What to expect

First stage

Active labour is often said to begin when contractions are strong, regular and lasting at least 60 seconds, and your cervix is open to at least four centimetres.

During the first stage of labour your contractions will continue to come regularly, and become progressively stronger. This stage of labour can last around six to 12 hours if it’s your first baby, and is often quicker if it’s your second or third baby.

When you arrive at your maternity unit (or your midwife comes to your home) and throughout the first stage of labour your midwife will offer regular assessments of your progress and wellbeing, and the wellbeing of your baby, including:

• your observations (blood pressure, pulse and temperature)
• abdominal palpation • listening to your baby’s heartbeat
• vaginal examination to assess the progress of labour and position of your baby.

Your midwife will support you with different positions and coping strategies, including pain relief if needed. If your midwife is concerned about you or your baby at any point, she will ask a senior midwife or obstetrician for a second opinion. This can sometimes mean transferring to the labour ward if you are at home or in a midwifery-led unit.

Towards the end of the first stage you may experience something known as ‘transition’ which can makes some women feel scared or out of control.

This is common and is soon followed by an urge to push as the cervix reaches 10 centimetres dilated, and the baby moves down into the birth canal. Your midwife will support you closely during this stage.


Second stage

This stage of labour starts when your cervix is ten centimetres dilated and your baby’s head is moving into the birth canal. This is normally accompanied by a pressure in your bottom, followed by an urge to push which can feel difficult to control and similar to the sensation of needing to open your bowels.

Some women may not get an urge to push, particularly if they have an epidural. If this is the case, your midwife will help guide you by feeling for a contraction on your abdomen and letting you know when to push.

Your midwife will check your baby’s heartbeat regularly and support you to try different positions. When your baby’s head is nearly born, your midwife will encourage you to gently breathe and avoid pushing if possible. This ensures your baby’s head stretches your perineum slowly and can help reduce tearing.

The second stage of labour ends with the birth of your baby. This stage of labour can last up to four hours if it’s your first baby, and is usually much quicker if it’s your second or third baby

Third stage

This stage is the time between the birth of your baby and the expulsion of your placenta.

After your baby is born, he/she will still be attached to the umbilical cord, which is attached to the placenta inside the womb. The cord should be left intact and not cut immediately, unless there is a problem with your baby’s breathing, or you are bleeding heavily.

There are two options for the delivery of your placenta. The first option is known as physiological third stage, and the other is active third stage.

Physiological third stage

This option may be suitable if you are planning a natural birth. If you require an assisted birth, or if your midwife is worried you may be at a higher risk of bleeding after birth, this may not be recommended for you. Some research has found that bleeding after birth can be slightly increased if the placenta is expelled naturally, however if you are fit and healthy with good iron levels pre-birth, this is unlikely to cause any problems for you.

After your baby is born, he/she will remain attached to the placenta via the umbilical cord, which provides oxygen and blood supply whilst yourbaby also starts to breathe. After 10-15 minutes this blood supply will naturally stop as the placenta separates from the womb. At this point the cord can be secured and cut. Soon after you will feel some mild contractions in the womb and perhaps an urge to push. You may find adopting upright positions helps, and your placenta will slide out easily. This is normally painless as the placenta is soft.

Active third stage

If you opt for an active third stage, or if your midwife recommends it after the birth of your baby, your midwife will give you an injection of a medication that causes the womb to contract. This injection normally takes a few minutes to work, and at this point the baby’s cord will be secured and cut. Your midwife/doctor will then place gentle pressure on your lower abdomen and carefully pull on the umbilical cord, causing the placenta to deliver. This process normally takes between 10-20 minutes.