Stages of labour

There are three main stages of labour plus the ‘latent’ phase of labour.

Hi, my name’s Lily McInnes, I’m one of the midwives at North Tees Hospital and I’ll be going through the stages of labour today.

The first stage of your labour is the latent phase, this is described as when your contractions start but are still irregular. These contractions can be quite irregular to begin with, but keep an eye out for them starting to become more strong and more regular in frequency. Your baby should still move the same amount and in the same pattern as it has previously.

During the latent phase, you can contact the hospital as much as you want for any support or advice, but you would most likely be advised to stay at home and take some paracetamol or have a warm bath and keep mobile.

We would class you as in active labour from 4 cm up until 10 cm of dilatation. You would usually find that your contractions have become more regular at this point and are lasting the same amount of time, usually between 40 to 60 seconds and usually 3 and 10 minutes.

We would advise that in this stage that you would still remain upright and in a mobile position for labour and your baby should still remain in the same pattern of movement.

As you get towards 7 to 10 cm, you will experience a transitional phase of labour. This is often when women experience a large sense of panic regarding their labour. You may ask for an epidural or caesarean section, however, do not worry as midwives are aware of this stage and it is usually a sign that you are coming up towards full dilatation.

When you are fully dilated, you may not experience the urge to push straight away. This can be quite normal and may take some time for you to get this feeling. We do advise for you not to push when you are fully dilated until you have that urge. The second stage can last anywhere from an hour to two hours, but sometimes can happen in a couple of minutes.

As your baby’s head is about to deliver, your midwife may ask you to take small breaths, and this is to control the delivery of your baby’s head and try and prevent any tearing.

Once baby has been delivered, baby will be placed up onto your abdomen and stimulated and dried with warm towels.

The third and final stage of labour is the delivery of your placenta. This can be delivered by two methods, either active or physiological.

Active delivery of your placenta is given by an injection of oxytocin into your thigh. This can speed up your delivery of your placenta and also reduce blood loss. This can sometimes take up to 30 minutes to deliver.

However, in physiological delivery of your placenta, no injections are given and we wait naturally until the placenta is delivered. This can sometimes take up to an hour. If you’ve chosen a physiological third stage for your placenta, you can change your mind at any point if you are concerned about bleeding or simply just wanting to speed things up.

Latent phase

The latent phase of labour is the period before the first stage begins. Often this can last a day or so with contractions typically stopping and starting.

You may benefit from taking simple analgesia at home, using a TENS machine, having warm baths or using a birthing ball. People often have a ‘show’ and sometimes their waters might break but they’re not yet classed as being in ‘established labour’.

People will often need to visit the hospital during the latent phase of labour for stronger pain relief and reassurance from midwives. It’s important to stay hydrated, mobile and eat little and often during the latent phase to keep your energy levels up. It’s also important to rest when you can.

Important things are happening during the latent phase of labour; the cervix (neck of the womb) starts to soften, move forward, thin down (or efface) and dilate.

First stage of labour

The first stage of labour is classed as ‘established’ labour. This is the stage of labour when you are contracting regularly (3 to 4 times every 10 minutes) and your cervix has reached 4cm dilatation.

This stage typically lasts between 8 to 18 hours for your first baby and 5 to 12 hours if you’ve had a baby before.

It would be recommended to stay in hospital once you’re in established labour for closer monitoring, or your midwife will stay in attendance if you’re having a home birth.

Your baby may need to be continuously monitored if you’re classed as being high risk. If you are low risk then your baby might be listened to intermittently. You will receive one-to-one care from a midwife when you are in established labour.

It’s important to be aware that there are pain relief options available to you:

Oral analgesia (Paracetamol, dihydrocodeine)
Water blisters
Entonox (Gas and air)
Diamorphine/Pethidine injections
Epidural

Second stage of labour

The second stage of labour starts once the cervix reaches full dilatation (10cm). This stage typically lasts from 1 to 3 hours.

Some people will feel the urge to push before they reach full dilatation but most will feel ‘rectal pressure’ and a strong urge to push once the cervix is fully dilated. Some people will start pushing straight away and in some circumstances, some people will wait an hour or longer before starting to push.

Some women may need an episiotomy (cut) at the time of birth and occasionally some women may need assistance from a doctor in the form of an assisted delivery.

Talk to your midwife about the OASI care bundle

The Obstetric Anal Sphincter Injury (OASI) Care Bundle was developed to reduce perineal trauma that is sustained during childbirth.

Find out more from the Royal college of Obstetricians and Gynaecologists (RCOG) website below:

RCOG: Perineal tears and episiotomies in childbirth

Third stage of labour

The third stage of labour is the time between the birth of the baby and the delivery of the placenta (after birth). You can choose to have a physiological or active third stage.

