Few other events in life can compare with the anticipation and excitement of the birth of a baby; soon you will meet the tiny human being you have carried and nurtured for so long. During my 20 years as an Obstetrician, the fear , the anxiety, the restlessness seen on the faces of the to be parents speaks of the ordeal they go through. Knowledge and counseling the couple about the first signs and final stages of labour can prepare them to enjoy this experience and face it with confidence...

Pre labour signs

1. Engagement or fixing of the head of the baby into the pelvic cage generally occurs 2 weeks prior to the delivery. In the second delivery the head enters the pelvis usually with the onset of labour pains.
2. Show During pregnancy a plug of jelly like mucus seals the lower end of the cervix to prevent infection. Towards the beginning of labour this plug mixed with little blood can get dislodged and present as thick discharge.
3. Braxton Hicks contractions or false pains occur off and on in the last few weeks of pregnancy. They are contractions or tightness of the uterus felt at irregular intervals and does not increase in intensity and duration.
4. Water Bag. This forms a protective covering around the baby and allows easy movement. Towards the end of pregnancy the fluid decreases and the movement slows down, causing concern to the patient and the doctor. If the water bag bursts {continuous leakage of warm fluid just like urine, generally colorless with white flakes} please inform your doctor and do not wait for labour pains. You need admission and speedy delivery
5. Frequency of urination as the head of the baby pushes against the urinary bladder.

Am I in labour
The only true sign that you are in labour is that you are experiencing regular uterine contractions {tightness and pain starting from the back, going to the front }and have an urgency to push or pass frequent stools.

Three stages of Labour

1. First Stage -The first stage starts with the onset of uterine contractions that open up the cervix or the mouth of the uterus to about 10 cms. Generally this lasts for 8-14 hours. Pain usually intensifies towards the end when the contractions become frequent and stronger. If you need pain relief please tell you doctor. You could opt for EPIDURAL ANAESTHESIA to decrease the pain. This is generally given when the cervix is 4-5 cms open. Your doctor does an internal examination to assess whether the progress of labour is satisfactory or not.
   Do not push. You can move about in the room and breathe easily. A low back massage, sips to drink and a comfortable change in position might ease out the discomfort.
2. Second Stage - This begins when the cervix is fully dilated and is completed with the birth of the baby. This stage lasts for 1-2 hours for the first baby. You can now bear down as directed by your doctor. You yourself will have an urge to push. The pains become intense though frequency decreases.. When the head of the baby is seen at the vulva and it is distended, an episiotomy or a lateral cut is given at the side of the vulva after a liberal local anaesthesia..This facilitates easy delivery of the baby.
   
   The mother is advised to push at the time of the contractions. She should give a sustained push as if passing stools, so that the baby descends from the narrow passage.
   
   Once delivered, the baby is directly placed on the mother?s abdomen where the umbilical cord is cut, and the baby is handed over to the pediatrician, who must be present in the labour room to receive the newborn and take care of any eventuality.
3. Third Stage- This stage starts immediately after the birth of the baby and concludes with the delivery of the placenta. It takes 15 mts to one hour. The delivery of the placenta is accompanied with some amount of bleeding. The episiotomy is stitched immediately afterwards.