Childbirth - vaginal delivery

Your health expert: Mr Ruwan Fernando, Consultant Obstetrician & Gynaecologist
Content editor review by Victoria Goldman, November 2022
Next review due November 2025

Here, we go through everything you need to know about vaginal delivery for childbirth, including the three stages of labour.

We have a separate topic page for women who choose or need to have a caesarean delivery.

First stage of labour

Labour is the process from when you start having labour pains to the delivery of the placenta. If labour continues without intervention, this is called a normal labour. In normal labour the baby is delivered through the vagina. This is referred to as vaginal delivery or vaginal birth.

The first stage of labour is from the start of labour pains until full dilation of your cervix to 10cm. Your cervix (the neck of your womb) gradually stretches and opens (dilates). By the end of the first stage, your cervix will be fully dilated so you’re ready to give birth. This will allow your baby to move down through your pelvis.

You’ll feel the muscles in your womb tensing and relaxing to stretch your cervix. This is called having contractions. Everyone feels contractions differently. They may feel like period cramps or your bump may feel very tight. Sometimes they cause discomfort or a dull ache in your back.

The first stage of labour is split into two parts – the latent phase and the active phase. During the latent phase, your contractions will be irregular. Your cervix gradually dilates up to 4cm. How long this takes varies, but it’s usually several hours.
The active phase of labour is sometimes called established labour. In this phase, you’ll have more regular, painful contractions. Your cervix will continue to dilate to 10cm – this is when you’re fully dilated. If you’re having your first baby, this can take an average of eight hours, but sometimes takes up to around 18 hours. If you’ve had a vaginal delivery before, the active phase may take five to 12 hours.

Your contractions may be every 30 minutes at first, but may be every two to three minutes by the end of labour. Your waters (the bag of fluid that surrounds your baby, also called amniotic fluid) will usually break at some point during this first stage. This is a normal part of labour. The fluid may rush out or leak out steadily – so you may want to wear a sanitary pad. The water should be clear. If it is blood-stained or green, contact the maternity unit straightaway.

Braxton Hicks contractions

You may get Braxton Hicks contractions towards the end of your pregnancy. These are different from labour contractions. Braxton Hicks contractions are irregular. You may only get one or two every hour. They tend to go away if you move around. You probably won’t find them painful, but they can be uncomfortable.
Labour contractions come at regular intervals. They get stronger, more painful and more regular over time

Speak to your midwife if you’re unsure about your contractions.

When should I go to hospital?

You won’t usually need to go to hospital (or a midwife-led birth centre) when you’re in the early stages of labour. But you can phone the hospital or your midwife whenever you want to. They’ll check how you’re feeling, whether your baby’s movements have changed, and go through what to expect next.

They’ll probably encourage you to stay at home until you reach the active phase of labour – when your contractions are more regular. Sometimes your midwife may ask you to go to hospital earlier. This may be because your waters have already broken.

You should go to the hospital immediately.

If the colour of your waters is blood-stained or green colour.
If the pain is severe and unbearable.
If you feel faint, dizzy or unwell.

Home birth

You can choose to give birth at home if you’re healthy and your pregnancy is considered to be low-risk. If you have a planned home birth you may be less likely to have an epidural, or medical intervention, such as a caesarean section, forceps or ventouse.

But it may be best for you to give birth to your baby in hospital if you:

have any medical conditions, such as diabetes or high blood pressure
are expecting more than one baby
have had complications during this pregnancy or a previous pregnancy

If you do plan a home birth, you may need to be transferred to hospital during your labour if there are any problems.

Second stage of labour

In the second stage of labour, your cervix is fully dilated and you give birth to your baby. This usually lasts a couple of hours if you haven’t given birth before, but may be quicker if you have.

Your contractions will get stronger, last longer and be more regular. You’ll also feel a strong urge to push with each contraction. This will help your baby to be born. You may find it helpful to try different positions, such as standing upright, kneeling, sitting or squatting. Choose whichever’s most comfortable for you.