Active third stage

An active third stage involves having an injection (a utero-tonic) after the birth of the baby. The cord will be clamped and cut and a midwife will help you to deliver the placenta by gently pulling on the cord. An active third stage typically lasts 30 minutes.

Physiological third stage

A physiological third stage can last up to an hour, involves no utero-tonic drug and you experience contractions and push the placenta out yourself. The risk of heavy bleeding is slightly less with an active third stage.

Speak to your midwife or obstetrician about your options.

Video resource: Third stage of labour

Community Midwife Rebecca explains the third stage of labour, known as the afterbirth.

Video transcript: Third stage of labour

Hi everyone, we’re now going to talk about the third stage of labour, or this is actually the delivery of your placenta, which is sometimes known as the after birth.

So once your baby is being delivered and you’re giving your baby a nice cuddle and skin to skin contact, your body is doing amazing things and your uterus is actually having little contractions now, in order to contract your uterus down and make it small and we need to then deliver your placenta.

So once the uterus is contracted enough and your placenta starts to separate from the line of the uterus, it’s ready to be delivered. Naturally, This can take about 30 minutes, sometimes a little bit longer. There is a slight increased amount of blood loss when it happens naturally. Or we can offer you an injection, normally given at the top of your leg once your baby’s born. Which is a synthetic hormone of oxytocin and brings on quite a big contraction to help separate that placenta quicker and help contract your uterus just to help control the bleeding.

We call this an active stage of labor, so active third stage of labour. Whereas if you choose for your placenta to come away naturally, it’s called a physiological third stage of labor.

The midwives looking after you will ask you what you’re wanting to do, so they know and they can plan for the birth. The active stage of labour normally takes about 10 minutes, by the time the placenta and the uterus is contracted and present separated. But once the placenta is separated from your body, the midwives will have clamped the umbilical cord and by this stage they will have also have clamped baby’s belly button.

They usually ask birth partners if they want to cut the cord to separate baby from the placenta and this actually also helps with the natural separation of the placenta.

So the midwives, they’re the ones that do the work you don’t need to worry about this and the delivery of your placenta is not like the delivery of the baby it’s just squidgy. There’s no bones involved. So the midwives usually will take hold of the umbilical cord and then they pull on your placenta.

They’ll ask you if you want to look at it if you want to, but not many people do and this is the delivery of the placenta and the membranes, which is the bag of waters that the baby is being protected inside of you for nine months.

So they then get rid of the placenta, which we do check later. But at this point then the midwives will press on your tummy and just to make sure that uterus is nice and contracted.

At this stage, it’s normal for ladies to bleed so expect to bleed a little bit, we’re used to that we manage that okay. And that’s what the body’s naturally doing. And once we’re happy that your uterus is contracted, the midwives will then ask you if it’s okay if we can check just to see if there’s been any tears or any trauma inside you.

They may need to put their finger into your back passage, into your bum hole, or into the vagina just to inspect and make sure everything’s okay. But at this point you’re going to have baby in your arms and you won’t care what they’re doing.

Optimal cord clamping

Delayed (or optimal) cord clamping is when the midwife waits for at least a minute before cutting the cord after baby is born.

Video resource: Delayed cord clamping

Delayed cord clamping

Hi, I’m Charlotte. I’m one of the specialist midwives from North and Hartlepool NHS Foundation Trust and this is Emma, one of our students from Teesside University. Today, she’ll be under my direct supervision talking to you about delayed cord clamping.

Your umbilical cord connects your baby to your placenta. In the minutes after your baby is born, it continues to work, transferring blood, oxygen, and stem cells to your baby.

Evidence suggests that delaying cutting the cord allows for extra blood to be transferred from the placenta to your baby. This is called delay cord clamping and is recommended for all babies.

Delay core clamping allows for additional iron to be transferred to your baby and is essential for brain development.

Once your baby is born, they’ll be dried, assessed, and placed into skin-to-skin. If all is well, there will be a delay in cutting the cord.

You can choose to wait for a couple of minutes or until the cord is completely white, which would show that there is no longer any blood flow to the baby. You also have the option of waiting until the placenta is completely delivered before cutting and clamping the cord.

If you’re having a caesarean birth, doctors can still facilitate delayed cord clamping. However, it will not be in the traditional way, including skin-to-skin. Once the cord is clamped and cut, the baby can then be placed into skin-to-skin contact.

Tommys: Delayed cord clamping optimal

Perineal tears

Once your placenta has been delivered, there are various checks that the midwife will carry out on you and your baby. They will check your perineum to assess for any damage (tears) and see if you require any stitches.

