First stage of labour
During the first stage of labour, contractions make your cervix gradually open up (dilate). This is usually the longest stage of labour.
At the start of labour, the cervix starts to soften so it can open. This is called the latent phase, and you may feel irregular contractions. It can take many hours, or even days, before you're in established labour.
Established labour is when your cervix has dilated to more than 3cm and regular contractions are opening the cervix.
During the latent phase, it's a good idea to have something to eat and drink as you'll need the energy once labour is established.
If your labour starts at night, try to stay comfortable and relaxed. Sleep if you can.
If your labour starts during the day, keep upright and gently active. This helps your baby move down into the pelvis and the cervix to dilate.
Breathing exercises, massage and having a warm bath or shower may help ease pain during this early stage of labour.
When to contact your midwives
Contact your midwifery team if:
- your contractions are regular and coming about 3 in every 10 minutes
- your waters break
- your contractions are very strong and you feel you need pain relief
- you're worried about anything
If you go into hospital or your midwifery unit before your labour has become established, they may suggest you go home again for a while.
Once labour is established, your midwife will check on you from time to time to see how you're progressing and offer you support, including pain relief if you need it.
You can either walk around or get into a position that feels comfortable to labour in.
Your midwife will offer you regular vaginal examinations to see how your labour is progressing. You don't have to have these if you don't want to - your midwife can discuss with you why she's offering them.
Your cervix needs to open about 10cm for your baby to pass through. This is what's called being fully dilated.
In a first labour, the time from the start of established labour to being fully dilated is usually 6-12 hours. It's often quicker in second or third pregnancies.
When you reach the end of the first stage of labour, you may feel an urge to push.
Monitoring your baby in labour
Your midwife will monitor you and your baby throughout labour to make sure you're both coping well.
This will include using a small handheld device to listen to your baby's heart every 15 minutes. You'll be free to move around as much as you want.
Your midwife may suggest electronic monitoring if there are any concerns about you or your baby, or you choose to have an epidural.
Electronic monitoring involves strapping two plastic pads to your bump, and possibly a clip attached to the baby's head (a foetal scalp monitor). These are attached to a monitor that shows your baby's heartbeat and your contractions.
You can ask to be monitored electronically even if there are no concerns. Having electronic monitoring can sometimes restrict how much you can move around.
If you have electronic monitoring with pads on your bump because there are concerns about your baby's heartbeat, you can take the monitor off if your baby's heartbeat turns out to be fine.
A foetal scalp monitor will usually only be removed just as your baby is born, not before.
Speeding up labour
Labour can sometimes be slower than expected. This can happen if your contractions aren't coming often enough or aren't strong enough, or if your baby is in an awkward position.
If this is the case, your doctor or midwife may talk to you about two ways to speed labour up: breaking your waters or an oxytocin drip.
Breaking your waters
Breaking the membrane that contains the fluid around your baby (your waters) is often enough to make contractions stronger and more regular. This is also known as artificial rupture of the membranes (ARM).
Your midwife or doctor can do this by making a small break in the membrane during a vaginal examination. This may make your contractions feel stronger and more painful, so your midwife will discuss pain relief with you.
If breaking your waters doesn't work, your doctor or midwife may suggest using a drug called oxytocin (also known as syntocinon) to make your contractions stronger. This is given through a drip that goes into a vein, usually in your wrist or arm.
Oxytocin can make contractions become stronger and more regular quite quickly, so your midwife will discuss pain relief options with you.
You will also need electronic monitoring to check your baby is coping with the contractions, as well as regular vaginal examinations to check the drip is working.
Second stage of labour
The second stage of labour lasts from when your cervix is fully dilated until the birth of your baby.
Finding a position to give birth in
Your midwife will help you find a comfortable position to give birth in. You may want to sit, lie on your side, stand, kneel, or squat, although squatting may be difficult if you're not used to it.
If you've had lots of backache while in labour, kneeling on all fours may help. It's a good idea to try out some of these positions before you go into labour. Talk to your birth partner so they know how they can help you.
Find out what your birth partner can do.
Pushing your baby out
When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. You may get an urge to push that feels a bit like you need to have a poo.
You can push during contractions whenever you feel the urge. You may not feel the urge to push straight away. If you have an epidural, you may not get an urge to push at all.
If you're having your first baby, this pushing stage should last no longer than three hours. If you've had a baby before, it should take no more than two hours.
This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you.
What happens when your baby is born
When your baby's head is almost ready to come out, your midwife will ask you to stop pushing and do some short breaths, blowing out through your mouth.
This is so the head can be born slowly and gently, giving the skin and muscles of the area between your vagina and anus (the perineum) time to stretch.
Sometimes your midwife or doctor will suggest an episiotomy to avoid a tear or to speed up delivery. This is a small cut made to the perineum.
You'll be given a local anaesthetic injection to numb the area first. Once your baby is born, the cut or any large tears will be stitched up.
Find out about your body after the birth, including how to deal with stitches.
Once your baby's head is born, most of the hard work is over. The rest of the body is usually born during the next one or two contractions.
You'll usually be able to hold your baby straight away and enjoy some skin-to-skin time together.
You can breastfeed your baby as soon after birth as you like. Ideally, your baby will have their first feed within one hour of the birth.
Read more about breastfeeding in the first few days.
Third stage of labour
The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.
There are two ways to manage this stage of labour:
- active - when you have treatment to speed things up
- physiological - when you have no treatment and this stage happens naturally
Your midwife will explain both to you while you're still pregnant or during early labour, so you can decide which you would prefer.
There are some situations where physiological management isn't advisable. Your midwife or doctor can explain if this is the case for you.
What is active management?
- Your midwife gives you an injection of oxytocin in your thigh as you give birth or shortly after. This makes your womb contract.
- Evidence suggests it's better not to cut the umbilical cord straight away, so your midwife will wait to do this between one and five minutes after birth. This may be done sooner if there are concerns about you or your baby - for example, if the cord is wound tightly around your baby's neck.
- Once the placenta has come away from the womb, the midwife pulls the cord - which is attached to the placenta - and pulls the placenta out through your vagina. This usually happens within 30 minutes of your baby being born.
Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth (postpartum haemorrhage), but increases the chance of you feeling nauseous and vomiting. It can also make afterpains - contraction-like pains after birth - worse.
What is physiological management?
- No oxytocin injection is given, and the third stage of labour happens naturally.
- The cord isn't cut until it's stopped pulsing - this means blood is still passing from the placenta to your baby. This usually takes around 2-4 minutes.
- Once the placenta has come away from the womb, you should feel some pressure in your bottom and contractions, and you'll need to push the placenta out. It can take up to an hour for the placenta to come away, but it normally only takes a few minutes to push it out.
If the placenta doesn't come away naturally or you begin to bleed heavily, you'll be advised by your midwife or doctor to switch to active management. You can do this at any time during the third stage of labour.
Article provided by NHS Choices