As you push, your baby will move further down through your pelvis. Usually, their head comes out first, then their shoulders and the rest of their body. When their head appears, this is called ‘crowning’.

Preventing tears

When you give birth, you may tear the skin or muscles around your vagina or anus. Your midwife or doctor may use some of the following measures so this is less likely to happen.

Telling you to stop pushing as your baby’s head is crowning, and using their hands to support your baby’s head.
Holding a warm compress on your perineum (the area between your vagina and anus) during the second stage of labour.
Massaging your perineum during birth.
Performing an episiotomy – a cut in your perineum (the skin between your vagina and anus) just before you give birth. There’s conflicting evidence about how helpful this may be. Episiotomies aren’t done routinely in England, your doctor may be more likely to suggest it if you need an assisted delivery (forceps or ventouse), or they need to deliver your baby quickly because it is taking too long.

If you do tear, or if you need an episiotomy, you may need to have some stitches. If the tear is quite severe, you may need surgery to repair it, but this is uncommon.

Third stage of labour

The third stage of labour is when you deliver the placenta after the birth of your baby.

You can choose to let this happen naturally – this means you’ll push out the placenta yourself (called a physiological third stage). You can have assistance (active management) to help speed up this stage.

Active management involves having an injection of oxytocin as your baby’s shoulders are being delivered. This makes your womb contract more strongly. After your baby is born, your midwife will clamp and cut the umbilical cord. They’ll then deliver the placenta by pulling gently on the umbilical cord.

Active management is generally recommended. This is because it shortens this stage of labour and means you’re less likely to have serious bleeding. It’s your choice though if you’d like to aim for a natural third stage. You may need to switch to active management if:

there’s a risk that you’ll lose a lot of blood
the delivery of your placenta takes more than an hour

Sometimes the placenta will not come out naturally, or after using oxytocin (known as a retained placenta). If this happens, the placenta has to be removed manually. An obstetrician will be called, or you will be transferred from a midwife unit to an obstetric unit. Manual removal of the placenta is carried out by an obstetrician in an operating theatre. An obstetrician is a doctor specialising in pregnancy and childbirth.

Induced labour

Sometimes your midwife or doctor may recommend that your labour is started artificially. This is called being induced, or induction of labour. You may be induced for several reasons, including:

your pregnancy is going on for longer than 41 or 42 weeks
your waters have broken, but labour hasn't started within 24 hours
there’s a problem with you or your baby that means it would be safer for you to give birth earlier

There are several different ways to induce labour.

Membrane sweeping. Your midwife or doctor will try this first. It involves putting their finger inside your cervix and making a circular movement to separate the membranes around your baby.
Prostaglandin treatment. Tablets or a gel are put inside your vagina. These make your cervix open up and your womb start to contract.
Artificially having your waters broken. Your doctor may suggest this if your cervix is already partly opened, or after you have had one or two doses of prostaglandin treatment. You may have this on its own, or with an oxytocin drip, which makes your womb contract.

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

Speeding up labour

If your natural labour is taking longer than usual, your midwife or doctor may suggest breaking your waters for you, if these haven’t broken already. This should strengthen your contractions and speed things up.

If this doesn’t help, you may be offered treatment with an oxytocin drip. The oxytocin helps your womb to contract more strongly and more frequently. You’ll be offered an epidural for pain relief beforehand.

Assisted delivery

Sometimes your doctor may need to use special instruments to help you deliver your baby. This is known as an assisted delivery and can happen for several reasons.

Your baby’s health is at risk – there may be a problem with the placenta, or your baby has an abnormal heart rate or pattern.
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 a longer labour may be dangerous for you.
There are two types of assisted vaginal delivery. Forceps. These are like large tongs with curved ends that fit around your baby's head. When you have a contraction, your doctor will pull gently on them while you push.
Ventouse (vacuum extraction). Your doctor attaches a metal or plastic cup by suction to your baby's head. Your doctor will then gently pull on the cup as you push. This helps to guide your baby out.

