobile once you've had a good rest, but rest in early labor is one of the most important things that we advise your body is using the same amount of energy, whether it's a long or a short labor, it's the same amount of energy is running a marathon, so there's no way you run the

00:11:22:16 - 00:11:46:17

Speaker 1

London Marathon on half a cereal bar and half a glass of water. You would be thinking about lots of protein, lots of carbohydrates, giving your body that energy stool so that when you're running the marathon you've got enough reserves there to use that with all these contractions that your body's going to have to cope with. So it's really, really important that even if you don't feel like it, even if you're feeling nauseous, that you really try and eat and drink as much as you can little and often is fine.

00:11:47:00 - 00:12:09:04

Speaker 1

But if you're starting to get signs that early labor is about to start, then it might be a good idea at that point to have a bowl of pasta with some chicken or some corn, something that, you know, is got high carbohydrate, high protein content that's going to give you that energy. And then once you're into the early labor process, you're starting to feel less like eating and drinking, just sipping isotonic drinks.

00:12:09:04 - 00:12:30:03

Speaker 1

So fantastic water, squash, juice, whatever you want, it doesn't matter as long as you're hydrating and then little snacks, you can try toast, you can have sweets, you can have whatever you fancy, but little things that you can just pick up and eat between the surges or between the contractions. So a lot of ladies do feel sick in labor and some ladies will vomit during the labor process.

00:12:30:03 - 00:12:45:15

Speaker 1

It's OK as long as you are then able to eat and drink again. If you're continuously vomiting and not able to keep anything down, we would encourage you to phone in and talk to us. It may be that you need to come in and have an assessment and just see if we need to give you some medication to get that vomiting under control.

00:12:45:23 - 00:13:13:23

Speaker 1

If it's just once or twice and you are then able to eat and drink enough to keep your energy up, then it's very normal. And we would say just continue. It's usually just due to the hormones reacting in the body to get you into labor and keep you in labor. And also the strong sensations that you're feeling can often give nausea and vomiting so it's really important in labor that you keep your bladder empty.

00:13:14:04 - 00:13:33:17

Speaker 1

Your baby is right next to your bladder during the pregnancy and during the labor process. If your bladder's full, it's going to stop your baby coming down as quickly as they ideally do. And it also may damage your bladder. If your bladder is very full and your baby is constantly pushing against it, it could cause some nerve damage there and give you long term problems.

00:13:33:17 - 00:13:50:16

Speaker 1

And that's not what we want for you. So we would like you to keep your bladder empty by going to the toilet every couple of hours more if you need to, but certainly every couple of hours going to try and empty your bladder. It may be a little uncomfortable as your labor progresses and your baby gets lower and you may find that you need to sit for a few minutes on the toilet.

00:13:50:16 - 00:14:08:05

Speaker 1

And some people find it helpful to just rock back and forward a bit just to try and push past the baby's head if your baby is very low in your pelvis. But it's important to keep drinking and emptying a bladder frequently. So it's really common in the early stages of labor for you to experience some loose stools.

00:14:08:05 - 00:14:22:01

Speaker 1

And that's because the uterus, as it's contracting, irritates the bowel and just makes your body have a bit of a clear out. And that's completely normal. As long as you feel well in yourself not feeling well in any way, then it's just part of the process and it's nothing to be concerned about.

00:14:27:17 - 00:14:49:00

Speaker 1

So a show is a substance that's a mucasy substance that sits inside the neck of the womb or cervix. And when you start to have changes in this in the cervix, so if you're having Braxton Hicks, you might find that the show is released and it's the mucus plug coming away. It looks like a snotty mucasy substance. It doesn't look particularly nice.

00:14:49:16 - 00:15:12:10

Speaker 1

It can be streaked with blood, it can be white, it can be brown and is completely normal, is just part of the process of the body changing, getting ready to go into labor. It's not a strong sign that labor is imminent. But you may find it is accompanied by contractions as well. We don't need to know about it unless you feel that it's actually red, fresh bleeding that's coming from the vagina.

