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Childbirth - vaginal delivery

Having a baby is a special time, and there’s lots of information to take in when you’re expecting. Here we go through everything you need to know about having a natural vaginal delivery. We include information on everything from the different stages and managing pain, to possible complications and some frequently asked questions.

An image showing a pregnant woman at the hospital

Details

  • Stages of childbirth Stages of childbirth

    Giving birth to your baby is known as labour. There are three stages when you give birth through your vagina, and how long each stage lasts varies. It can depend on things like whether or not it's your first pregnancy, the size of your baby and its position in your womb (uterus).

  • Childbirth – stage one Childbirth – stage one

    During the first stage of labour, your body goes through some changes to prepare to give birth. The balance of your hormones (your body’s natural chemicals) changes to kickstart the process. The neck of your womb – your cervix – will become softer and shorter. You may also have what’s called a ‘show’. This is when a ‘plug’ of mucus that acts as a seal in your cervix during pregnancy falls out as your cervix changes shape. This can happen anything from several days to a few hours before you start labour.

    You’ll also have contractions, which means the muscles in your womb tense and relax so that your cervix stretches and opens (dilates). The contractions will start gently at first and gradually build up to become intense, and will then ease off. It can take a while for your contractions to become regular, but they’ll gradually get stronger and closer together.

    Your doctor will ask about your baby’s movements. It’s important to keep checking how your baby moves throughout your pregnancy and to get to know what’s normal for you. And labour is no exception. Your baby might kick, spin, twist and turn anything from around 18 weeks (although this varies). They’ll be active up to the start of labour, and will continue to move around during early labour too. If you don’t feel your baby moving during this time, let your midwife know.

    The first stage of labour is often split into two periods – the latent phase and the active phase.

    • During the latent first phase, you’ll have irregular contractions, and your cervix will dilate by up to 4cm. For most women, the contractions aren’t particularly painful at this stage.
    • The active phase of labour can last for several hours. You’ll have more regular contractions, which will be more painful, and your cervix will continue to dilate from 4cm up to 10cm fully dilated.

    At first you might only have a contraction every 10 to 15 minutes. After a while, you’ll get them more often (every two to three minutes) and they’ll be stronger. Each contraction lasts about 20 and 40 seconds to begin with, and they’ll get longer as your labour progresses, to around 60 seconds, on average (it’s different for every woman).

    Contractions also feel different to different women. They might feel like period cramps, or your bump might feel very tight, like there’s a lot of pressure in your tummy (abdomen). Some women feel some discomfort in their back.

    Your waters will break too. This is a normal part of labour and is when the bag of fluid that surrounds your baby breaks, sometimes as your cervix widens. The fluid may rush out in one go or steadily leak out – you might want to wear a sanitary pad if so. Your waters can break at any time during labour. If your waters break when you're not in labour, contact your midwife or doctor for advice about what to do next. Normally the water is clear – if it isn’t, contact your midwife or doctor straightaway, for example if it looks green.

    At 10cm, your cervix is fully dilated, which will allow your baby to move down through your pelvis. If you’re having your first baby, you’ll probably be in the first stage of labour for, on average, about eight hours. It’s unlikely to last longer than 18 hours. It will probably take less time (five hours on average) if you’ve had a vaginal delivery before because your pelvis and vagina have been stretched before.

  • Childbirth – stage two Childbirth – stage two

    The second stage of labour is when you give birth to your baby. It usually lasts an hour or two.

    In this stage, you’ll feel a strong urge to push, which will help your baby to be born. It’s a unique feeling that your body does of its own accord. Your contractions will continue and these will help you push. If you stand upright, kneel, sit or squat while this is happening, it might help with the discomfort but see what works best for you.

    As you push, your baby will move further down through your pelvis until its head stays at the entrance to your vagina between contractions. This is called 'crowning' and means your baby is about to be born. Usually, your baby’s head comes out first, and then the shoulders and the rest of the body. Your midwife will let you know when your baby’s head is crowning and will guide you on when to stop pushing and to take shorter breaths (pant). This will slow things down while your baby’s head is coming out, which makes you less likely to tear. For more information about tears, see our FAQ: Healing.

