What Happens During Labour and Birth
There are three stages to labour:
The first stage, when your contractions make your cervix gradually open up (dilate). This is usually the longest stage
The second stage of labour is when your cervix is fully open and you give birth. This is the part of labour where you help your baby move through your vagina by pushing with your contractions.
The third stage of labour is after the birth, when your womb contracts and causes the placenta to come out through the vagina.
The first stage of labour – dilation
The cervix needs to open about 10cm for a baby to pass through. This is what's called being "fully dilated". Contractions at the start of labour help to soften the cervix, so that it gradually opens.
The process of softening can take many hours before you’re in what midwives call "established labour". Established labour is when your cervix has dilated to more than 3cm. If you go into hospital or your midwifery unit before labour is established, you may be asked if you’d prefer to go home for a while, rather than spending extra hours in hospital or the midwifery unit. If you go home, you should make sure you eat and drink, as you’ll need the energy.
At night, attempt to get comfortable and relaxed. If you can, try to sleep. A warm bath or shower may help you relax. During the day, keep upright and gently active. This helps the baby move down into the pelvis and helps the cervix to dilate.
Once labour is established, the midwife will check on you from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker in subsequent pregnancies.
Your midwife will tell you to try not to push until your cervix is fully open and the baby’s head can be seen.
To help you overcome the urge to push, try breathing out slowly and gently or, if the urge is too strong, in small puffs. Some people find this easier lying on their side, or on their knees and elbows, to reduce the pressure of the baby’s head on the cervix.
Foetal monitoring in labour
Your baby’s heart rate will be monitored throughout labour. Your midwife will watch for any marked change in the rate, which could be a sign the baby is distressed and something needs to be done. There are different ways of monitoring the baby’s heartbeat:
Your midwife may listen to your baby’s heart intermittently, at least one minute every 15 minutes when you are in established labour, using a handheld ultrasound monitor. This method means you are free to move around.
Your baby’s heartbeat and your contractions may also be followed electronically through a monitor linked to a machine called a CTG (cardiotocograph). The monitor will be strapped to your abdomen (tummy) on a belt. You can get up and move around with a CTG. How far you can move will depend on the type of machine.
If the midwife cannot get a good trace of your baby's heart rate through your abdomen, they may recommend putting a clip on the baby’s head to record the heart rate. The clip is put on during a vaginal examination and your waters will be broken if they have not already done so. Ask your midwife or doctor to explain why they feel the clip is necessary for your baby.
If you don’t feel comfortable with any of these methods, tell your midwife.
Speeding up labour
Your labour may be slower than expected if your contractions are not frequent or strong enough or because your baby is in an awkward position. If this is the case, your doctor or midwife will explain why they think labour should be sped up and may recommend the following techniques to get things moving:
Breaking your waters using a procedure called ARM (artificial rupture of membranes) is often enough to get things moving. During an internal examination, the midwife or doctor makes a small break in the membranes around your baby using either a long thin probe or a finger.
If this doesn't work, you may be given a drip containing a drug (syntocinon), which is fed into a vein in your arm to encourage contractions – you may want some pain relief before the drip is started.
After the drip is attached, your contractions and your baby’s heartbeat should be continuously monitored with a CTG.
The second stage of labour
This is the "pushing" stage. It begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and guide you when you feel the urge to push.
Finding a position to give birth in:
Find the position you prefer and that will make labour easier. You may want to remain in bed with your back propped up by pillows.
Alternatively, you can stand, sit, kneel or squat (although squatting may be difficult if you are not used to it).
If you are very tired, you may be more comfortable lying on your side. If you've had backache while in labour, kneeling on all fours may be the easiest position. It can help if you have tried out some of these positions beforehand.
Pushing the baby out
When your cervix is fully dilated you can push when you feel you need to during contractions:
Take two deep breaths as the contraction starts and push down
Take another breath when you need to
Give several pushes until the contraction ends
After each contraction, rest and get your strength up for the next one
This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you. This stage may take at least an hour, so it helps to know how you’re doing. Find out more about what your birth partner can do.
What happens at the actual birth?
During the second stage, the baby’s head moves down the vagina until it can be seen. When the head is almost ready to come out, the midwife will ask you to stop pushing and to do a couple of quick short breaths, blowing out through your mouth. This is so your baby’s head can be born slowly and gently, giving the skin and muscles of the perineum (the area between your vagina and anus) time to stretch without tearing.
The skin of the perineum usually stretches well, but it may tear. Sometimes, to avoid a tear or to speed up delivery, the midwife or doctor will inject a local anaesthetic and cut an episiotomy. Afterwards, the cut or tear is stitched up to help the healing process. Find out about your body after the birth, including how to deal with stitches.
Once your baby’s head is born, most of the hard work is over. With one more gentle push, the body is born quite quickly and easily. You can have your baby lifted straight onto you before the cord is cut by your midwife or birth partner.
Your baby may be born covered with a white, greasy substance known as vernix, which has acted as protection in the uterus.
The third stage of labour – the placenta:
After your baby is born, more contractions will push out the placenta. Your midwife will offer you an injection in your thigh just as the baby is born, which will speed up the delivery of the placenta. The injection contains a drug called syntocinon, which makes the womb contract and helps to prevent heavy bleeding (postpartum haemorrhage).
If you plan to breast feed, let your baby breastfeed as soon after birth as possible. This helps with breastfeeding later on and it also helps your womb contract. Babies start sucking immediately. However, this sometimes occurs just for a short period of time – they may just like to feel the nipple in their mouth.