Bearing down

There really needs to be a break between pregnancy and labour, and another break between labour/delivery and actually caring for the baby.

One of the things I said shortly after I had my first child. I had gone from a very challenging pregnancy during which I was in and out of hospital, to a difficult labour, to sleepless nights and struggling to breastfeed.

One thing a lot of people don't realise is that there is actually a break somewhere along the way, though not where I had hoped it would be. Now most people know that labour is divided into three stages. The first stage of labour is when the contractions start to get more regular, and the cervix aka the neck of the womb begins to open. The second stage of labour is from full cervical opening (10 cm) to the delivery of the baby. And the third stage of labour is the delivery of the placenta.

A lot of people might know that there is a pause between the end of second stage and the beginning of third stage. After all, the baby doesn't come out holding the placenta. But what many people fail to realise is that there is often also a pause between the end of first stage and the beginning of second stage. What I'm trying to say is that the moment you hit full cervical dilatation/opening is not necessarily the moment the baby starts to exit from the birth canal. Unfortunately, once the cervix is 10 cm dilated, women are encouraged to start pushing start pushing. Whereas if you wait a little, the uterus starts to push the baby out - a phenomenon known as the foetal ejection reflex.

Do you know that in the first stage of labour, as cervical dilatation is occurring, the baby is also moving down in the birth canal? Without any active contribution from the pregnant woman! Think about it. Many women go into labour while the foetus is not yet engaged (head hasn’t entered the pelvis), but by the time you’re ready to “push”, the head (or whatever part is coming first) is right there at the perineum and is in fact what gives the urge to bear down. That's because the uterus is a very powerful muscle and it pushes the baby down while also dilating the cervix.

If a woman gets to the end of second stage, and the baby is not quite ready to come out and the woman starts pushing, she's putting a lot of pressure on the pelvic floor - straining, oftentimes holding the breath to push the baby out rather than waiting for the uterus to do its thing. This causes a lot of stress to the pelvic floor which can contribute to conditions such as prolapse, incontinence and haemorrhoids.

So next time you're in labour, when you get to full dilation, wait a little; the baby will come. Pause and be thankful.