  • Childbirth – stage three Childbirth – stage three

    Once your baby is born, your womb will continue to contract, which causes the placenta to separate from the wall of your womb. You then deliver the placenta – or after-birth – and this is the third stage of labour. You can let this happen naturally, or you can take a medicine to help the process.

    How your midwife or doctor can help

    Your midwife or doctor will be on hand to get you through the third stage as quickly and safely as possible. As your baby's shoulders are coming out, they may give you an injection of a hormone called oxytocin, or wait until your baby is born. After a few minutes, this will cause your womb to contract strongly.

    They’ll clamp and cut the umbilical cord after your baby is born – usually between one and five minutes afterwards. When the time’s right, your midwife or doctor will then deliver the placenta by pulling gently with one hand on the part of the umbilical cord that’s still attached to it.

    All of this can take up to half an hour. Research has shown that this method reduces your risk of serious bleeding, which is a risk after you give birth. Yet you might get some side-effects as a result of the medicines, such as feeling sick, or a headache.

    A natural (physiological) third stage

    You may choose to deliver the placenta without taking any medicines. After your baby is born, your midwife will encourage you to keep pushing, or to try breastfeeding. This will make your body release hormones that will help your womb to contract and push out the placenta. Your midwife or doctor won’t usually clamp and cut the umbilical cord until your placenta is out. This can take anything up to an hour.

    There’s a higher risk of bleeding after you give birth if you have a natural third stage. And this is even higher if you’ve given birth four times before. Sometimes it might not be possible for you to have a natural third stage – talk through your options with your midwife or doctor.

  • Complications Complications of childbirth

    Complications are when problems occur during or after a vaginal delivery. Sometimes labour doesn't go as planned and you might need some extra help.

    Induction of labour

    Sometimes you’ll need some extra help to go into labour and this is called being induced. It happens to around one in five women, and reasons to be induced include:

    • a problem with either you or your baby (or both of you) that means you need to give birth early
    • your pregnancy going on for longer than 41 or 42 weeks
    • if your waters have broken, but labour hasn't started 24 hours later

    There are different ways to induce labour. To begin with, your midwife or doctor may try something called membrane sweeping. They’ll put their finger inside your cervix and make a circular movement. This separates the membranes around your baby from your womb and releases hormones, which can start your labour. If this doesn't happen, other ways include those below.

    • Prostaglandins. These are hormones that are usually produced by your body to trigger the beginning of labour. They stimulate your cervix to get softer and shorter. You’ll have tablets, or your midwife or doctor will put a gel into your vagina.
    • Rupture of membranes. This is when you artificially have your waters broken. It's done using a special plastic probe. Rupturing your membranes causes hormones to be released that can start your labour.
    • Oxytocin. This causes your womb to contract and you’ll receive it through a drip inserted into a vein in your arm.

    Having labour induced can be more painful than going into labour naturally, so talk to your midwife or doctor about pain relief options.

    Speeding things up when you’re in labour

    If you’re in labour for longer than usual, you might need treatment to speed things up. This is known as augmentation of labour and helps to open up your cervix and make your contractions stronger. You may be given oxytocin through a drip to help your womb contract more strongly.

    Assisted delivery

    Sometimes you might need some extra help to give birth to your baby. Your doctor may need to use instruments to help your baby out. This can happen for the following reasons.

    • Your baby isn't getting enough oxygen, or there’s another problem putting their health at risk. This is called fetal compromise or fetal distress.
    • Your baby’s in an awkward position so it’s difficult for them to get out without help.
    • You’ve been pushing for a long time and are exhausted, so need a bit of extra help.
    • You have a health condition that means you can’t keep pushing.

    You’ll usually be given local or regional anaesthesia before an assisted delivery. The two types of assisted delivery are below.

    • Forceps. These are like large tongs with curved ends that fit around your baby's head. Your doctor will pull gently on them while you push.
    • Vacuum extraction. Your doctor will put a cup on your baby's head and attach this to a vacuum machine. Your doctor will then gently pull on the cup as you push, which will help to guide your baby out.

    If you need an assisted birth, your midwife or doctor will talk you through the procedure and options.

