Words Jodie Thomson of My Child Magazine

Experts say every woman's labour is unique, but for first-time mothers it can help to have an idea of what's in store. Here's a guide to what to expect in labour and what it might feel like.

I'd always prided myself on having a sky-high pain threshold; the ability to withstand prolonged bouts of pain or discomfort. As a regular runner of moderate distances, this kind of comes with the territory, as does the happy endorphin rush afterwards.

And so when I discovered I was pregnant the first time, the prospect of a natural birth didn't phase me too much, even though I was carrying twins. Childbirth didn't bother me in the way it seemed to induce fear and anxiety in so many of my pregnant girlfriends.

Many of them spent much of their pregnancies consumed with how they'd cope with the birth and what kind of pain relief they'd be taking (an epidural for most, thank you). They swapped bad birth stories they'd heard with a kind of hushed and horrified glee.

Their fears aren't so out of line when you consider the hype and mythology that surrounds giving birth in society today. Older mothers tell tales of the agony of childbirth that can't be compared to anything else life throws at you. Younger mothers-to-be are giving birth with more medical intervention than ever before.

The latest Mothers and Babies report from the Australian Institute of Health and Welfare showed that in 2007 almost 75 percent of mums used some form of pain relief during labour, and that 32 percent of new mothers gave birth via a Caesarean section.

But these tales don't tell the whole story. Birthing experts will tell you every single birthing event is unique and every woman's experience of labour distinct. For every woman who had an unpleasant time, there's at least one who had a fabulous birth. The good ones don't tend to make such great stories, so you tend to hear about them far less.

We seem to have forgotten that childbirth may seem improbable when you consider the size of a newborn baby and the women's body parts involved, but it's in fact something women's bodies were designed to do. Proponents of natural childbirth argue that the easiest and most successful births come with the least medical intervention, so women can do what comes naturally and let the body's own coping mechanisms come into play.

The secret to a good birth, experts argue, is being physically and psychologically prepared, and as relaxed as is humanly possible.

'The whole process of labour and birth is very psychological,' says Anna Higgs, a midwife who now runs her own business, Postnatal Angel Service, visiting new mums at home. 'You can will yourself into something and you need to have a positive frame of mind going into childbirth.'

STAGES OF LABOUR

A little knowledge goes a long way when it comes to childbirth. Understanding each stage of labour and what's happening to your body will help lessen any fears.

PRE-LABOUR As the baby engages, the cervix softens and ripens, and mums may feel a bit of lower backache, a little like period pain, that can come and go or be there all the time. For some women, the shifting of the pelvic ligaments as they relax causes a dull backache.

FIRST STAGE Things start getting serious here, when the cervix starts to dilate. The uterus begins to contract, and the contractions get closer and stronger as the body begins to force the baby down the birth canal. The waters may break around now or earlier, but this can happen later in labour too.

In the early stage, the cervix dilates around 3 to 4cm and you can usually relax at home and distract yourself. Once the cervix dilates
to about 6 to 7cm, the contractions come more frequently, every three or four minutes, and it can be harder to talk or relax. This is usually the time to call the doctor or midwife.

From here, the contractions get quicker and stronger, until it feels like there is no break between them, and the cervix keeps dilating.
By the time it's dilated to around 10cm, you may feel the need to push, or go to the toilet, as the baby's head touches the rectum.

SECOND STAGE This is where all the action takes place as the baby is delivered. If your waters haven't broken yet the doctor may artificially rupture them. Your doctor or midwife may instruct you to push the baby when you have a natural urge, or when each contraction hits to maximise your energy. This is when mums get pretty tired, and the delivery stage can take up to a few hours for first-time mums, less for women who have delivered vaginally before. Once the baby is delivered, the doctor or dad cuts the umbilical cord.

THIRD STAGE The uterus starts to shrink and the placenta is delivered, often with one last gentle push.

WHAT LABOUR FEELS LIKE Talk of contractions and dilating cervixes is all very well but how do you describe to a first-time mother what childbirth will actually feel like?

For a start, it helps to avoid even using the word 'pain'. 'We talk about a tightness, weightiness, pressure, a pulling-up sensation when describing contractions,' explains Susan Ross, a midwife, childbirth educator and director of Birth Right, which runs pre-natal and early parenting classes, along with doula services and doula training. Ross also wrote the childbirth guide Birth Right (Random House Australia, $22.95).

Be mindful, especially when you hear tales
of other women's labours, that everyone has a different concept of pain.

'Labour is very individual and everybody's pain threshold is different,' explains Higgs. 'It's never going to be the same for different people, and you've got nothing to compare it to the first time around.'

Thinking about what's going on medically during labour helps make sense of the various physical sensations going on. Period-like cramps, backaches and diarrhoea can all result from the early stirrings of the uterus preparing to start contracting. Contractions themselves can be felt across the lower abdomen, and the small of the back, upper thighs and bowel, in increasing intensity as the contractions speed up. And in the final stage the feelings are more sharp and burning around the vagina and perineum as everything stretches to make way for the baby. Many women also feel nauseous during labour and may vomit at some point.

It's also worth remembering that the body produces its own pain-busting endorphins during labour, which help to dull the intensity
of any pain.

'It's like a cocktail of hormones that help women through the labour,' says Ross.

