You are said to be in the Active phase of labour when your cervix is more than 3cm dilated. Once the cervix has pulled back and thinned out and the baby’s head is pressing onto your thinning cervix, then rate of dilatation is usually more rapid. The rate is on average about 1 cm an hour, meaning that going from 3cm to 10cm would take approximately 7 hours. Some women will progress much quicker and some much slower.
It is during this stage that you can consider an epidural. If you feel you can cope with the level of pain you may want to see how quickly you are progressing and if you can perhaps do without one. If for example, you are progressing quickly and have managed to get to 5cm without any pain relief and feel that you have a bit more left in you, then you may want to wait an hour or so and then make a decision. If after 2 hours you are 8cm and still coping well you may wish to carry on without pain relief. If after 2 hours you are only 6cm and the pain has increased dramatically or you are very tired, you may wish to think about an epidural.
If you are 3cm dilated and have had a very long latent stage, are exhausted and in terrible pain, an epidural might be a very welcome relief. With an epidural, you may find you are suddenly 100% pain free and able to sleep for a few hours whilst your cervix finishes dilating. This may help you to relax, prepare and re-energise for the final pushing stage.
It may be worth noting that if your baby is OP then you may feel more rectal pressure when in active labour. This can come as a shock to some women who were not expecting to feel pain in their bottoms.
When to go in?
Each hospital has it own arrangements and advice, but it is a good idea to call your hospital or midwifery team when you think you have started labour. They will assess you over the phone and if you can hold a conversation with them and are not having regular painful contractions then they will probably encourage you to stay at home. The phone on the labour ward is manned day and night 365 days a year so there will always be a midwife to talk to.
If there are no risk factors then you should try and stay at home as long as you can. It is much more relaxing and comfortable to be in your own surroundings with your creature comforts. If you go in to hospital and you are less than 3cm dilated you are likely to be sent home again which can be discouraging and add an irritating extra car journey to your day! However, if you are particularly worried and feel you need reassurance or help then you can of course go in to the hospital where you will be assessed and advised accordingly.
These are some circumstances under which you must go in to hospital.
- As a general rule, once your contractions are coming every 5 minutes, you should think about going in soon, especially if you think you need pain relief.
- If your waters break- you must go in- this does not need to be immediately (unless instructed otherwise) but within the next few hours.
- If you have bright red bleeding you must go in immediately.
- If pain is continuous rather than in waves you must go in immediately.
- You should also go straight in if baby is not moving well or has stopped moving.
What happens when you get into hospital?
You will usually be seen by a midwife straight away. She will do some basic observations – take your temperature, pulse and blood pressure and check through your history.
You will be examined – this will involve measuring your tummy with a tape measure, checking the position and presentation (the leading part of baby, head, shoulder, bottom) of the baby and how low the baby’s head is in the pelvis.
This first assessment may include an internal examination to see whether you are in active labour or if your cervix is opening.
The baby’s heartbeat will be monitored with an old fashioned trumpet, a hand held ultrasound machine, or a CTG with 2 bands put across your tummy to record heart rate continuously. If there are any risk factors or concerns about your pregnancy then a CTG will always be performed.
There will be a chance to discuss your birth plan if you have one, or to mention any special requests you have for your labour, such as your husband cutting the cord or having skin to skin contact with the baby as soon as it is born. Do not worry if these are not discussed now, you will have time to mention these things later.
You will then be managed according to the observations. You may be kept in or sent home to await events.
You will only be seen by an obstetrician if this is needed, or if you are having private care with an obstetrician.
If you are less than 3cm dilated you will more than likely be sent home. If you are more than 3cm you will probably be kept in hospital and if you are in active labour you will be moved onto the labour ward and into your own room with one-to-one midwifery care. There may be times when she is assisted by another midwife, health care assistant, and/or a student, there is likely to be someone in the room with you most of the time. You may also meet an Anaesthetist, Obstetrician and Labour Ward Matron depending on your case.
Routine observations will be made on you and the baby regularly throughout your active labour. If you are in a Birthing Pool, these can usually be done without having to get out.
Usually you will be given an internal examination every 4 hours, or more frequently depending on your progress.
If you haven’t already, you may be given an opportunity to discuss pain relief or any special requests in your birth plan.
The average rate of progress is about1cm an hour approximately, but this can vary greatly from woman to woman, so you may find things moving faster or slower than expected.
Read about Breathing Techniques
Read about How to Push