    Caesarean delivery

    If you can’t give birth to your baby vaginally, you’ll need this operation. You can read all about this in our topic on a caesarean delivery.

    You can plan in advance to have a caesarean, or you may go into labour and then need an emergency caesarean because of complications. It’s also possible that you may need an emergency caesarean before you go into labour.

  • Pain relief Pain relief

    All women cope differently with labour, and you may have an idea about the type of pain relief you want. But this may change once it's actually happening. There’s scientific evidence to show that having someone with you throughout labour can reduce your need for pain relief. So it’s definitely worth asking your partner, or a family member or friend to be with you.

  • Self-help for pain relief Self-help for pain relief

    There are lots of ways to relieve pain that you can try if you don't want to use medicines. These methods include:

    • using breathing and relaxation techniques, or massage
    • being in warm water, such as a birthing pool
    • moving around, standing up, kneeling and leaning forward

    Some women find using a TENS (transcutaneous electrical nerve stimulation) machine can help during early labour. Four electrodes are placed on your back and electrical impulses are sent to the nerves to block pain signals going from your womb to your brain. There isn’t any scientific evidence to prove that it works but you might decide to give it a go.

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  • Medicines for pain relief Medicines for pain relief

    There are different types of medicines that you can choose from for pain relief, and you can sometimes take a combination of them. It's important to talk to your midwife or doctor about these so you’re aware of the risks and benefits of each.

    Gas and air (Entonox) for pain relief

    This is a mixture of nitrous oxide and oxygen. As you feel a contraction start, you slowly breathe in the mixture through a mouthpiece or a mask over your nose. It's a mild painkiller and will make you less aware of your pain. You may find that Entonox makes you feel sick and light-headed though.

    Opioids for pain relief

    Opioids are strong painkillers that your doctor will inject into a muscle. They include diamorphine and pethidine. They can cause side-effects, which include feeling sick, dizzy or very sleepy. It’s not always a good idea to take opioids – ask your doctor about the pros and cons.

  • Epidural for pain relief Epidural for pain relief

    An epidural is an injection of anaesthesia into your lower back, which blocks pain from your waist down. See our topic on Epidural for more information. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push as much. It may also make moving around more difficult because you might need to be connected to machines that monitor you.

    Some hospitals offer mobile epidurals. These use a lower dose of local anaesthetic plus an opioid painkiller. It allows you to walk about during the first stage of labour, which you may prefer.

  • FAQ: Eating and drinking Can I drink or eat while I'm in labour?

    Yes usually, but you might not feel like it. Try and drink some water during labour to keep well hydrated.

    You can eat during labour, unless you’ve had opioid painkillers, such as pethidine or diamorphine. Or if there’s a high chance that you’ll need to have a general anaesthetic. But you’ll still be able to sip some water.

    If you have to eat, it’s fine to eat normally in the early stages of labour if you feel like it. It will help to keep your energy up. It’s best to have starchy carbohydrates, such as cereals, and brown bread or rice, as these release energy slowly, over a longer period of time.

    Are Braxton Hicks contractions the same as the contractions that I’ll have during labour?

    Answer

    No, Braxton Hicks contractions are different from the contractions you will have when your baby is born.

    Explanation

    Braxton Hicks contractions are also sometimes called practice contractions. You may start to get this kind of contraction from around the middle of pregnancy. As your pregnancy progresses, you may feel them more often and they may get stronger.

    Braxton Hicks contractions are different from the contractions that occur during labour, which are more powerful and come at regular intervals. Braxton Hicks contractions are irregular and you probably won't find them as painful, although they may be uncomfortable.

    Can I give birth at home?

    Answer

    Some women who have a straightforward pregnancy choose to give birth to their baby at home. However, there’s not enough information available to say if having a home birth is as safe as a hospital birth.

    Explanation

    During pregnancy, you will need to think about where you want to give birth to your baby. There are several options and one of these includes having a home birth. You may decide that you would prefer to give birth to your baby at home rather than in a hospital. This could be for various reasons. For example, because you will feel more relaxed in familiar surroundings.

    Some studies have shown that women who have a planned home birth are less likely to have medical treatments, such as pain relief or to have assisted delivery.

