Stages of labour

There are three stages of labour (giving birth):

• 1st stage: Dilation of the cervix.
• 2nd stage: Birth of the baby.
• 3rd stage: Delivery of the placenta.

Dilation of the cervix

If your contractions are regular and painful, you are in labour. Your cervix has begun to soften and dilate. Your waters might already have broken.

The midwife will check whether labour has started. She will check whether your waters have broken and whether the cervix has begun to dilate, as well as checking the baby's position and the frequency of your contractions.

A cardiotocogram (CTG) or monitoring is carried out, to record your baby's heart rate and the frequency and intensity of your contractions.

On average, the cervix dilates at a rate of one centimetre per hour. It thins and opens gradually. At the same time, the baby moves down into your pelvis in preparation for birth. Your cervix is fully dilated when it reaches around 10 cm. Labour generally takes longer with your first baby than for subsequent births.

If you wish, and you have had a pre-anaesthetic consultation, you can ask for epidural anaesthesia, unless it is contraindicated.

Birth of the baby

This second phase begins once the cervix is fully dilated and continues until your baby is born.

Once the cervix is sufficiently dilated, you can start pushing.

With each contraction, the midwife or gynaecologist will ask you to push hard.

It is important to apply the breathing techniques you have learned when preparing for birth (typically in your antenatal classes).

If you have not attended any preparatory classes, the midwife will explain some breathing techniques to you, and guide you through them.

When the contraction has passed, breathe normally again to recover for your next contraction, which may come on very suddenly, and you will need to push again.

When the baby's head is about to be born, the gynaecologist or midwife will ask you to stop pushing, to allow the head to come out as slowly as possible.

To prevent perineal tearing, the gynaecologist or midwife might perform an episiotomy. Once your baby's head is free, their shoulders and body can then come out. Sometimes, it might be necessary to use forceps or a ventouse.

Your child has been born. They will cry for the first time, and the midwife will generally rest the baby on your tummy while the umbilical cord is being cut.

Once the umbilical cord has been clamped, it can be cut (possibly by your birthing partner). This does not hurt the baby.

You will stay in the delivery room for around 2 hours after your baby is born.

If you have decided to breastfeed, then the baby will be put to your breast. If not, they will be given their first bottle feed.

After a prolonged initial period of skin-to-skin contact, your baby will be weighed and measured, and given medical attention.

Delivery of the placenta

Around quarter of an hour after your baby is born, you will deliver the afterbirth. The placenta comes away from the wall of the uterus, and is expelled by renewed contractions.

The midwife or gynaecologist will examine the placenta, and check that everything has come away, so as to avoid haemorrhaging or subsequent infection. If part of the placenta is missing, the gynaecologist or midwife will examine your uterus to find it.

If you have had an episiotomy or perineal tearing, the gynaecologist will stitch up the wound.

The gynaecologist and midwife will also monitor the amount of blood lost, and the fundal height. They observe and check that the uterus has contracted sufficiently.

They will also monitor your general state of health: blood pressure, pulse, temperature and general wellbeing.

After giving birth, you will continue to experience some bleeding. This will continue for around 15 days, decreasing and becoming lighter as time goes on. If bleeding persists, or is accompanied by pain, fever or foul-smelling or pus-like discharge, you must consult your gynaecologist as soon as possible. These symptoms could indicate an infection.