When quizzed on the specifics of their births, most of my friends detail particular events, rather than particular sensations, during the labour. Like the friend whose waters broke a few weeks before her due date while she sat on a crowded Sydney ferry during peak hour. Or the other friend who went drug-free for her labour and insisted on stomping around her delivery suite stark-naked, refusing the midwife's pleas to put on a hospital gown.

Many categorised their births as wondrous, positive experiences, one even using the word 'orgasmic' in her descriptions. Others used words like 'gruesome', 'gruelling' and 'hideous', though these cases usually involved some medical intervention or complication, like
a baby's blood pressure drop and emergency Caesarean.

Certainly my own births weren't the stuff of horror tales. The twins were born by Caesarean after the top twin became wedged in a transverse position too dangerous to be delivered vaginally.

But my son was born naturally and drug-free and I can only describe it as an amazing experience. I'm pretty sure I got double-doses of those childbirth endorphins, as I felt high as a kite for hours after he emerged into the world.
I was amazed at how primal and intuitive the labour was, how I seemed to know what to do, curling onto my side on the bed and going into some other place in my head as I breathed through the contractions. Apart from barking at my husband once to turn the TV off I barely uttered a sound for the six hours I was in the delivery suite. The gentle, seasoned midwife who looked after me remarked that she'd never seen a mother in labour so calm and silent.

Did it hurt? At the end, sure it did but only in a numb kind of way. The contractions felt more like waves I had to dive under and hold my breath during, something that wrapped me uncomfortably tightly each time. Orgasmic? Not exactly, but nothing to be anxious about at all.

LABOUR COPING STRATEGIES

The best way to boost your chances of having
a happy, positive birth is to prepare yourself mentally well before the first contraction starts.

Ross teaches hypnobirthing during the pregnancy to help encourage a calm, relaxed mindset about the upcoming labour, utilising meditation to reduce any fears or concerns.

'It teaches things like the regular practice of listening to a relaxation CD, focusing on the positive and getting rid of anxieties,' Ross says.

Reducing fear is also a sure-fire way to minimise the pain felt during labour. 'Fear equals tension equals pain,' Ross says. 'Fear affects the uterine muscles during labour so if you eliminate it you can have a beautiful, calm, peaceful birth. It's really simple.'

Part of that calming process is ensuring that the mother feels secure and confident while she is in labour.

'There are a whole lot of other factors that can affect your pain,' Ross says. 'The support you've got, how safe and supported you feel, and how confident you feel with your caregiver.'

A doula, she explains, can help with that
as they will have developed an established relationship with the mother before she goes into labour and can provide a "protective bubble" through the process.

Medical intervention at any stage in the labour can also impact on the pain felt and how the labour progresses. For example, mothers
who are induced medically to bring on the labour will often find the contractions start swiftly
and strongly.

'The contractions come fast and furious and the endorphins don't have time to kick in. The mother can become fearful, her pain levels go up and then she may need an epidural,' Ross says.

Higgs believes some methods of pain relief, like pethidine and nitrous oxide (gas), can help calm fears in the early stages of labour and keep it going smoothly.

'I've found that women who hold off on pain relief tend to have longer labours,' Higgs says. 'When your body is in pain you tend to tense up and hold your breath, but when you do that your cervix can't open. The breathing helps to relax your body but gas and pethidine can play a big part, taking your mind away from the pain and giving you another focus. Pethidine takes the edge off the pain and completely relaxes your body when you're not contracting.'

For the same reasons, Higgs stresses that women need to prepare their bodies and minds for the process of labour.

'You need to have a positive frame of mind,' she says. 'A lot of people get distracted by things like renovating or finishing work, and labour gets put to the back of their mind.'

Your mental disposition, she says, will have a big impact on what you feel during labour. 'The most highly strung, anxious women
have the hardest time,' she suggests, 'while the ones who go with the flow tend to have a wonderful time.' .

PAIN RELIEF OPTIONS

Pethidine The narcotic drug pethidine is given by intramuscular injection in
the leg or buttock and is said to have a calming effect. It can have some side effects like giddiness and nausea, though some hospitals give anti-nausea medication to combat that.

Gas Nitrous oxide is inhaled by a mask or mouthpiece and is aimed at calming anxieties rather than taking the pain away. Some women find holding the gas mask gives them a comforting distraction and focus.

Edpidural Epidural anaesthesia involves injecting an anaesthetic into the back, in the lining of the spinal cord, which makes the mother feel numb from the waist down. The mother remains awake and alert throughout the birth and low-dose epidurals are popular for this reason. The downsides are that epidurals can cause the mother's blood pressure to drop, which can slow the baby's heart rate. Trans-Cutaneous Electrical Nerve Stimulation (TENS)

Trans-Cutaneous Electrical Nerve Stimulation (TENS) With a TENS machine, electric currents are used to block pain impulses to the nerves, through electrodes attached to either side of the brain.

This article is brought to you by My Child Magazine.
Words Jodie Thomson.

My Child is a fantastic parenting, health and lifestyle magazine that helps mums and dads know what to expect during pregnancy and birth, babyhood and the toddler and preschool years. There are great articles, heart-warming stories, personal tales of parents' experiences, and gorgeous fashion, interiors, style and product pages. This is Australia's first truly stylish and informative parenting magazine. Available quarterly. You can also visit our friendly forum or subscribe at www.mychildmagazine.com.au.