    However, there’s not enough information available to say for sure whether it is safer to have your baby at home or in hospital. A study of healthy and normal pregnancies in England in 2011 showed that:

    • if it’s your first baby, it’s slightly safer for the baby to give birth in hospital
    • if it’s your second or subsequent baby, there’s no difference in safety whether you give birth at home or in hospital

    However, a large US study found that babies born at home or in a midwife unit had a higher risk of problems soon after birth.

    There may be reasons why it's best for you to give birth to your baby in hospital. These include:

    • having a condition such as diabetes or high blood pressure
    • if you’re expecting more than one baby
    • having had complications during this pregnancy or a previous pregnancy

    It's important to remember that you won't be able to have an epidural if you choose to give birth at home. It will also take longer to get emergency care for you or your baby if problems develop during labour.

    There are a number of other places where you can choose to give birth, such as birth centres run by midwives. Your midwife or doctor will be able to give you more information about your options. And remember, you can change your mind at any time about where you wish to give birth.

    Are there any benefits to using water during labour?

    Answer

    Yes, there’s evidence to show that being in water during labour may reduce your need for pain-relief medicines and make your contractions less painful. It may slightly reduce the need for labour to be speeded up.

    Explanation

    You may find water helpful as a method of pain relief. There’s evidence that being immersed in water during the first stage of labour may reduce the pain you feel and the need for an epidural. You may also have a shorter first stage of labour.

    You may also want to give birth to your baby while you’re in water. You should speak to your midwife or doctor for more information about giving birth in water. There’s currently a lack of evidence to show whether or not there are any increased risks to you or your baby.

    Some hospitals and birth centres have birthing pools. It's also possible to hire birthing pools to use at home.

    What will happen if I'm having twins or triplets?

    Answer

    If you’re pregnant with twins, you may be able to give birth vaginally to one or both of your babies. If you’re having triplets, they will be delivered by caesarean.

    Explanation

    If you’re pregnant with twins, triplets or even quadruplets, this is called a multiple pregnancy. About 16 pregnant women in every 1000 in the United Kingdom in 2011 had a multiple pregnancy. Women who become pregnant after in vitro fertilisation treatment (IVF) have a higher chance of having twins or more.

    If you’re pregnant with triplets or quadruplets, you will be advised to have them delivered by caesarean. If you’re expecting twins, you’re more likely to need a caesarean delivery than if you were pregnant with one baby. However, it's often possible for at least one, if not both, of your twins to be born vaginally. If the first twin is in the head downwards position, then it's likely that vaginal labour and birth can go ahead.

    After the first baby is born, you may stop having contractions. If they don't start again, you will probably be given oxytocin to encourage your uterus (womb) to start contracting. Your midwife or doctor will examine you to see which way your second baby is pointing. They may try to turn your baby into a good position to be born vaginally, or you may need to have a caesarean delivery.

    Is complementary therapy helpful for pain relief during labour?

    Answer

    Relaxation, acupuncture and massage may be helpful to reduce pain during labour. However, there’s a lack of evidence to show whether other kinds of complementary therapies are effective.

    Explanation

    Many women give birth with little use of medicines for pain relief. Massage may help you relax and reduce your anxiety during labour. Acupuncture may also reduce pain in labour. There isn’t enough information to say whether aromatherapy and hypnotherapy reduce pain in labour. It's important to speak to your midwife or doctor before trying any complementary therapy. If you do decide to use a complementary therapy, make sure that you only go to a registered practitioner.

  • FAQ: Braxton Hicks contractions What are Braxton Hicks contractions?

    Braxton Hicks contractions – also known as practice contractions – are different from the contractions you’ll have when your baby is born.

    You might start to get Braxton Hicks contractions from around the middle of your pregnancy. They’re different from the contractions that you get during labour, which are more powerful and come at regular intervals. Braxton Hicks contractions are irregular and you probably won't find them as painful, although they can be uncomfortable.

  • FAQ: Home birth Can I give birth at home?

    You can choose to give birth at home if you’re healthy and your pregnancy is considered to be low-risk.

