Stages of labour
Labour is often talked about in stages and it is helpful as a guide to what to expect. Not everyone's labour will neatly fit the textbooks, however, and sometimes babies take everyone by surprise.
First stage
Early labour is also known as the 'latent phase'. During early labour, your cervix (neck of the womb) shortens and flattens, and as it thins out it will begin to open. Your cervix is inside your body, at the back of your vagina.
Active labour, also called established labour, describes the phase where your cervix is opening, is 4cm wide or more, and your contractions are long, strong and regular. During active labour, your midwife will want to care for you and your baby with regular checks and monitoring. If you choose an epidural for pain relief in labour, the procedure is carried out once you are in active labour.
The neck of the womb will open further during this stage until it is fully open (the space needed for the baby's head is around 10cm across). This opening is called dilation or dilatation, and when the cervix is wide enough for the baby to leave the womb, it is 'fully dilated'.
Transition
Transition is where the baby's head passes through the 10cm opening in the cervix, and into the vagina. The baby's head is pressed up against the inside of the cervix all through the first stage, but now the contractions are pushing the baby through the gap, and the bottom of the womb is being stretched out of the way (think of pulling on a roll-neck sweater!) At the end of this transition phase, the baby's body is still in the womb, while the head is outside of the womb, inside the vagina.
Contractions may be very intense during transition, and then ease off for a short 'rest' before the next stage.
Second stage
As your cervix has been opening, your contractions have also been pushing the baby down into your pelvis and your baby's head is usually quite low in the pelvis at this stage.
Some women will experience an overwhelming urge to push. For some women pushing is very deliberate, while others experience their bodies doing the pushing. If you've had an epidural, you may need to be guided by your midwife when to push.
It is important to find a comfortable position for the pushing part of the second stage, as this will help you to get the most out of your contractions and pushes. Your midwife can make suggestions to help you find a comfortable position to give birth.
The pelvic floor muscles between your vagina and bottom need to flatten and spread out for your baby to move past. This process takes time and your baby will move down during contractions and then back up again during the rest phase. This can be disheartening if it's not expected, but it is part of the normal pattern of labour, allowing your baby and you to rest between contractions.
Eventually, the baby's head gets very near to being born and can be seen just behind the vaginal opening. This is called 'crowning' and some women feel a stinging or burning sensation. This is the last part of labour just before the arrival of your baby.
Third stage
The third stage is after the birth of your baby when your womb contracts and the placenta 'comes' away from the womb. This can happen naturally, which usually takes within 30 minutes of your baby being born. This is a safe choice following a birth without intervention. It is often called the 'physiological' third stage.
As the placenta is birthed, some blood loss is normal. Once the placenta is out, the womb can contract firmly which prevents too much blood loss.
There is always the option of an injection to 'actively manage' the birth of the placenta. This can make the third stage quicker and can help with the contraction of the womb. Depending on the way the birth has gone, you may be advised to have the injection to protect you against heavy blood loss.
You can discuss these options with the midwife while you are still pregnant, and you may be asked about your preferences in early labour. You can see how things go and you can also change your mind.
It is normal for there to be some bleeding during the third stage of labour. Your midwife will be checking to make sure this stays within safe limits.
What is a placenta?
Your placenta is the life-support system for your baby in the womb. From 12 weeks, your baby's heart pumps blood through the cord to the placenta to collect oxygen, food, water and protective antibodies. At birth, the placenta typically weighs about a third of what your baby weights.
You and your birth partner can ask to see this amazing organ after your third stage, but this is definitely optional.
The midwife will carefully check to make sure it has all come away from your womb, as it can cause a problem if any is left inside you.
Find out more about retained placenta on Tommy's website.
With your consent, your midwife will carry out an examination after your baby is born and the placenta is delivered to check whether you need stitches.
Delayed cord clamping
It is now normal practice to delay clamping the umbilical cord for at least a minute to allow the blood to flow through to your baby, so long as they have a normal heart rate and do not need any breathing support. This increases your baby's blood volume, iron and stem cell levels.
The cord will be purple at first and turn white or cream as the blood moves through.
Read more about delayed cord clamping on Tommy's website.