There are different classifications of tears:

1^st degree
2^nd degree
3^rd degree
4^th degree

Video resource: Perineal tears

Perineal tears

Hi, I’m Sar, I’m a midwife and this is Scarlett she’s a student midwife working under direct supervision and she’s going to talk to you about perineal tears and episiotomies.

So, perineal trauma can happen to anyone. It’s really common for first-time mums who are given birth to tear during delivery.

A midwife will try her hardest to help and avoid a woman from tearing during childbirth, she will ask you to stop pushing and to breathe and pant very slowly while the baby’s head is emerging from the vagina. In order for her to do this, it gives the muscles around the vagina and the skin to stretch for baby’s head to be delivered.

After delivery, a midwife with your consent will ask to inspect the vagina and areas around the vagina to see if you have had any trauma following delivery.
The first form of trauma is a first-degree tear and these usually don’t require any sutures and it may just have grazes along the vaginal wall. These may be sore when going to the toilet.

The next degree of a tear is a second degree and usually these do require a few sutures, again it can be sore when going to the toilet or opening your bowels.
Sutures are done in the room by a midwife with your consent, a numbing agent is given via an injection to the area to help with pain and these stitches dissolve within two to three weeks.

Third and fourth degree tears are more rarer, they will be inspected by a doctor and will need to be repaired in theatre under a spinal anaesthetic for adequate pain relief. You will need to stay in hospital as an inpatient until you’ve had a poo just to make sure everything is healed nicely.

All sutures will dissolve within two to three weeks. If you have any concerns, you must inform your midwife or GP.

Massaging the perineum in the last few weeks of pregnancy can help reduce the chance of you needing an episiotomy for the delivery of your baby. You insert two fingers to the bottom of the vagina and massage gently in a downward sweeping action to help soften and stretch the skin ready for the delivery of your baby. The type and frequency of the perineal massage depends on how comfortable you are at 37 weeks gestation.

An episiotomy is a cut that’s made in between the vagina and the anus. It can be done by a doctor or a midwife in the room along with the woman’s consent after an informed decision’s been made.

It is done to allow for baby’s head to be delivered more easily as it makes the vaginal opening more wider and it also prevents severe tears from happening. Episiotomies are not routinely done in the UK. However, if a decision has been made for an episiotomy to be done for the delivery of your baby along with a woman’s consent, it is usually for various reasons.

If baby is showing signs of fetal distress, you are having a breach delivery and need to make the vagina wider. If mum has serious health conditions or an instrumental delivery such as forceps or ventouse. If the decision for an episiotomy has been made, a numbing agent can be given to you before and which will cover you for the repair afterwards as well. If you already have an epidural on board, then this can be topped up to give you adequate pain relief.
If you have any concerns with your episiotomy or your sutures in the healing process, please highlight this with your midwife.

Find out about the different types of tears that can occur during childbirth from the Royal college of Obstetricians and Gynaecologists (RCOG) website below:

RCOG: Perineal tears during childbirth

Monitoring in labour

Information about what happens when you’re admitted and how we monitor your labour.

Monitoring in labour

Hi, my name is Charlotte and I’m a community midwife working at North Tees and I’m going to talk to you today about what to expect in terms of monitoring in labour.

Once you’ve been admitted into hospital, you will be given a named midwife who will orientate you to the room and she will do certain monitoring for yourself and your baby.

First things first, she’s going to check your essential observations. So, she’s going to do your blood pressure. She’s going to check your temperature and your heart rate. She’s then going to ask you if she can listen into your baby.

So, in low risk laborers you will be listened into using a doptone similar to what the midwives use in your community setting.

When you are in the first stage of labour the midwife will listen in every 15 minutes for approximately 1 minute. When you are in the second stage of labour and ready to have your baby she will listen in every 5 minutes for approximately a minute.

In certain labours if you are classed as high risk you will need to be continuously monitored. To do this, we use a CTG machine which is very similar to this.

You will have two bands placed underneath your back and there will be two probes. The first is to monitor the contractions and to make sure everything is well in your abdomen. That is placed at the top of your bump. The second is to monitor baby’s heart rate and that is placed at the bottom. These will then stay on continuously and you are able to get up and move around off the bed, however, you are limited to the length of the cables available.

An alternative method of monitoring your baby’s heart rate is by the use of a foetal scalp electrode or FSE. This is a small clip which attaches directly to your baby’s scalp through your vagina. It is then attached to the CTG monitor and we can monitor baby’s heart rate much more clearly and much more concisely.

If your waters have broken, the midwives will continuously check the colour of your waters draining, they should be either clear or slightly straw coloured or ever so slightly blood stained. We don’t like red and we don’t like green.

Finally, a midwife’s most important job is to monitor yourself and your emotional well-being. We are here for support. We are here to be your advocates and we are here to guide you through your labour.