Childbirth is divided into several stages and each one has a specific role to play in the birth process. Understanding what is happening to your body will help to relieve any anxiety and allow you to concentrate on the birth of your baby.
As you move into the first stage of labour, contractions build in intensity, becoming more frequent and regular, and also changing in nature, with pain starting higher up in the abdomen and moving down into the pelvis as the uterine muscles begin to push your baby down.
This is the longest stage of labour, lasting around 6–12 hours, or more in a first labour, although it is often shorter in subsequent labours.
During this stage, contractions cause the cervix to soften further and shorten (a process known as effacement) and then, crucially, to open (or dilate). ‘Active’ labour is the point when your cervix starts to dilate more quickly in response to regular, strong contractions.
The first stage finishes when your cervix is fully dilated, at around 10cm. Once your contractions are coming about every 5 minutes and lasting for 45–60 seconds, it’s time to head to the maternity home or hospital.
Once on the unit, you will be assessed to confirm you’re in active labour. The doctor or nurse will record the frequency of contractions and will palpate the uterus to assess their strength.
She may also do an internal examination to check how far your cervix is dilated. If she is happy you are in established labour, you will be monitored regularly.
The progress of your labour will be recorded on a ‘partogram’ chart, which plots your labour curve – a graph that maps your cervical change against the position of your baby’s head in the pelvis – and also includes your blood pressure, pulse and temperature readings, and your baby’s heart rate.
You may be happy to continue with gentle pain relief techniques, such as breathing, or you may want to supplement these with stronger medical pain relief. It’s a good idea to move around and stay active during this stage as this helps to make contractions more efficient.
Your birth partner can be a great source of support now, motivating and encouraging you, as labour can sometimes feel very long. They can provide physical support, such as giving you a soothing back and shoulder massage, getting you drinks and cooling you down with a cold cloth.
During pregnancy, the cervix forms a long, thick muscular base at the bottom of the uterus, and is sealed with a mucus plug that protects your baby from infections.
Once in labour, the plug is dislodged and the cervix needs to dilate, so that your baby can pass into the vagina to be born.
The cervix starts to soften towards the end of pregnancy in response to hormones called prostaglandins, and in early labour Braxton Hicks’ or 'practice' contractions shorten and thin the cervix (called effacement).
Gradually, as contractions become stronger and more regular, the cervix starts to dilate. In a first labour, the cervix dilates around 0.5cm an hour, and at 3–4cm dilation you are said to be in established labour, at which point dilation may speed up.
By the end of the first stage, the cervix is fully dilated at 10cm, and you can push your baby out.
Transition marks the switch from the end of the first stage into the second ‘pushing’ stage, when your baby is born. Transition starts when the cervix is about 8cm dilated and ends when it is fully dilated.
You may experience pressure in your pelvis and rectum and feel a strong urge to bear down, but you will need to hold off pushing until your doctor signals that the cervix is fully dilated. She may show you how to take short breaths to resist pushing.
For many women, this can be an especially challenging part of labour as contractions intensify – possibly caused by a peak in hormones – coming every two minutes and lasting for up to 90 seconds, and sometimes ‘double peaking’, providing little, or no, respite.
This is the point when many women feel out of control and may shout and swear, or you may feel vulnerable, exhausted and unsure that you can carry on. Some women tremble and shake, and may feel nauseous and even vomit.
Active support from your birth partner and doctor or nurse is essential now to remind you that you are close to the birth and all the hard work will soon pay off.
Some women experience a brief lull before the second stage starts, where contractions tail off, providing an opportunity to rest and have a few sips of fluid.
The second ‘pushing’ stage starts once your cervix is fully dilated, at 10cm, and ends with the birth of your baby.
In a first labour, this stage lasts around 45 minutes to two hours, but may be considerably quicker in subsequent labours. You may feel more in control of labour now as you actively start to push your baby out. On the other hand you may feel tired after a long first stage and need encouragement to push.
Contractions are usually very strong now, although they may be slightly less frequent, coming around every 2 to five minutes. As your baby moves further down in the pelvis you will feel a sense of fullness in your vaginal and bowel, and a strong urge to bear down, as though you need to do a bowel movement. It’s normal to pass a stool now, and your nurse or hospital maid will discreetly clear this away.
