Stages of Labour

Labour is divided into three stages - the dilation of the cervix, the delivery of the baby, and the delivery of the placenta. For first-time mothers, labour takes around 12 to 24 hours. Women who have undergone childbirth before can expect about seven hours of labour.  (Remember these are averages only and every women is different)

Recognising the start of labour
Braxton-Hicks contractions are sometimes mistaken for labour. These ‘false’ contractions usually start halfway through the pregnancy and continue for the duration. You may find these contractions visibly harden and lift your pregnant belly. It is not known what triggers the onset of labour, but it is thought to be influenced by the hormone oxytocin, which is responsible for causing uterine contractions. Some of the signs and symptoms of going into labour may include:

• Period-like cramps
• Backache
• Diarrhoea
• A small bloodstained discharge as your cervix thins and the mucus plug drops out
• A gush or trickle of water as the membranes break
• Contractions.

The first stage of labour
The first stage of labour is concerned with the thinning of the cervix and its dilation to around 10cm. The different phases include:

• The latent phase - generally, this stage is the longest and the least painful part of labour. The cervix can thin out over weeks, days or hours and be accompanied by mild contractions. The contractions may be regularly or irregularly spaced, or else you might not even notice them at all.
• The active phase - the next phase is marked by strong, painful contractions that tend to occur around three or four minutes apart and last up to a minute or so. The cervix dilates to around 7cm.
• The transition phase - the contractions become more intense, painful and frequent. It may feel like the contractions are no longer separate but running into each other. The cervix may take around an hour or so to dilate the final 3cm. It is not unusual to feel a strong urge to go to the toilet as the baby’s head pushes against the rectum.

The second stage of labour
Once the cervix is dilated to around 10cm, the second stage of labour can begin. The contractions should now be regular and spaced apart, so that you can relax between them (as best as you can). As each contraction builds to a peak, you may feel the urge to bear down and push. The sensation of the baby moving through the vagina is described as a stretching or burning, particularly as the baby’s head crowns (appears at the vaginal entrance). Once the head has emerged, the delivery staff will turn the body to deliver the shoulders. The rest of the baby will then slip out. The second stage of labour typically lasts around 15 minutes to one hour.

The third stage of labour
The placenta is then delivered, usually five to 30 minutes later. Your uterus gently contracts to loosen and push out the placenta, although you may not be able to feel these contractions.

Suggestions for the early stages of labour
Call your hospital, doctor or midwife and let them know that you think you are in labour. They will ask you to describe what you are experinceing and will be able to guide you what to do next.  First time labour can be slow to progress so after listening to your symptoms your healthcare provider might suggest you rest at home for a while until the contractions become more intense and closer together.

• Once the contractions are around seven to 10 minutes apart, you might like to start timing them. You do this by noting how many minutes elapse between the start of one contraction and the start of the next.
• Once your contractions are five minutes apart, or if you no longer feel comfortable being at home, go to the hospital.
• If your waters break or if you start bleeding from the vagina, go immediately to hospital.

Once in hospital
 Resist any urge to push until your cervix is fully dilated.

• The pressure of your baby’s head helps to widen your cervix, so use gravity and walk around, stand or sit upright. Be guided by your doctor or midwife, they will let you know when to start pushing
• Don’t feel embarrassed or inhibited by your appearance or behaviour - the medical team have seen it all before and many of the midwives have been there themselves. You may feel the need to grunt or scream - go ahead. Passing a bowel motion during labour is also normal and nothing to be concerned about.

Where to get help

• Your doctor
• Obstetrician
• Midwife
• Your hospital

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