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Key takeaways

• Labour has three main stages, from early contractions to delivering the placenta.
• The first stage of labour is the longest, with your cervix opening up.
• The second stage involves pushing and the birth of your baby.
• Skin-to-skin contact after birth helps with bonding and your baby's well-being.

An overview of labour and birth

Labour is the process your body goes through to give birth. If you are having a vaginal birth, your labour will have three stages. Knowing about these stages can help you feel calmer.

Signs that labour might be starting include contractions or tightenings. You may also notice a 'show', which is when the plug of mucus from your cervix comes away. Backache or an urge to go to the toilet can also be signs. Your waters breaking is another sign that labour has begun.

The first stage of labour: from early contractions to transition

The first stage of labour is usually the longest. It is split into two main parts: the latent stage and established or active labour. Your cervix – the opening to your womb – softens, thins, and begins to open (dilate) during this stage. It needs to open to about 10cm for your baby to be born.

The latent phase of labour

You might not even realise the latent stage has started. Your cervix begins to soften and open. You will start to have contractions, but they may not be regular. They might be regular for a while, then slow down or stop.

During a contraction, the muscles in your womb tighten then relax. Some people compare them to intense period pains. You may also get backache. You can take paracetamol if it helps.

This stage can take hours or even days. It tends to be longer if this is your first pregnancy. Try to stay calm and comfortable. Eating and drinking will give you energy for when contractions become more intense.

Managing the latent phase

If labour starts during the day, stay upright and gently active by walking. Try not to tire yourself out. If labour starts at night, try to get some sleep. Breathing exercises, massage, and a warm bath or shower may help ease pain.

You can contact your midwife at this point. If you are over 37 weeks pregnant with an uncomplicated pregnancy, they may advise you to stay home. Staying home can lead to fewer interventions for some people. Discuss what is best for you with your midwife.

Established labour

Established labour begins when your cervix has opened to at least 4cm. Your contractions will become stronger and more regular. Your midwife will check on you often at the maternity unit or during a home birth. They will monitor your progress and ask how you are feeling.

To make sure you and your baby are doing well, your midwife will check on you regularly. This includes listening to your baby's heartbeat about every 15 minutes and checking on your contractions every half an hour. They will also keep an eye on your pulse, temperature, and blood pressure every few hours.

Your midwife will also check how often you empty your bladder. They will offer vaginal examinations at least every four hours to see how dilated you are. If your labour is progressing well, you should not need extra monitoring.

For a first baby, the established phase usually lasts around 8 hours. It rarely lasts longer than 18 hours. If you have had a baby before this phase may be shorter.

Transition

Towards the end of the first stage, your cervix becomes fully dilated. Your contractions will likely get stronger and more intense. This is known as transition. It feels different for everyone.

You may feel a strong urge to push. Alternatively, you might feel a lull and a chance to rest. This stage can be overwhelming. You might need support from your midwife and birth partner to get through it.

Transition is both a mental and physical experience. You may feel impatient, tired, or irritable. You might also feel angry or frustrated. These are natural reactions and mean your baby's birth is close. Your midwife will guide you through contractions and help you find the best position. It is okay to tell people how you are feeling.

The second stage of labour: pushing and meeting your baby

The second stage of labour starts when your cervix is fully open. It ends once your baby is born. Your womb muscles will be tightening and loosening. You will focus your energy on pushing your baby down and out.

If you do not feel an urge to push straight away, this is called the passive second stage. Once you have the urge to push, you are in the active second stage. Many people describe the urge to push as pressure in their bottom. It can feel like really needing to go to the toilet.

You will likely feel three to five strong urges with each contraction. You usually get a break between contractions to rest a little. Pushing can be hard work. Your midwife and birth partner will offer support.

Pushing techniques and monitoring

Your midwife will closely monitor you and your baby during this stage. They can help you find a comfortable position. You may want to:

• sit
• lie on your side
• stand
• kneel
• squatting or kneeling on all fours may help if you have backache.

You can push during contractions whenever you feel the urge. If you have had an epidural, you may not feel an urge to push at all. Tell your midwife if you prefer to follow your instincts and push when it feels right. If not, they can guide you through each push.

