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Onset of Labour: Signs, Stages & When to Go to Hospital
The onset of labour refers to the point at which regular contractions begin, causing the cervix to dilate and the uterus to move the baby through the birth canal.
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The onset of labour refers to the point at which regular contractions begin, causing the cervix to dilate and the uterus to move the baby through the birth canal.
What is the Onset of Labour?
The onset of labour is the medically defined point at which a pregnant woman enters the active phase of childbirth. It is characterised by regular, painful uterine contractions that occur at consistent intervals and lead to progressive dilation (opening) of the cervix. The onset of labour marks the transition from pregnancy to childbirth and serves as a key reference point for expectant mothers and obstetric healthcare providers.
Signs of the Onset of Labour
There are several classic signs that indicate the imminent or actual beginning of labour:
- Regular contractions: Contractions occurring every 5–10 minutes, lasting at least 30–60 seconds each, and increasing in intensity are a reliable sign that labour has begun.
- Rupture of membranes: The breaking of the amniotic sac and the release of amniotic fluid (commonly called the waters breaking) may initiate or accompany the onset of labour.
- Mucus plug discharge: The passage of the cervical mucus plug (often called a “show”) is frequently an early sign that labour is approaching.
- Cervical dilation: Progressive opening of the cervix, confirmed by obstetric examination, is a key indicator of the onset of labour.
Phases of Labour
Labour is medically divided into three main stages:
1. First Stage: Cervical Dilation
The first stage begins with the onset of regular contractions and ends when the cervix is fully dilated (10 cm). In first-time mothers, this stage typically lasts 8–12 hours; in women who have given birth before, it is usually shorter.
2. Second Stage: Expulsion
During the second stage, the baby is pushed through the birth canal and delivered. This stage lasts approximately 1–2 hours in first-time mothers and is often shorter in subsequent births.
3. Third Stage: Delivery of the Placenta
In the third stage, the placenta is expelled from the uterus. This typically takes 15–30 minutes after the baby is born.
Preterm and Post-term Onset of Labour
A preterm onset of labour (before 37 weeks of pregnancy) is classified as preterm birth and requires immediate medical attention. A post-term onset (after 42 weeks) is referred to as prolonged pregnancy and may necessitate induction of labour to reduce risks for both mother and baby.
Induction of Labour
When labour does not begin spontaneously or must be initiated for medical reasons, induction of labour may be performed. Common methods include:
- Administration of oxytocin (a uterine stimulant) via intravenous infusion
- Use of prostaglandins to ripen the cervix (soften and prepare it for labour)
- Mechanical methods such as balloon catheter insertion
- Amniotomy (artificial rupture of the membranes)
When to Go to the Hospital
Expectant mothers should go to the maternity unit if:
- Regular contractions are occurring every 5 minutes or more frequently
- The membranes have ruptured (waters have broken)
- There is heavy vaginal bleeding
- Fetal movements have noticeably decreased
- Severe headaches, visual disturbances, or significant swelling occur (possible signs of pre-eclampsia)
References
- World Health Organization (WHO): WHO recommendations: intrapartum care for a positive childbirth experience. Geneva, 2018. Available at: https://www.who.int/publications/i/item/9789241550215
- National Institute for Health and Care Excellence (NICE): Intrapartum care for healthy women and babies. Clinical Guideline CG190, 2014 (updated 2022). Available at: https://www.nice.org.uk/guidance/cg190
- Cunningham FG et al.: Williams Obstetrics. 25th edition. McGraw-Hill Education, 2018.
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