Knowing what to expect when it comes time for labour and delivery can help ease any anxiety you may have about the birth process, especially if this is your first baby. Reviewing these facts will help, as will talking to our doctors and nurses and taking advantage of childbirth classes.

When You Arrive at the Hospital

Before you are formally admitted to your hospital`s labour and delivery area, you will probably be given a vaginal exam to determine the progress of your labour. This exam will determine your cervical effacement and dilation, and how far your baby has descended into your pelvic cavity.
You will be asked for general information that includes the following:
- Your partner`s or support person`s name.
- The name of the doctor you have chosen for your baby.
- Your participation in any type of childbirth classes.
- Your plans for breast feeding.
- Your plans for circumcision if the baby is a boy.
You will be asked for specific information that includes the following:
- The date and time your contractions began and the average length (duration) of your contractions.
- How frequently your contractions are occurring.
- The date, time, colour, and amount of vaginal discharge.
- The date, time, and colour of fluid if your 'water broke' (amniotic membranes rupture).
- When you last ate, had a bowel movement, and any occurrence of diarrhoea.
Your complete medical and prenatal history will be reviewed.

Procedures

A hospital patient I.D. bracelet will be attached to your wrist.
Measurements will be taken of your temperature, pulse, breathing rate, and blood pressure.
Blood and urine samples and vaginal cultures may be taken.
A test may be performed to determine whether your amniotic membranes ('bag of water') have broken or is still intact.
An estimation of foetal age and weight and presentation of your baby will be made.
You may receive an intravenous (IV) line that can be used to give fluids that prevent dehydration and/or administer medication quickly.
You probably will not be allowed to eat during labour. Ice chips are usually allowed.

Foetal Monitors

Our doctors and nurses may use one particular method, or possibly a combination of methods, to help them determine how your baby is reacting to labour.

- Auscultation Monitoring
This method involves listening to the foetal heartbeat with a Doppler device or stethoscope and recording it at specific intervals between contractions. Our doctors and nurses will also place their hands on your stomach to feel for uterine contractions.

- Electronic Monitoring
This method measures the response of your baby`s heart rate to the contractions of your uterus, and provides a continuous printout of information that can be read by our doctors and nurses. Monitoring is done through one of two different methods:

The external monitor is secured to your abdomen with two elastic belts, one holds a sensor that measures your contractions, and the other secures an ultrasound device that uses sound waves to pick up your baby`s heartbeat.
Internal monitoring is done by attaching an electrode (a thin spiral wire) to your baby`s scalp to provide a recording of his heart rate. At the same time, a transducer (pressure gauge) is placed on your uterus to measure the strength and frequency of your contractions. Internal monitoring can`t be used until your amniotic sac has ruptured and your cervix has begun to dilate.

Stages of Labour and Delivery

The length and difficulty of each woman`s labour and delivery will vary. Factors that play a role include the size and shape of your pelvis, the size and position of your baby, your cervical status at the time labour begins, and the strength and frequency of your contractions.

Labour is described as having four stages. The first stage is defined as the time from the onset of progressive labour contractions until the cervix is completely dilated. The second stage is from complete dilation of the cervix until the baby is born. The third stage is from the birth of the baby until the placenta is delivered. And finally, the fourth stage is from the delivery of the placenta until the mother`s medical condition is stable and safe.

The progression through the four stages of labour varies among women. For some women, labour starts slowly and then speeds up unexpectedly, while for others labour starts rapidly and then slows down. In some cases, our doctors may decide that it is time for your baby to be born even though true labour has not yet started. Induction of labour is the process of starting labour artificially by the use of medication, primarily oxytocin.

- The First Stage of Labour

This stage is almost always the longest and may last approximately 8 to 20 hours if this is your first pregnancy, or 5 to 14 hours if you have previously given birth. Early, or latent, labour begins with the onset of regular contractions and ends when your cervix is approximately 3 centimetres dilated. Contractions last approximately 30 seconds and may occur every 10 to 20 minutes from the beginning of one to the beginning of the next, with your uterus relaxing between each one. Much of your time in this early phase of labour may be spent trying to figure out if you are in true labour or not. The most common sign and symptoms of this phase include backache, menstrual-like cramping, indigestion, diarrhoea, and bloody show. You may experience all of these or just one or two.

Active labour begins when your cervix is dilated to 3 centimetres and ends when it is fully dilated to 10 centimetres. Effacement, or thinning of the cervix, is usually complete or almost complete. Contractions are stronger and longer (30 to 60 seconds) and occur every two to three minutes. You may become serious and quite, focused on only one thing, labour. At this point, support, encouragement, help, and comforting gestures from your partner will be appreciated. You may experience emotional up