For a first baby, this pushing stage should last no longer than three hours. If you have had a baby before, it should take no more than two hours.

As your baby's head stretches the birth canal, you may feel a strong burning sensation. This usually lasts a few minutes. You will also feel the area between your vagina and anus (your perineum) stretch. If there is a chance of a tear, you might be asked to pant or push more gently. This helps your baby be born slowly.

When your baby's head can be seen completely at your vulva, this is called crowning. Once your baby's head is out, the hardest work is usually over. When your baby’s head is born, your midwife will check for the umbilical cord around their neck. The rest of their body will usually come out quickly. Throughout this stage your midwife will guide you and can give you clear instructions on when to push or pant.

The third stage and immediate postpartum care

The third stage of labour happens after your baby is born. Your womb contracts, and the placenta comes out through your vagina. The placenta is the organ that supplied nutrients to your baby through the umbilical cord. This stage also delivers the membranes that are attached to the placenta, that held your baby and amniotic fluid.

Delivering the placenta

There are two ways to manage this stage:

• Active management – You have treatment to make it happen faster.
• Physiological management – You have no treatment, and this stage happens naturally.

Your midwife will explain both options to you during pregnancy or early labour. You can then decide which you prefer. In most hospital units, active management is common. This is because it is known to reduce the risk of significant blood loss.

Active management involves an injection of a hormone called oxytocin into your thigh. This is often given as your baby is being born. Oxytocin helps your womb to contract. This speeds up the delivery of the placenta, which usually happens within 30 minutes. Some people may feel sick or be sick after the injection. Anti-sickness medication can be given.

As the injection works, your womb contracts in size. This helps the placenta to come away. You may be able to push the placenta out. Your midwife may also help by putting a hand on your tummy and keeping the cord pulled tight (a technique called cord traction). The placenta will come away, and the blood vessels will close off. This helps prevent too much bleeding, though some bleeding is normal.

Physiological management means you deliver the placenta without the oxytocin injection. This usually takes longer than active management. Your body releases oxytocin naturally when you breastfeed your baby or have skin-to-skin contact. As with the injection, this helps your womb tighten and push out the placenta and membranes.

Complications during placenta delivery

A possible complication of the third stage is heavy bleeding after birth (primary postpartum haemorrhage, or PPH). Losing some blood is normal, but PPH is excessive bleeding. In rare cases, the placenta doesn't come away on its own. If this happens, you will need some help from a doctor to have it removed. This is done with an anaesthetic so you are comfortable, and your midwife will explain everything to you.

The golden hour

After your baby is born, you will usually be able to hold them immediately. Skin-to-skin contact is highly encouraged as soon as possible. This means holding your naked baby (or baby in just a nappy) against your bare chest.

Skin-to-skin contact offers several benefits:

• It helps with bonding.
• Your baby can hear your heartbeat and voice, which calms them.
• It also helps to keep your baby's temperature, breathing, and heart rate steady.
• This contact can boost your milk supply and stimulate your baby's feeding instincts.
• It releases oxytocin (your body's feel-good chemical) and helps build your baby's immunity.

UNICEF recommends skin-to-skin contact after birth. This should last at least until after the first feed, and for as long as you wish. You should be encouraged to offer the first feed in skin contact. This should happen when your baby shows signs of readiness to feed. If, for whatever reason, immediate skin contact is not possible, start it as soon as you can.

You can breastfeed your baby as soon as you like. Ideally, your baby will have their first feed within one hour of birth. If you cannot hold your baby skin-to-skin, you can hold their hand or gently touch them. Any touch from a parent can comfort them and help you bond.

Newborn care and observations

Making eye contact with your baby also helps with bonding. Newborn babies can see, but their vision is blurred. They cannot see colours very well. They can best focus on things close to them, like your face.

After delivery, your midwife or maternity support worker will help you wash and freshen up. Small tears and grazes often heal without stitches. If you have a larger tear, you will need stitches. The same applies if a surgical cut (an episiotomy) was made to the area between your vagina and anus to help your baby be born. You should be able to cuddle your baby while this is done.

You will be offered an injection of vitamin K for your baby. This helps prevent a rare bleeding disorder. Your baby can have vitamin K by mouth instead if you prefer, but this requires further doses.