Are You in Labour

Are you in labour?  Usually contractions will begin slowly, gradually increasing in frequency and strength. Contractions feel like period pains or Braxton-Hicks contractions but are stronger, and tend to last longer.
If they don't settle with a warm bath then it may well be labour. Contact the hospital or myself if you think that you are in labour, especially if you are less than 37 weeks (Premature Labour).
If you rupture your membranes put on a pad and go to the hospital. Do not wait at home to see if contractions are going to start. Please ring the hospital to tell them that you are coming in. The hospital will notify me if you are admitted.

How Long Is labour?  Most women, in labour with their first baby, will be about 3cm dilated when they present to the maternity unit. In normal labour, you should then dilate 1cm or more per hour once established in labour.
Therefore, seven hours later, the woman should be close to fully dilated. When the urge to push is present, you are examined to confirm full dilation and then encouraged to push. The baby will be delivered within an hour for most women, with a range of 1 minute to 90 minutes.
This means labour should be no more than 12 hours out of your life. But what a life changing 12 hours. For women who have already had one baby, labour may be very short indeed, irrespective of the previous length of labour.

Why Are Some Labours Much Longer?  About 10-15% of all first labours are complicated by an OP (occipto-posterior) position. This means the baby's head is looking up instead of down. This is commonly and erroneously known as 'babies back to your back'.
Classically, the is a prolonged period of braxton hicks type contractions occurring irregularly over 24 hours. Women often break their waters prior to labour and this is followed by the gradual onset of irregular contractions of variable intensity. In these labours, contractions tend to be very painful, poorly co-ordinated and ineffective resulting in little or no progress while you become exhausted.
The only way to confirm progress in labour is to do a vaginal examination on arrival, repeating the examination, at most, 4 hours later and comparing the result. If you have not progressed then you may have a problem and it is reasonable to consider augmenting labour with Syntocinon. If you don't assist the labour then you may well have a much longer labour than necessary. In addition, the head is not encouraged to rotate into the most beneficial position by these ineffective contractions. Waiting only increases the likelihood of the head moulding into the pelvis in a less optimal manner and this will prevent the head from rotating. When syntocinon is started too late it is less effective.
You also increase the chances of needing an assisted delivery or caesarean section if you intervene too late.

Augmentation? If you are not progressing adequately then you will have the option of improving your contractions by either rupturing the membranes, if this has not already occurred, or by having intravenous Syntocinon.

If you are not progressing adequately then you will have the option of improving your contractions by either rupturing the membranes, if this has not already occurred, or by having intravenous Syntocinon.
Syntocinon is a drug which is very similar to your body's Oxytocin which is responsible for contractions. If Syntocinon is introduced early when there is a problem, your chance of vaginal delivery is higher. Long labours are directly related to poor outcomes for both the mother and baby.