Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone (City Hospital campus): 0800 052 1195 Freephone (QMC campus): 0800 183 0204 From a mobile or abroad: 0115 924 9924 ext 65412 or 62301 The latent phase of labour Maternity Department Minicom: 0800 183 0204 E-mail: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR www.nuh.nhs.uk This document can be provided in different languages and formats. For more information please contact: QMC labour suite Tel: 0115 8754672 City Hospital Tel: 0115 9691169 ext. 55127 Fiona Lakin, Jackie Gandy, Maternity Department March 2011. All rights reserved. Nottingham University Hospitals NHS Trust. Review March 2013. Ref: 0965/v1/0311/CR.
This leaflet is designed to help you understand the process of labour, especially the early part of the first stage, known as the Latent Phase. The leaflet includes suggestions for you and your birth partner on how to help you cope at home or within the hospital setting during your latent phase. Notes Labour is a physiological process, which can often take a long time. Every woman s labour is different Labour has three stages: The first stage, when the neck of the womb (cervix) opens to 10 centimetres. The second stage, when the baby moves down through the vagina and is born. The third stage, when the afterbirth (placenta) is delivered. Before labour starts, the neck of the womb is long, firm and closed. As the latent phase begins, the neck of the womb begins to shorten, soften and open up (dilate). The latent phase is the early part of the first stage of labour. During this time the neck of the womb shortens down and softens. This is called effacement. It can also open up to about 3-4cms dilated. There may be contractions at this point, but they are often irregular in occurrence, short lasting and milder in strength than those when you are in the active phase of your labour. The active phase is when the labour has become established. This means that the contractions are stronger and regular and lasting longer than previously. Both the Latent and Active phases take place during the first stage. Eventually, at the end of the first stage, the neck of the womb has opened up to 10cms and is described as being fully dilated. 2 11
Remember labour is a journey and the Latent Phase of the First Stage of labour can take a long time. This is normal. Quick labours are not always the easiest to cope with! We hope that by using some of these tips in this leaflet, it will help you through your labour and look forward to meeting you and your baby soon. The Latent Phase in more detail: The latent phase can last several days or weeks before active labour starts. Some women can feel backache or cramps during this time. Some women will have bouts of contractions lasting a few hours which can often stop and start irregularly. This is normal. You may have experienced Braxton Hicks contractions throughout your pregnancy they are the tightening of the womb s muscles and last for about 30 seconds. They are usually painless. During the latent phase Braxton Hicks may become more noticeable and more frequent, lasting between 35 and 45 seconds. However, some women may not notice anything at all. Signs of labour beginning: The show As the neck of the womb begins to soften and open, the mucus which has been protecting the entrance to your womb comes away. This is called the show. It is has a jelly-like appearance and can often be streaked with blood, either bright red, pink or brown. It may also be clear. This is all normal. Having a show means that your body is starting to get ready for labour but the actual birth of your baby is very likely to be some time away. Some women have a show several days before the labour starts. Some women have several shows. If there is ever any bright/fresh red blood on its own, you should telephone the Labour Suite straight away. 10 3
Your waters breaking: Before active labour starts, your waters may break. During pregnancy, your baby is surrounded by amniotic fluid the waters. For some women (about 1 in 10), the first sign that labour is going to start is that the waters begin to leak. It is quite common for women to leak a small amount of urine towards the end of pregnancy and it can sometimes be difficult to tell if your waters have broken or if it is urine. If you are not sure if your waters have broken, put a sanitary pad on and sit or lie down for 30 minutes, if the pad is wet after this time, it is likely that they have broken. If you have a definite gush of fluid, it is a clear sign that your waters have broken and you should telephone the Labour Suite or Triage department for advice. If the waters have broken, it is important for you to look at them: The waters are often clear or straw coloured; sometimes they change to a pinky colour. This is normal. If you notice that the waters are green, brown or heavily blood stained you should contact the Labour Suite straight away for advice. Monitor your baby s movement they should remain the same. You and your birth partner: Choose a supportive birth partner who can be with you throughout your labour. Some women choose to have the support of more than one person. Your birth partner(s) can encourage and reassure you and help you tell your midwife what you would like in your labour. Birth partners can also help with things such as: Massage Keeping you active Getting you food and drinks Praising and encouraging you Giving cuddles Keeping you company and even trying to make you laugh! Most importantly your birth partner should be someone who you can be totally relaxed and comfortable with. If the waters break and labour has not yet begun, this is still normal. The majority of women (about 86%) will go into labour within 24 hours of their waters breaking. However, during this time you will need to be assessed by a midwife. It is not essential for your waters to break for you to go into labour. 4 9
Keeping as mobile as you can, whilst remembering to save your energy for the active phase of labour Drink plenty of fluids water, sports drinks and apple juice are all good Eat little and often carbohydrates (bread, pasta, rice and cereal) for slow-releasing energy, plus sugary food for quick releasing energy. You may find it helps to make love kissing, cuddling and having a orgasm all cause your body to produce oxytocin (the hormone which stimulates contractions) Put on your TENS machine if you have one Experiment with different positions that you find comfortable, such as standing, sitting, squatting, kneeling and walking around. Staying upright and mobile encourages gravity to work for you. It is ok to take Paracetamol at regular intervals as per the instructions on the packet. Contractions: As previously discussed, in the latent phase of labour contractions may start and stop. This is normal. Alternatively, contractions may be continuous for several hours but remain short lasting and mild. This is normal too, within the latent phase. This time can be tiring, but it is important to remember that your body already knows how to give birth. When you begin to understand what helps or hinders the natural process, you can create the right environment around you. If you find that labour has slowed down, this is a good time for you and your birth partner to get some rest and have something to eat. When your body has built up some energy supplies, your contractions will start again. If you telephone the midwife for advice, and everything sounds normal you will be encouraged to remain at home for as long as possible. Most women are more relaxed at home in the latent part of the first stage and you can use this leaflet to help you to manage this part of your labour. There is also evidence to show that the further on in labour you are when you come in to hospital, the more likely you are to have a normal birth. Remember a start-stop pattern of contractions is common in the latent phase. 8 5
As labour establishes, and you enter the active phase, contractions should continue until the baby is born. When you have regular contractions they will be longer, stronger and close together. You can help your labour to carry on smoothly by avoiding stimulating the rational part of your brain. You need peace, quiet and a feeling of safety to help you relax and so increase the levels of your own natural pain relievers endorphins. During labour you can take measures such as avoiding: Bright lights People asking you questions which you have to think to answer People talking to you during contractions Feeling as if people are watching you or judging you By having privacy, quiet, being in a darkened room and feeling safe your rational brain will be less stimulated and can allow your body to help you to begin your labour. Listening to music you have chosen can also help. Things you can do to help yourself: Pottering around the house Taking a walk Watching TV/DVD Taking a warm bath or shower Having a nap (lying on your left side is often best) Doing some relaxation Keeping your breathing quiet and fluid breathe in gently, sigh out slowly Trying a massage ask your birth partner to do this for you Putting a hot water bottle on any areas that ache your lower back, tummy (under your bump) or between your thighs. Wrap it in a small towel first to avoid it getting too hot. Try your birthing/gym ball if you have one What can YOU do in the Latent Phase of labour? It is not possible to say when active labour will begin. It could start within a couple of hours of the latent phase commencing, or in several days. So try to stay as relaxed as you can and distract yourself from focussing only on the contractions. It helps if you avoid stimulating the rational part of your brain during labour. This can override the primitive part which produces endorphins (your own natural pain-relievers) and oxytocin (the hormone which stimulates contractions). 6 7