What are the stages of labour?
Labour is the process from when you start having labour pains to the delivery of the placenta. There are three stages of labour.
In the first stage of labour, your cervix (the neck of your womb) gradually opens and thins (dilates). Your waters (the bag of fluid that surrounds your baby, also called amniotic fluid) will usually break in this first stage. Sometimes, a midwife or doctor breaks them for you.
Your cervix is fully dilated at 10cm. You’ll feel the muscles in your womb tensing and relaxing to stretch your cervix. This is called having contractions. The contractions will be irregular at first (latent phase) and then will become more regular (active phase). How long this takes varies. The latent phase can be several hours. The active phase can be:
- up to 18 hours for your first baby
- between 5 to 12 hours if you’ve had a vaginal birth before
You won’t usually need to go to the hospital until the active phase. But, you’re advised to go to the hospital earlier if your waters have already broken, to check on you and your baby’s condition.
In the second stage of labour, your cervix is fully dilated and you give birth to your baby. This will usually last a couple of hours, but if you’ve given birth vaginally before it may be quicker.
You’ll have strong regular contractions that last longer. 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.
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’.
When you give birth, you may tear the skin or muscles around your vagina or anus. Your midwife or doctor can take measures so this is less likely to happen.
The third stage of labour is when you deliver the placenta. You can choose for this to happen naturally, where you push the placenta out yourself. Or you can have assistance.
You can talk to your midwife about your options for delivery of the placenta.
Can I induce or speed up labour?
Your midwife or doctor may recommend your labour is started artificially if:
- 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.
You can also speed up labour if it’s 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. You’ll be offered an epidural (anaesthetic injection into your back) for pain relief beforehand.
What is an assisted delivery?
Sometimes your doctor may need to use special instruments to help you deliver your baby. This is known as an assisted delivery. Some of the reasons for assisted delivery are below.
- 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.
- You’ve been pushing for a long time and are exhausted.
- You have a health condition that means a longer labour may be dangerous for you.
There’s 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, or a 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.
Is vaginal birth painful?
Labour and vaginal delivery can be painful. There are lots of ways to ease the pain, including breathing techniques. There are also painkillers below that can be used for pain relief.
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 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. Your midwife or doctor will tell you if you can have opioids. If you’ve had opioid painkillers, you’ll usually be advised not to eat. Check with your midwife if you’re unsure.
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. You may also be more likely to need assistance with forceps or ventouse. Moving around may be more difficult. You can only have an epidural if you’re in hospital. Some hospitals offer mobile epidurals with a lower dose of local anaesthetic. Having a mobile epidural means you can walk about during the first stage of labour.
Can I have a 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 giving birth in hospital may be better 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 still need to go to hospital during your labour if there are any problems.