You may push instinctively, but if you’re not sure your doctor will guide you. With each contraction, you should focus on bearing down deep into your pelvis and bottom, perhaps taking several steady breaths (it’s important not to hold your breath at this point), or grunting or making a noise if that feels most natural.
Each time you bear down your baby will move a bit further down into the pelvis then may slip back up slightly at the end of a contraction. In this manner she will gradually make her way down the birth canal until eventually her head ‘crowns’, becoming visible at the opening of the vagina.
At first, the head may slip back out of sight after a contraction, but eventually it remains visible. At this point, you may feel a stinging sensation in your vagina as the head stretches the vaginal opening.
Your doctor will tell you to take short, panting breaths to stop you bearing down so that the perineum has time to stretch and the baby’s head can be delivered slowly and gently to try to avoid a tear or the need for a cut to the vaginal opening (episiotomy).
Once the head has been born the doctor will check that the cord isn’t around the neck. With the next couple of contractions, your baby will turn so that first one shoulder can be delivered, and then the next.
When both shoulders have emerged the rest of the body is delivered swiftly, often just slipping out, together with the remaining amniotic fluid.
As soon as your baby is born and before the cord is cut, she can be placed on your chest so that you can say hello and enjoy precious skin-to-skin contact. This close contact has numerous benefits for both baby and mum and later for dad too.
Being held close, skin to skin helps us regulate your baby’s temperature, promote breastfeeding as your baby instinctively turns her head to ‘root’ for your nipple, stabilise your baby’s blood sugar levels and reduce crying.
Mum’s physical and mental wellbeing is thought to benefit from holding her baby skin to skin, giving her a chance to welcome her baby and gaze at her features – often the start of bonding.
Soon after this, your baby will be given some newborn checks to assess her breathing, responses, movement, pulse and appearance. She will be given a score out of 10, known as the Apgar score, and if this is on the low side she can receive some extra medical attention to ensure that all is well.
After the birth the umbilical cord will be left to pulsate for a few minutes before it’s cut. Studies show that allowing the blood to pulsate from the placenta to the baby for a little longer, increases the baby’s blood volume at birth, ensuring a higher concentration of haemoglobin and increased iron reserves for the first six months.
Before cutting the cord, the doctor will clamp it in two places, and then the cord will be cut with scissors between the clamps. Your partner may be asked if they wish to cut the cord.
The final stage of labour starts after the birth and ends with the delivery of the placenta and the membranes. The placenta can be delivered naturally, or speeded up with drugs; this is known as a ‘managed’ third stage.
You may routinely be offered an injection of the drug syntocinon (synthetic oxytocin), given around the time of delivery, which stimulates contractions after the birth so that the placenta comes away from the wall of the uterus without you having to push.
This takes from 5 to 30 minutes, and can reduce the risk of excessive bleeding and anaemia.
If your labour was straightforward you may prefer to deliver the placenta naturally, known as a physiological third stage, which can take 20 minutes to an hour.
A few minutes after the birth, mild contractions will start up again as the placenta peels away from the wall of the uterus, and the uterus contracts down.
Breastfeeding your baby now can help as the sucking triggers the release of your body’s natural oxytocin, which in turn encourages contractions.
Your doctor may also suggest that you adopt an upright position, such as squatting, to help the placenta move down. If this takes longer than an hour, your doctor may recommend an injection to speed things up.
Your doctor will watch for a lengthening of the cord to signal that the placenta has detached and will then gently pull on the cord while pressing down on your abdomen to draw the placenta out.
She will examine the placenta thoroughly to ensure it is complete and that none is retained in the uterus, which carries a risk of heavy bleeding (postpartum haemorrhage).
If you had any tearing or an episiotomy during the birth, you will have some stitches now under a local anaesthetic. Your baby may be offered a vitamin K injection soon after delivery.
Some women have a physical reaction after birth, shaking uncontrollably, or feeling nauseous and sick. Whatever you’re feeling, you are likely to go through a whole range of emotions as you gaze at your amazing new baby, euphoric one moment, then perhaps tearful and overcome with exhaustion.
Once the medical staff are happy that all is well with you and your baby you will be left alone to recover and enjoy some precious time alone to get acquainted with each other and absorb the incredible newness of it all.