Normal delivery in Dubai: what happens in labour and birth

How labour starts, and how it differs from practice tightenings

In late pregnancy the womb often tightens and relaxes. These practice tightenings, called Braxton Hicks contractions, come at irregular times, do not build in strength and often settle with rest, a walk or a change of position.

Labour contractions settle into a regular rhythm, grow longer and stronger and come closer together, whatever you do. Other signs may come before or with them: a show (the mucus plug from the cervix, sometimes streaked with blood), backache, or your waters breaking as a gush or a trickle.

The early, or latent, phase can last many hours, especially if you have not given birth before. Many women spend it at home with rest, food and drinks, a warm bath and steady breathing, as long as mother and baby are well.

When to go to the hospital

Your team will usually tell you when to come in and give you the labour ward’s number. In general, phone or go in when:

• contractions are regular, strong and close together, in the pattern your team described
• your waters break, even without contractions
• you have any bleeding from the vagina
• your baby is moving less than usual, or differently
• you feel unwell, or you are worried that something is not right

If the baby is moving less, phone straight away rather than waiting until the next day.

If your team has given you specific advice, for example after a previous cesarean or because of twins, diabetes or high blood pressure, follow it rather than these general points.

The stages of labour, and how the baby is monitored

Labour is described in three stages. In the dilation stage, contractions gradually open the cervix; from about 4 centimetres with regular contractions, labour is called established, and progress is checked at intervals, including by vaginal examination if you agree.

The second stage runs from full dilation, at about 10 centimetres, to the birth. Many women feel a strong urge to push; with an epidural it may be weaker, and the midwife guides you. Upright, kneeling or side-lying positions all work, and lying flat on your back is usually discouraged. The third stage, delivery of the placenta, is covered below.

The baby’s heartbeat is checked throughout. In a straightforward labour the midwife listens at intervals with a handheld device, so you can keep moving. A CTG, two sensors on belts recording the heartbeat and contractions continuously, is advised with risk factors, an epidural, a drip, or a change in the heartbeat. A change on the trace does not always mean the baby is in difficulty; it prompts a closer look and an explanation.

Pain relief in labour, and the trade-offs of each option

Labour pain differs between women and between labours, and no method suits everyone. The main options are:

• Breathing, relaxation, massage and moving around, which combine with any other method.
• Warm water in a bath or birthing pool, which eases pain for many women in established labour. Not every hospital has a pool, and it may not suit you if the baby needs continuous monitoring.
• Gas and air (Entonox), breathed through a mouthpiece. It takes the edge off contractions and wears off quickly, but can cause nausea and light-headedness.
• An epidural, a local anaesthetic given through a fine tube in the lower back, which usually relieves pain far more fully. It needs continuous monitoring and a drip, may weaken your legs, and can lower blood pressure or cause itching or a raised temperature. It does not make a cesarean more likely, but the pushing stage can last longer and ventouse or forceps become more likely. A severe headache afterwards is uncommon and treatable.

You can change your mind at any point, but an epidural takes time to set up, so say early if you may want one.

Birth preferences, and what happens when labour changes course

Written birth preferences tell the team what matters to you: who is with you, pain relief, positions, holding the baby skin to skin, and feeding. Keep them short and flexible, as labour does not always follow a plan.

Sometimes the baby needs help in the pushing stage, because it has gone on long, you are exhausted, or the heartbeat suggests the baby should be born sooner. An assisted birth uses a ventouse (a suction cup on the baby’s head) or forceps (curved instruments that fit around the head), and the doctor pulls gently as you push. Pain relief is given, a small cut (episiotomy) is often needed, and the baby may have a mark on the head that fades over the following days. The reasons are explained and your agreement asked for beforehand.

A cesarean may be advised during labour if the cervix stops opening despite measures such as breaking the waters or a drip, if the baby’s heartbeat shows signs of strain, or if an assisted birth is not possible. The reasons are still explained, more briefly if time is short.

What happens in the hours after birth

If you are both well, the baby is dried and placed skin to skin on your chest under a warm towel, which keeps the baby warm and helps feeding start.

An injection in your thigh as the baby is born is usually advised: it helps the womb contract, brings the placenta out sooner and lowers the risk of heavy bleeding. Some women choose a physiological third stage without the injection; this is discussed beforehand, and the injection can still be given if there is bleeding or a delay.

The perineum, between the vagina and the back passage, often tears during birth, particularly in a woman who has not given birth vaginally before. Many tears involve just the skin. Tears into the muscle are repaired under local anaesthetic with dissolvable stitches. A smaller number reach the ring of muscle around the back passage (the anal sphincter); these are repaired in theatre and followed up, as they can affect bowel control. You should be properly numb before any stitching.

Babies are often alert and ready to feed soon after birth, and a midwife can help with positioning and attachment. Early feeds are small, of colostrum, the thick early milk. Bleeding from the vagina is expected after birth, heavier at the start and easing over the following weeks.