Stages of labour

Labour is considered to be established once the cervix (opening to the neck of the womb) is at least 4cm dilated and regular painful contractions are experienced. Labour is then divided into three stages:

First stage of labour

Established labour is the period of time during which the cervix dilates from about four cm to 10cm (fully dilated) and you experience regular and painful contractions. You will notice that your contractions have a regular pattern and are closer together, becoming more intense and lasting longer.  During the first stage you will usually be able to walk around and find comfortable positions to help ease your discomfort. Research tells us that women who remain upright often find that labour is quicker and less painful.

Your midwife will monitor your progress during labour by assessing the following:

  • Length, strength, and frequency of your contractions
  • Blood pressure, temperature, and pulse
  • Vaginal examination to check your labour progress
  • Your baby’s wellbeing.

Eating and drinking in labour
It is important to keep your energy levels up. We know that sports drinks (isotonic drinks) are good for labour. During labour, it is best if you can drink plenty of water to keep yourself hydrated and eat light energy foods such as fruit and toast if you feel like it and there are no concerns about you.  

Passing urine
You will be encouraged to try to pass urine regularly to avoid any damage to your bladder. If you have difficulty passing urine then please let us know. If you are unable to pass urine because you have an epidural, you may be asked if you would be happy to have a catheter inserted to help avoid long-term bladder problems.

Transitional phase
The end of the first stage of labour (which is on average 10–12 hours after labour is established) is called the ‘transitional phase’. Women who are close to giving birth may suddenly feel ‘out of control’. This phase does not last for very long and is usually a good indicator that your baby will be born soon. Your birth partner and midwife will be there to reassure and encourage you.

Second stage of labour

This stage begins once the cervix is 10cm dilated and ends with the birth of your baby. Your midwife will need to listen to your baby’s heart rate more often, usually after each contraction or a minimum of every five minutes (if you are not attached to a fetal heart monitor).

Some women will feel an overwhelming urge to bear down as soon as their cervix is fully dilated, while others may have a short rest where the contractions slow down and you have a chance to get your breath back. When you have reached the second stage, you should actively use the pain to push your baby down through the birth canal. This often means that you will not experience the contraction pains in the way that you did during the first stage of labour. Women often feel the contractions as ‘expulsive urges’ like needing to have your bowels open. We encourage you to listen to your body and push or bear down when you have the urge to do so.

As baby’s head is born, you will feel stinging and burning sensations due to the skin stretching. It can feel quite intense, but will only last for a few contractions and goes when the baby is born. There is then a short wait before your next contraction so that your baby can rotate its shoulders to fit neatly through the pelvis, and with the next contraction the baby is usually born.

If your labour and birth is straightforward, your midwife will be present. You may be asked if you mind a student being present at the birth. They would be supervised by a midwife at all times, but if you would rather not allow this, please let your midwife know. If you experience any problems with labour or birth, a doctor will be asked to attend. Your midwife will keep you informed throughout.

Once your baby has been born, providing there is no problem with you or your baby, you will be offered the opportunity for a period of unhurried ‘skin-to-skin’ contact with your baby, ideally for not less than 30 minutes. This will help you to bond with your baby.  It is also helpful for that first important breastfeed and breastfeeding success thereafter. 

Third stage of labour

The third stage of labour is following the birth until the afterbirth has come out. You may not even notice this stage, although you may experience some period-like pains. The placenta either:

  • Delivers naturally (also known as a physiological third stage): which is recommended only if the rest of your labour has had no additional help
  • Active management:  where a small injection is given into your thigh at the time of the birth which reduces your chance of bleeding heavily. Your midwife will discuss the best option for you.

Will I need stitches?

Once the placenta is out, the vagina and perineum (skin between the vagina and anus) will be checked to see if you need any stitches. This can be uncomfortable, but you can use the gas and air. Many women having their first baby will experience some damage to the vagina and perineum. Sometimes this is slight and the skin will heal nicely if left alone. However, if the tear is bleeding or deep, you will be advised to have stitches to help it heal. A local anaesthetic will be given to numb the area before stitching. Your midwife will also advise you how to care for the stitches afterwards.

An expectant mother sitting on a ball