Stages of labour

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

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.

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.

Tommys: Delayed cord clamping optimal

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

Perineal tears

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

Video resources

Stages of labour

Community Midwife Rebecca explains the different stages of labour.

Video transcript: Stages of labour

Hi everyone, I’m now here in this session to talk to you about the stages of labour. What I would say, is you don’t need to get too hung up about the different names of the stages of labour.

You don’t really need to know the different names and the stages of labor. But it’s good to have an understanding of the process of what’s happening in labour, and what’s happening to your body, and why you are feeling different things at different times.

So the first part of labour, is what we refer to as the latent phase of labour, or what you may well have heard of it with being referred to as slow labour. When you hear stories about so-and-so being in labor for several days, and it’s your body starting with contractions, that stop and start, and stop and start and this is the first part of labour.

And within latent phase, quite often the pains are irregular, and you might get a strong pain and then a not so strong pain.

And as I’ve said, it can go on for a long time and at this point, the contractions aren’t necessarily in a regular pattern. Now at this point you may have had a show, which would be normal and just to use the props that we’ve got. The latent phase of labor, in labour we’re talking about your cervix opening up, and your cervix starts off shut. But within the latent phase of labor, it’s starting to gradually open up, and also your cervix starts off very thick, and it started to be pulled up. So what it’s doing, is the contractions pulling up the cervix, and they’re opening up the cervix.

The next stage of Labour, is the first stage of labor, and that’s when you’re four centimeters dilated or in active labor. Now on this dilatation chart, four centimeters dilated isn’t all the way until here, when when the cervix is approximately opened up about four centimeters. But to get to this stage can take a long time, and this is why we stress the importance of staying at home for as long as you possibly can, because getting to here you can really take a couple of days in some cases.

Once you’re past four centimeters dilated, usually then that’s when you’re having regular contractions, and they would be coming every few minutes and should have been coming every few minutes, lasting at least 30-40 seconds. Sometimes up to a minute. And really the need to have been coming regular like that for about two hours, before things are really starting to happen and your cervix is starting to open at a more regular pace.

In the first stage of labour it moves from being an irregular pattern into a more regular pattern of contractions. And when you speak to the midwives for advice over the phone, they’ll ask you about the pattern of the contractions and guide you and whether think you’re the right stage of labour to come into hospital.

During this stage of labour, it becomes harder to cope as well, so just be mindful of that. If you feel like you’re able to breathe through, you’re possibly not in established labour, but on the first stages of labor. But as the pain increases in strength, that’s a sign that things are starting to happen.

Now your body has the contractions which then helps the cervix to dilate all the way through these different phases of the cervix, until you get to be 10 centimeters. So here for example, is 6 centimeters, here is 8 centimeters, and when you are fully dilated that’s when all of the cervix has disappeared and there’s there’s nothing holding your baby back.

To get from 4 centimeters all the way to 10 centimeters dilated actually takes on average of about 12 hours, so it’s a really long time. It’s a really long time for you and your birth partner to be in the hospital environment, and that’s another reason why it’s such a good idea to stay at home if you’re calling for as long as you can.

When you are in labour, the midwives know how far dilated you are by doing a vaginal examination, with your consent. And that’s where we put two fingers into your vagina, to find the cervix and we can feel how open the cervix is, how thin the cervix, but also – I don’t know if you can see, but these funny little lines and triangles to mimic the markings on your baby’s head – and this helps us to define the position of your baby.

During the labour process, what happens, if you imagine this is your pelvis in labour, and your baby, along with the contractions, is getting its head pushed down, and its body push down more and more and more, through the pelvis.

And the contractions each time pushing, pushing, pushing, and then also pulling, pulling, pulling, up your cervix and open up your cervix to enable your baby to pass through the pelvis and to be born.

Now what is quite tricky, what you don’t really need to get your head round, but helps us to understand what’s happening in the labor. Is when your baby descends into the pelvis, it has to rotate, and then rotate again, in order to descend through the different dimensions within the pelvis. So when the midwives are examining you, as well as feeling how open are how dilated your cervix, they’re also feeling the position of the baby, by feeling baby’s head vaginally and baby’s body abdominally.

When they feel your tummy, it helps them understand better how the labour is progressing, so that’s why we do that.

Now towards the end we get to the third stage of labour, which is detailed in the next video.

Labour: third stage

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.

Tears and cuts

Community Midwife Rebecca, discusses tears and cuts and allays any fears.

Video transcript: Tears and cuts

Hi everyone in this session we’re just going to talk for a few moments about tears or cuts.

When I speak to my ladies ante-natally, this is one of the biggest fears that I find and people are frightened that they’re going to need to be cut in labor.

What I would say when I was a midwife on the labour ward for over 10 years, I can count on probably two hands the amount of ladies I had to do an episiotomy on.

An episiotomy is the formal name for a cut, and that’s where we make an incision to create a bit more space for the baby to be born.

When your baby is being born, the midwives will often try to control the rate at which your baby is born, to try to eliminate any tears or extended tears that you may need.

They will only need to do a cut in a real emergency situation, if they feel like the baby’s head’s a little bit stuck, or if they feel that we need to deliver baby quickly.

Unfortunately, if you do need a forceps delivery or a ventouse delivery, the likelihood is that the obstetrician delivering your baby will perform an episiotomy and that’s in order to be able to deliver your baby safely. To be able to put the instruments inside of you in a safe manner. If we do an episiotomy, we will give you local anaesthetic first like when you go to the dentist and get filling, just to help numb everywhere so you won’t feel the cut.

In terms of tears it is very common for ladies to tear when they’ve had a baby, but this is natural and that part of your body is full of vessels and it’s very vascular and it heals really well after you’ve had your baby. It does tend to be a little bit more common in first-time moms, rather than second or third time mums, but it can happen in any labour.

Once your baby is born and the midwives will inspect the area to see if you have torn and any tears or cuts they will recommend that we stitch them up afterwards in order to just bring everything back together and help with the healing process. It’s such an important part of your body it’s really important that we get it right.

You’ll be stitched straight after you’ve had your baby, if you do have a water birth we may leave you about an hour before we do the the stitch, but you tend to have your baby in cuddles anywhere, or maybe breastfeeding your baby. So you’re usually quite happy to let the midwives get on with what they’re doing, and your legs will be put into a lithotomy position so we can see what we’re doing. And you will be given more local anaesthetic, or you can use your gas and air if you want to. The stitches that the midwives use are dissolvable and don’t need to be removed and they tend to come away after about a week to 10 days, but your midwives postnatally will give you advice and guidance on that.