00:15:12:10 - 00:15:39:09

Speaker 1

But if it's just the mucus on wiping or on a pad and it's streaked with fresh red blood, that's OK. It's perfectly normal and nothing to be concerned about. If you think the bleeding is heavy, red, fresh, it's on a pad, it's on wiping, it's running down your legs, that's different. That could be a concern. And we would like you to phone in straightaway and talk to a midwife so waters breaking is different.

00:15:39:09 - 00:16:00:21

Speaker 1

That's the SAC that is around that your baby bursting and that can be either from behind your baby if they've kicked a hole at the top of the sack in the water is running down the uterus and out of the cervix through the vagina or it can be the bank of water that sits in front of your baby's head as your baby has descended into the pelvis, you might find that you get trickling of water and that you have pads that become wet over the day.

00:16:00:21 - 00:16:19:11

Speaker 1

So we usually encourage late pregnancy. You can have an increase in vaginal discharge. And to our panty liner, if that panty liner is becoming wet rather than a little damp with discharge then we would encourage you to phone in. If you have a large glass of water when you're sitting, lying down, moving around, you suddenly feel a big gusher fluid again.

00:16:19:11 - 00:16:40:18

Speaker 1

That's another way that your waters can break. And we would again want to know about that. So if you think your waters may have gone, call in to the unit straightaway and talk to a midwife. I will encourage you to come in for an assessment, so there should be a nice, clear or slightly yellow tinge. We call it straw coloured in the waters.

00:16:40:18 - 00:17:08:13

Speaker 1

If there's any other color, if they are green or brown stains, we would like you to call in straightaway and tell us that it could be that your baby has passed their first stool that's called Meconium into the Waters Inside, and that would be a reason for you to come in and be monitored more closely if the water is clear, if it's even a bit of pinky stains and that's completely normal, we'd still want you to come in for an assessment, but you wouldn't usually need further monitoring if everything was fine.

00:17:08:13 - 00:17:42:22

Speaker 1

On that assessment with the midwife when you came in so Tense Machine is a drug free form of pain relief that can be used throughout. Labor is best started in the early stages of labor, but can be used throughout labor. It's works by the pants, transmits small electrical pulses up and through the nerves of the spine. The run either side increases your natural endorphins, which are your painkillers, and it also helps you to be distracted a little for the sensations that you're feeling by interrupting the pain pathway that's between the uterus and the brain.

00:17:43:20 - 00:18:07:17

Speaker 1

Paracetamol can be helpful in early labor. You can take two paracetamol tablets every 4 hours to a maximum of four times over 24 hour periods. Oxytocin is a hormone that is really important in labor. It's the hormone that gets you to start labor and it keeps your labor going. The most important way that you can help to stimulate oxytocin is by keeping your environment as calm and relaxed as possible.

00:18:07:22 - 00:18:30:22

Speaker 1

You can do this by keeping the lighting low. Perhaps some candles you can try and keep some nice music going in the background. You can put on a film or TV program that will distract you and make you laugh. That will help to keep you oxytocin levels high and encourage your labor to progress the birth partners role is really important in early labor.

00:18:30:23 - 00:18:49:08

Speaker 1

You're going to be the one who's able to keep your partner calm and relaxed, and this will really help her labor progress. Keep encouraging her to eat and drink, keep encourage her to raise you to go to the toilet, keep her calm and relaxed as you can. You can offer back massages, hand massages, but do bear in mind that some women don't like to be touched in labor.

00:18:49:08 - 00:19:20:13

Speaker 1

So she asks you to stop and just abide by her wishes. Look after yourself in labor as well. It's really important that you keep yourself hydrated and keep eating because you're going to need your energy to keep supporting her throughout the labor process. If your contractions space out, use this time to really rest, lean over the pillows that you have supporting you, go to beds and get tucked up and just try and keep yourself really, really comfortable and try and sleep where you can some women experience their labor pains in their back, some in their fronts, some in their hips.

00:19:20:20 - 00:19:42:17

Speaker 1

If you're feeling that discomfort, then you might find it soothing to try a hot water bottom or a warm compress like a wheat bag warmed in a microwave, just laid against where you're feeling that discomfort most. And it can be really soothing. Warm water can also be really soothing and relaxing in early labor. So if you have one, try and run a warm, deep bath and you can relax into the water for as long as you feel comfortable.