    More information

    You’ll need to think about where you want to give birth to your baby ahead of the event. There are several options and one of these includes having a home birth. You might feel more relaxed in familiar surroundings so it’s understandable that you might want a home birth.

    Some studies have shown that women who have a planned home birth are less likely to have pain relief or an assisted delivery. But there’s not enough information available to say for sure whether it’s safer to have your baby at home or in hospital.

    Sometimes there may be reasons why it's best for you to give birth to your baby in hospital. These include:

    • having a condition such as diabetes or high blood pressure
    • if you’re expecting more than one baby
    • having had complications during this pregnancy or a previous pregnancy

    Remember that you won't be able to have an epidural if you choose to give birth at home. It will also take longer to get emergency care for you or your baby if you have any problems during your labour.

    Other options to consider include birth centres run by midwives. Talk these through in advance with your midwife or doctor so you can make a decision that’s right for you.

  • FAQ: Twins and triplets What will happen if I'm having twins or triplets?

    If you’re pregnant with twins, you might be able to give birth normally through your vagina to one or both of your babies. If you’re having triplets, you’ll usually need to have a caesarean.

    More information

    If you’re pregnant with twins, triplets or even quadruplets, this is called a multiple pregnancy.

    If you’re pregnant with triplets or quadruplets, your doctor will usually recommend that you have a caesarean. If you’re expecting twins, you’re more likely to need a caesarean delivery than if you were pregnant with one baby. But it might be possible for at least one, if not both, of your twins to be born vaginally. If your first twin is in the head downwards position, then it's likely that you can have a vaginal birth.

    After your first baby is born, you might stop having contractions. If they don't start up again, you’ll probably be given oxytocin to encourage your womb to start contracting. Your midwife or doctor will look to see which way your second baby is pointing. They may try to turn your baby into a good position to be born vaginally, or you may need to have a caesarean.

  • FAQ: Healing How long will it take to heal after giving birth?

    How long it takes you to recover from giving birth will depend on how your birth went, and if you had any tears. Your midwife will let you know when you are ready to go home. This will depend on your (and your baby’s) health, and how much support you have at home.

    More information

    Sometimes when you give birth you can tear, and this is graded depending on where the tear is. It can happen in your vagina, the muscular area between your vagina and anus (called the perineum) or the muscles in your bottom. But your midwife or doctor will make every effort to prevent this happening.

    They’ll let you know when your baby’s head is crowning and will tell you to stop pushing and to pant for a bit. This will slow things down and make you less likely to tear. Or they might massage your perineum or put a warm compress on it. Other things they can do is inject local anaesthetic, or do what’s called an episiotomy. This means they’ll make a cut in your perineum just before you give birth to make your vagina wider to make it easier to deliver your baby.

    After an episiotomy, your midwife or doctor will use stitches to close the cut and it will heal over time. They’ll usually use dissolvable stitches so you won’t need to have them taken out. Sometimes, if the tear is quite severe, a surgeon will need to repair it.

    You might need to take some medicines after an episiotomy, such as antibiotics and laxatives to help while you heal. And you might need to do some physiotherapy exercises. How long it takes to heal will depend on where your cut was – most women are completely back to normal within a year.

  • Other helpful websites Other helpful websites

    Further information

    Sources

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    • The pregnancy book. Chapter 9: labour and birth. Health and Social Care. www.publichealth.hscni.net, published 28 April 2016
    • Management of normal labor. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2017
    • Reduced fetal movements. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published February 2011
    • How to tell when labor begins. American College of Obstetricians and Gynecologists. www.acog.org, published May 2011
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    • Prostaglandins and oxytocics. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed March 2017
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, April 2017
    Expert reviewed by Miss Sangeeta Agnihotri, Consultant in Maternal Medicine, Obstetrics & Gynaecology
    Next review due April 2020

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    We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.

Contact us

If you have any feedback on our health information, we would love to hear from you. Please contact us via email: healthinfo@bupa.com. Or you can write to us:

Health Content Team
Battle Bridge House
300 Grays Inn Road
London
WC1X 8DU

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Legal disclaimer

This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

For more details on how we produce our content and its sources, visit the 'About our health information' section.

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