It’s recommended that you have anaesthesia before having an assisted birth, so that you won’t feel any pain. You may be offered a top-up of epidural (anaesthetic injection into your back) or local anaesthetic injection inside your vagina. You may need to have an episiotomy (a cut into your perineum) if you’re having an assisted birth.

Pain relief for childbirth

Everyone copes differently with labour. You may have an idea about the type of pain relief you want. But this may change once labour’s actually happening. Try to keep an open mind, and be prepared to do things differently from how you originally planned.

Self-help

Try moving around during labour to find the most comfortable position for you. To ease your pain, you can try lots of things that don’t involve taking medicines. These include the following.

Breathing and relaxation techniques.
Back massages.
Being in warm water, such as a bath or birthing pool.
Using a transcutaneous electrical nerve stimulation (TENS) machine. You put this on your skin. It sends out mild electrical impulses, which block pain signals going to your brain. There’s no scientific evidence to prove TENS works, but many women decide to give it a go.
Hypnobirthing. This uses visualisation and relaxation techniques, alongside breathing exercises.
Complementary therapies, including acupressure, aromatherapy and reflexology. There’s not much evidence to say how well these work. But you can try them if you want to, if they’re available where you’re giving birth.

Gas and air (Entonox)

This is a mixture of nitrous oxide and oxygen. It's a mild painkiller that takes the edge off your pain. As you feel a contraction start, you slowly breathe in the mixture through a mouthpiece or a mask over your nose. Entonox can make you feel sick and light-headed.

Opioids

Opioids are strong painkillers, such as diamorphine and pethidine. Your doctor will inject these into a muscle. Opioids can cause side-effects, such as feeling sick, dizzy or very sleepy – and these can be passed onto your baby too. Your midwife or doctor will tell you if opioids are an option, depending on your stage of labour.

It’s usually fine to eat and drink as you wish when you’re in labour. But if you’ve had opioid painkillers, you’ll usually be advised not to. Check with your midwife if you’re not sure.

Epidural

An epidural is an injection of anaesthetic into your lower back. It blocks all feeling from your waist down. It eases pain better than opioids. But it can make your second stage of labour longer. It may also make you more likely to need assistance with forceps or ventouse. It can also make moving around more difficult. You can only have an epidural if you’re in hospital, where it can be given by an anaesthetist.

Some hospitals offer mobile epidurals. These use a lower dose of local anaesthetic. Having a mobile epidural means you can walk about during the first stage of labour.

A vaginal delivery is when you give birth to your baby through your vagina. Your baby moves out of your womb, through your cervix, into your pelvis.

Having a natural vaginal delivery is best for you and your baby. But if you or your baby’s health is at risk, or you’re exhausted from a long labour, you may need an assisted vaginal delivery. You can talk to your obstetrician about the need for an assisted delivery to make a decision. See our Assisted Delivery section for more information.

Labour can cause painful contractions. Vaginal delivery itself can also be painful. There are lots of ways to ease the pain, including breathing techniques and painkillers. See our Pain Relief for childbirth section for more information.

Childbirth - vaginal delivery

First stage of labour

Braxton Hicks contractions

When should I go to hospital?

Home birth

Second stage of labour

Preventing tears

Third stage of labour

Induced labour

Speeding up labour

Assisted delivery

Pain relief for childbirth

Self-help

Gas and air (Entonox)

Opioids

Epidural

More on this topic

Did our Childbirth - vaginal delivery information help you?

Childbirth - vaginal delivery

First stage of labour

Braxton Hicks contractions

When should I go to hospital?

Home birth

Second stage of labour

Preventing tears

Third stage of labour

Induced labour

Speeding up labour

Assisted delivery

Pain relief for childbirth

Self-help

Gas and air (Entonox)

Opioids

Epidural

More on this topic

Stages of pregnancy

Epidurals for surgery and pain relief

Other helpful websites

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