00:19:42:24 - 00:19:53:04

Speaker 1

You may find that sitting or lying on your back in the bath is not very comfortable. But if you tip slightly over on your left or your right side, you'll be able to submerge your pump under, and that will be more soothing.

00:19:56:24 - 00:20:17:24

Speaker 1

So this position is ideal at all stages of labor, but particularly if we're trying to help the baby to rotate in the pelvis to come around to the ideal position where the back is at the front and also trying to keep the pelvis open as much space as possible for the baby to come down. If Catherine was sitting upright there would be less space for the baby to come down as soon as she's tipping forward.

00:20:18:04 - 00:20:53:22

Speaker 1

There's a lot more space here. This lower part of the back, the coccyx can lift and make as many outlets possible for this baby to come down. Also in this position, the heaviest parts of the baby are their head and their back. So by tipping forwards, the baby is much more likely to rotate around and come to the front so that it's in a much better suction position and able to descend into the pelvis so some very simple massage techniques that we can show you for birth partners to do at home, which will help mom to stay relaxed and keep her breathing nice and calm and controlled.

00:20:54:12 - 00:21:11:24

Speaker 1

If mom is experiencing a lot of lower back pain than a really soothing massage to help, is that during a surge or contraction, if you use the heel of your hand, just pop it against the sacrum right at the base of the back and just give a bit of counter pressure. Because what mom may be feeling is that lower part of the back, the coccyx being pushed up by the baby.

00:21:12:05 - 00:21:59:09

Speaker 1

So to push back against it can be quite soothing, relieving. The other thing that you can do is what we call a light touch massage. These can be done either between contractions or with contractions. It's completely up to how the mom is feeling. So by doing a light touch massage, if you go to the top of the back and then just gently press down as mom breathes out, and then you just want to do figure of events very, very lightly, just down the back try and keep continuous contact with mom's skin or over her clothes, depending on what she prefers and be much more soothing it's quite common in labor that ladies can feel a

00:21:59:10 - 00:22:31:02

Speaker 1

Little tense and can start to breathe quite quickly when they're trying to manage the sensation of a contraction so by encouraging her to take deep breaths through her nose and slowly out her mouth, she will find it much easier to manage the pain. So just say Katherine. Nice deep breath in through your nose for me and then try and blow out through your mouth, soft, open mouth, breathe and slow that breath down and just keep reminding her nice, deep, slow breaths.

00:22:31:11 - 00:22:38:01

Speaker 1

Drop those shoulders, try and keep that breath really slow and really deep.

00:22:46:15 - 00:23:22:02

Speaker 1

Deep breaths sometimes it helps to count so you can ask her to breathe in for three and then out for eight. Breathe in through your nose one, two, three. And then release one, two, three, four, if you've rested and you're keen to get your labor to progress, it can be helpful to go up and down the staircase sideways.

00:23:22:02 - 00:23:47:22

Speaker 1

This will help to tip your pelvis and encourage your baby to descend. If you have rested previously, you've tried the stairs needing a change of scene. It can be helpful to go outside and go for a walk in the fresh air so we'd like you to call in when your contractions are three every 10 minutes that are lasting at least a minute and they're really strong and powerful every time.

00:23:48:00 - 00:24:06:24

Speaker 1

If they've been in that pattern for an hour, that's a good sign that your labor is established and we'd like you to call it. We'd also like you to call if your waters break or you suspect your waters have broken. And we'll invite you in for an assessment. If you have reduced movements from your baby at any time or you're concerned that your movements have changed in pattern we'd like you to phone in immediately.

00:24:07:09 - 00:24:32:14

Speaker 1

If you have fresh red bleeding from the vagina that's not accompanied by sticky mucus, we would like you to call if you feel unwell at any time. Or have any concerns about yourself or your baby need further advice. You can call us at any time. 24 hours a day, you'll be able to speak to a midwife if you're not coping at home with the contractions if you need some advice on what to do, or you just feel that you need an assessment from a midwife, you will always be welcome to come into the hospital.

00:24:33:03 - 00:24:44:07

Speaker 1

If after assessment you and your baby are well and you're feeling better and able to go home, we will encourage you to do so because we know that the early stage of labor for most people will go more smoothly and efficiently.