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Childbirth - vaginal delivery


Expert reviewer Miss Sangeeta Agnihotri, Consultant in Maternal Medicine, Obstetrics & Gynaecology
Next review due April 2020

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.

<A pregnant woman having her blood pressure taken by a nurse

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

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

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

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 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

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

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.

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

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.

Frequently asked questions

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.


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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, April 2017
    Expert reviewer Miss Sangeeta Agnihotri, Consultant in Maternal Medicine, Obstetrics & Gynaecology
    Next review due April 2020



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