Labour and birth

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.

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

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 your baby 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.

During pregnancy, a plug of thick mucus forms in the cervix, and as the body prepares for labour this plug may pass out through the vagina. This can happen one to two weeks before labour, during labour or sometimes not at all. It appears as a clear or pink/slightly blood stained jelly-like substance, and you might notice it once or on a few occasions. You don’t need to call your midwife about this unless you are worried, however if you notice that it is heavily blood stained or that you are losing fresh blood, call your maternity triage/assessment unit straight away.

When early labour (sometimes known as the latent phase) starts, you may experience irregular contractions that vary in duration and strength. This can sometimes last for a few days, and it is important to rest when you can until they become regular. When your contractions become strong and regular, it may be helpful to start timing them (approximately how often they are coming and how long they last for).

If it is your first baby, you will normally be advised to come to the maternity unit when your contractions are every three minutes and lasting for 60 seconds. If it is your second or subsequent baby, you may be advised to come to the maternity unit when your contractions are every five minutes and lasting for 45 seconds.

You can call your maternity unit for support at any time, and a midwife will advise you on when to come to the maternity unit. If you’re planning a homebirth, your midwife will come and visit you at home at the appropriate time. Many women find trying different positions, walking, a warm bath, distraction and relaxation techniques, massage and resting in between contractions useful when at home. It is important to have regular light snacks (even if you don’t feel hungry) and to sleep when possible. It is also important to drink, taking regular small sips of fluids in order to remain hydrated. You don’t need to drink more than you would normally.

The amniotic sac is the fluid filled bag that your baby grows inside during pregnancy, and this sac may break before your baby is born. When it breaks, the fluid will drain out from the vagina.

Most women’s waters break during labour, but it can happen before labour starts. If your waters break, you may feel a slow trickle or a sudden gush of fluid. This fluid is normally clear or pink in colour, however sometimes a baby can pass their first poo (called meconium) inside the sac, causing the fluid to become green or yellow.

If you think your waters have broken it is important to call your maternity triage/assessment unit straight away, particularly if you think you can see meconium. If you think your water’s have broken, wear a thick sanitary pad as your midwife will ask to see this when you attend your maternity unit for a check-up. You can also take a photo of the initial loss of fluid as this can help with the assessment.

Make sure you take plenty of pads and a change of clothes with you on your journey into the maternity unit as once your waters have broken, you will continue to leak amniotic fluid. If your waters do break before labour, it is likely that your labour will start naturally within 24 hours, however if it doesn’t start it may be recommended that your labour is induced (started with the aid of medications) to reduce the risk of infection for both you and your baby. Your maternity team will discuss this with you and agree a plan if this is the case.

• your waters break
• you have any fresh red vaginal bleeding
• your baby isn’t moving as often as usual
• you have strong and regular contractions
• you have constant abdominal pain
• you feel unwell or you are worried.

Our maternity helpline is open 24 hours a day, 365 days a year and can be reached at

• 01284 713755

If you have had a healthy pregnancy without complication and haven’t gone into labour by 41 weeks you will have a routine appointment with your midwife to discuss the next steps.

You will be offered a membrane sweep at this appointment, which is an internal examination of the cervix. During this examination your midwife will insert the tip of her finger into your cervix and sweep around the bag of membranes that cover your baby’s head. This has been shown to release hormones that may encourage labour to start within 24 hours. Sometimes the cervix isn’t yet open, and a sweep isn’t possible. You may be invited to return for several sweeps. At this appointment your midwife will also offer you a date to have your labour induced. This is normally recommended by 41 weeks and three, four or five days (depending on your maternity units guidelines and availability). Some maternity units are able to offer complementary therapy to encourage labour to start naturally. Ask your midwife about this.

These interventions will always be discussed with you, to ensure you fully understand the risks and benefits, and your consent will be gained prior to anything happening. For those women declining an induction of labour a plan can be put into place with support from the obstetric team.

How is labour induced?

Your midwife or obstetrician will have a full discussion with you in the antenatal period routinely at your 36 or 40 week appointment regarding induction of labour and the benefits and risks of this, enabling you to make a fully informed decision. Methods used to induce labour vary depending on a range of factors. Your doctor and midwife will discuss the different methods with you and advise a method based on your personal circumstance.
When you come into the maternity unit for your induction, a midwife will undertake a full assessment of you and your baby and this will include electronic fetal monitoring (CTG) of your baby’s heartbeat and to see if you are having any contractions. Then the midwife or doctor will assess your cervix by undertaking a vaginal examination. Following this examination options for induction will be discussed with you.

Skin-to-skin contact after your baby is born, so long as he/she is well, you will be encouraged to have immediate skin-to-skin contact. This type of contact is known to be beneficial to both mother and baby by: • regulating your baby’s breathing, heart rate, temperature and blood glucose levels • soothing and calming your baby • encouraging early breastfeeding and increased milk production • supporting longer term breastfeeding success. Even if your baby needs help with breathing after birth, or to be seen by a neonatal doctor, you will be offered skin-to-skin contact as soon as practically possible.

After your placenta has been delivered, your midwife or doctor will ask to check and see if you have any tears to the perineum and/or vagina that might require stitches. If you do need stitches, your midwife or doctor will explain this to you.

Before stitching your midwife or doctor will ensure the area is numbed with local anaesthetic, or if you have an epidural already, this will be topped up. Most tears will be repaired in your birthing room, more significant tears require repair in an operating theatre. Tears are repaired using dissolvable stitches and normally heal within a month of birth.

All women will lose some blood after giving birth, this happens because the area of the womb where the placenta was attached takes time to heal. Bleeding may be heavy immediately after the birth, but will reduce significantly over the next few days and weeks. Bleeding will normally last between two and six weeks. Your midwife will check on your bleeding regularly straight after birth.

During skin-to-skin contact with your baby, he or she may show early feeding cues. Your midwife will support you in feeding your baby shortly after birth. Some babies want to feed very soon after birth, whereas others take several hours to show signs that they are ready to feed.

Your baby’s weight will be checked, and a midwife or neonatal doctor will check him/her from top-to-toe to exclude any major abnormalities. Your baby will be offered a supplement of Vitamin K.

In some, your baby may need to be transferred to the neonatal unit for a period of time for specialised treatment. This is more common with babies born prematurely, very small, with an infection or through a particularly complicated birth. If this happens to you, you will have plenty of support and help from your maternity team.