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What stages will I go through during labour and childbirth?

The process of labour followed by childbirth can be divided into three stages:

The first stage of labour

This will begin with the onset of contractions and the gradual effacement or thinning out and opening of the cervix (i.e. neck of womb), also known as dilation.

This is followed by active labour. Your cervix will be dilating more rapidly and your contractions will be getting closer together.

The last part of your active labour is called transition, and your cervix will have dilated fully to ten centimetres.

The second stage of labour

Often referred to as the pushing stage, this stage begins once the cervix is fully dilated and ends with the birth of your baby.

The third and final stage

Although your baby’s been born, you still need to wait for the placenta to separate and be delivered. This will complete the third stage of your labour.

How long will the entire process take?

If you are at 37 weeks along, labour and delivery takes an average of 12-15 hours. However, for many women it can take up to 20 hours.

Women who’ve given birth before will find that their subsequent labours are much shorter, and only take around eight hours.

First stage: Early labour

It can be difficult to pinpoint exactly when true labour starts. Once the contractions are coming at regular intervals and your cervix is dilating and effacing (i.e. softening/ripening) you’re in labour.

But because of the ‘fake’ contractions many women experience, officially called Braxton-Hicks, it can be difficult to know whether you’re experiencing a false alarm or the real thing.

If you’re not yet 37 weeks and you’re noticing contractions or other signs of labour (for example backache) call your GP or midwife immediately. You could be in premature labour, but it could well just be Braxton-Hicks. In addition, if your waters break, contact your GP or midwife immediately.

The experience of labour varies widely but it typically starts with contractions coming every ten minutes and lasting 30 seconds each. As you reach the end of early labour they’ll be coming every five minutes and lasting 40 to 60 seconds each.

Will it be painful?

Sometimes early labour contractions are quite painful but you’ll find that you can still be active in the early stages. You’ll be able to talk through them, and walk around if you want to. But do try and conserve your strength at this stage. Turn on the TV, have a bath or even a sleep if you need to. You’ll need all your strength in the later stages.

Will there be any vaginal discharge, and what’s normal?

You’ll probably notice something called a “show”, which is a vaginal discharge tinged with blood.

This is normal, but anything more than just a spot of blood is a good reason to call your GP or midwife. You should also call them if your water breaks, even if you’re no longer having contractions.

Should I go straight to hospital?

You’ll discuss exactly what steps to take when you’re in early labour with your midwife or doctor during your antenatal visits.

As a general rule if you’re at least 37 weeks along, and unless your doctor or midwife tells you something different, you’ll probably spend your early labour at home.

When does early labour finish?

Early labour ends when your cervix is three to four centimetres dilated.

How long will early labour last?

It’s not easy to say how long this phase typically lasts. With a first baby, if your cervix isn’t effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter.

If your cervix is already very ‘ripe’ or if this isn’t your first baby, this period is likely to go much more quickly.

Is there any ‘inside information’ that can help me manage this stage?

You don’t need to start timing all your contractions just yet. You’ll find it too stressful at this stage and it’s not really necessary.

Your body will let you know when your contractions are more serious, and that’s the time to start timing them methodically. It’s important to rest and drink plenty of water. Empty your bladder as much as possible to give your baby room to descend.

First stage: Active labour

At this stage your contractions become much more frequent, longer and stronger. Your cervix begins dilating faster, going from three to four centimetres to 10 centimetres.

In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes. You’ll no longer be able to talk through the contractions as they’ll be too strong.

Should I leave for hospital now?

As a general rule, once you’ve had regular, painful contractions each lasting about 60 seconds regularly every five minutes, it’s time to call your midwife or doctor and head to the hospital.

Toward the end of active labour your baby may begin to descend, though he/she might have started to descend earlier or he might not start until the next stage.

How long will this stage last?

On average it takes about six hours for a woman having her first baby to go from four centimetres to full dilation.

Is there any ‘inside information’ that can help me manage this stage?

Breathing exercises, relaxation techniques, massage and lots of gentle encouragement are great at this time. It’s also a good stage to take a warm bath or shower.

You may also find that it feels good to walk around. When you get to the hospital you should be able to move freely around the room, as long as you have no health complications.

Each time you have a contraction you’ll probably want to stop and lean against something or someone – probably your partner. A rocking chair is great at this time if you can get hold of one. Alternatively, try lying in bed on your side to help you manage the pain.

If the pain is becoming too much speak your doctors about an epidural or other pain relief medication.

First stage: Transition

Transition is the last part of the first stage of labour and it’s when your cervix dilates from eight to a full ten centimetres.

It’s called transition because it marks the time when you’re in transit to the second stage of labour and it’s the most intense part of the experience.

Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more.

You may find yourself shaking and shivering, and as the baby descends into your pelvis, you may feel the urge to move your bowels. Some women bear down spontaneously and push, and may even start grunting. You should expect to see a lot of bloody discharge, and you may even need to be sick.

However, some babies descend before their mother is fully dilated, and some don’t descend until much later meaning that you wouldn’t feel any rectal pressure. It’s different for every woman and every birth.

If you’re labouring with the help of an epidural, you’ll feel varying amounts of pressure. This will depend on the type and amount of medication you’re getting, and how low the baby is in your pelvis.

If you’d like to be able to be more active in the pushing stage ask to have your epidural dose lowered at the end of transition.

How long will this period take?

The length of transition periods vary enormously. Some last for minutes, some a few hours. It’s more likely to be fast if you’ve previously had a vaginal delivery.

Is there any ‘inside information’ that can help me manage this stage?

