When we talk about labour, a great deal of the focus is on contractions. There’s often an assumption that everyone knows what a contraction is, when, in reality, many women have no idea. Understanding what’s happening to your body as it’s having a contraction helps to reduce the fear of the unknown.
How do labour contractions work?
A contraction is when the muscles of the uterus tense and relax, passing in waves from the top, travelling inwards and downwards. During the first stage of labour, the uterus becomes thinner (this is called effacement), so it’s no longer tube shaped but can be felt as a thin rim around the baby’s head by the midwife. As these muscles stretch and relax, the neck of the uterus (cervix) starts to open until it’s fully dilated, and then the baby moves deeper into your pelvis, and the first stage of labour is complete.
During the second stage of labour, contractions play a different role, pushing your baby down the birth canal. After he’s born, further contractions push out the placenta, which completes the third and final stage of labour.
What do labour contractions feel like?
Although a contraction affects the whole of the uterus, some women only feel it in one area of their abdomen or back. Most consider labour to be painful, but it tends to start gradually and build up, with the contractions intensifying as the cervix becomes more dilated. Some moms-to-be feel the pain through every nerve ending, whereas others find it easier to bear. After each contraction there’s a period of rest, which helps you to relax and prepare for the next one. Contractions are temporary, and for many women it’s this thought, and the reward at the end of labour, that helps them to cope.
When will they start?
Some women experience regular contractions in the days before labour really kicks in properly, but none of it is ‘wasted’, as it is all part of effacement. Most women’s labour begins after 37 weeks, with period-like pains that eventually have some regularity to them, lasting longer and becoming stronger. Braxton Hicks tightenings are ‘practice’ contractions, which can feel irregular and uncomfortable, but they shouldn’t be painful. If you’re concerned that you may be experiencing contractions before the 37th week of pregnancy, you should contact your gynae for an examination, as your baby will be considered premature.
How do I push?
For the majority of women, the contractions in the second stage of labour feel very different to the first stage, and this is because they’re doing a different job. As your cervix is fully dilated these contractions have an ‘expulsive’ effect, causing an involuntary, overwhelming sensation to bear down so that your baby is pushed out. Many women find this stage easier and don’t need to be guided – they just go with their body and automatically push with the contraction.
If you have an epidural and can’t feel the contractions, your midwife will instruct you when to push. By placing her hand on your abdomen, she’ll be able to feel the contraction and tell you to take a deep breath, put your chin down to your chest and push into your bottom. Even if you have an assisted birth (during which forceps or a ventouse will be used), you’ll still need to push to help move the baby down.
What if my contractions slow down?
Sometimes contractions can slow down or stop during labour, which can be disheartening. But staying upright and walking around will encourage them to keep coming. Nipple stimulation produces the hormone oxytocin, which can get your uterus contracting again, but if this doesn’t work, the midwife may use a synthetic form of the hormone, called syntocinon (given via an intravenous drip in the hand). If you become very tired or have an epidural, contractions are more likely to slow down. With natural birth it can also indicate transition (the period where the cervix is fully dilated) but there’s a period of rest before pushing begins.