If you’re going through labour without an epidural, you may begin to lose faith in your ability to cope. Those around you will need to give you lots of extra encouragement to keep on going. You can usually be coached through this transition with constant reminders that you’re doing a great job and that the end is near.

Second stage: Pushing

You’re now in the second stage. Your cervix is fully dilated and you’re ready to push. Your contractions may be a little further apart which will give you the chance for a bit of a rest in-between.

Let your body guide you

If your baby’s very low in your pelvis, you may feel an involuntary urge to push early on but if your baby’s still relatively high, you won’t have this sensation right away.

As your uterus contracts, it will exert pressure on your baby and will move him down the birth canal. If everything’s going well, you could take it easy and let your uterus do the work until you feel a strong urge to push. Waiting may make you less exhausted, and could feel more natural to you.

However, in many hospitals it’s still routine practice to coach women to push with each contraction in an effort to speed up the baby’s descent, so be prepared to let the medical team know that you’d like to wait for the spontaneous feeling to come through.

Women who’ve had an epidural can find it more difficult here, as the loss of sensation makes it harder to feel what’s happening. Your midwife or doctor will help you by giving you clear instructions about when to push.

How quickly will the baby come down?

It’s not easy to predict what may happen at this stage of labour. Some babies descend quickly, others appear more gradually.

The force of your uterus combined with the force of your abdominal muscles if you’re actively pushing exerts pressure on your baby to continue to move down through the birth canal.

The contractions work in a “two steps forward, one step back” kind of progression. The baby’s head will come forward and then back a little when the contraction subsides.

Experiment with different positions for pushing. Stand, squat or kneel if it’s possible, as using the natural affect of gravity will help your labour to really move forward.

What happens when the baby’s scalp becomes visible?

The tissue between your vagina and rectum, known as the perineum, will begin to distend with each push, and the baby’s scalp will become visible. You will now be able to actually reach down and touch your baby’s head, a very exciting moment.

The urge to push will become extremely compelling, and more and more of your baby’s head will appear with each push.

A gentle controlled birth

The pressure on the soft tissue of your vagina is intense at the moment, and a sensation of tearing in the region may be experienced.

To reduce the possibility of a tear you need to take things easy. You may be asked to stop pushing to give your vagina and perineum a chance to stretch gradually. You’ll be asked to pant and blow to control your urge to push from becoming too strong during contractions.

The baby’s head will eventually “crown”. This is when the widest part of the head becomes visible. Once the face is visible, the doctor or midwife will clear the mouth and nose and check if the umbilical cord is around the neck. If the cord is in this position it will either be slipped back over his head or clamped and cut.

Your baby’s head will turn to the side and the shoulders will rotate inside the pelvis ready to come out. With the next contraction, you’ll be asked to push the shoulders out one at a time. The rest of the body will now follow easily. Congratulations – your baby has been born!

What will happen to my baby when he emerges?

Your baby’s most immediate need is to be kept warm so he will be wrapped in a towel and dried off. The doctor will check that he is breathing properly and that there are no complications. Your baby may be suctioned if there’s lots of mucus in the nose and mouth.

Then he will be lifted onto your tummy so you can cuddle him for the first time.

This vital skin-to-skin contact helps to keep him really warm and he will also be covered in a warm blanket. The umbilical cord will be clamped in two places and then cut between the two clamps.

As you hold your baby for the first time you’ll probably feel an incredible range of emotions that will banish all feelings of tiredness. Euphoria, awe, pride, disbelief, excitement and of course relief will flood through you.

How long will the second stage last?

The entire second stage can last anywhere from a few minutes to one to two hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you’ve had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.

Third stage: Delivering the placenta

Within minutes after giving birth, your uterus will contract again. These first few contractions will separate the placenta from the uterine wall.

The doctor or midwife may ask you to gently push to help expel the placenta. Don’t worry, this is normally just one short extra push that’s not difficult or painful.

How long will the third stage last?

On average the final stage should only last about five to ten minutes, though it can last up to 30 minutes or more.

What will happen to my body next?

Breastfeeding begins

Starting nursing early is good for you and your baby. Also, nursing triggers your body to release the hormone oxytocin. This is the same hormone that causes contractions, and it helps your uterus to contract back after delivery.

Your baby may not nurse immediately, but if you hold his lips close to your breast for a little while he may well start.

The uterus contracts

Your uterus should contract and get very firm after you deliver the placenta and you’ll be able to feel the top of it in your tummy, around the level of your navel.

It’s important that it stays firm as otherwise you’ll continue to bleed from the open blood vessels at the site where the placenta was attached. When the uterus firms up it collapses these open blood vessels and helps the healing process.

If you’re not breastfeeding and your uterus isn’t becoming firm, you’ll be given the hormone oxytocin to help it contract.

Contractions may continue

If this is your first baby, you may feel only a few contractions after you’ve delivered the placenta.

If you’ve had a baby before, you may continue to feel occasional contractions for the next day or two, and they’ll feel similar to strong menstrual cramps. You may also find that you get a case of the chills or feel very shaky.

These symptoms are perfectly normal, but do ask for medication to help ease the pain, and a warm blanket to help ease the chills.

Final checks and procedures

Your placenta will be examined to make sure it’s all there and your doctor will check thoroughly for any tears in the perineum that need to be stitched.

If you did tear or had an episiotomy, you’ll be given a local anaesthetic and then sutured. If you had an epidural the catheter will be removed from your back.

Try and insist on some quiet time with your baby now. Unless he needs urgent special care this is a precious time to spend with your newborn.

Here are some more tips to help you through labour in this PDF download »