The stages of labour
Knowing about what happens during labour can help you feel calmer while you are going through it. Although every labour is unique, there are 3 distinct stages to it. Here, we talk you through them, from first twinges to delivering the placenta after your baby is born.
The first stage of labour
The first stage of labour tends to be the longest. It’s split into 2 stages:
The latent phase of labour
During the latent phase of labour, you may not even notice that it has begun. Your cervix (the opening to your womb) moves forward, softens, thins and begins to open (dilate) as it gets ready for your baby to be born.
You will start having contractions, but they will not be regular at this point. Or you might find they are regular for a while, then slow down or stop.
During a contraction the muscles in your womb tighten then relax. Some people compare them to intense period pains. You may also get backache. You can take paracetamol if you think it may help.
This is the warm-up to the main event, so try to stay as calm and comfy as you can. Having something to eat and drink will give you energy for when the contractions become more intense. If your labour starts during the day, it can help to stay upright and gently active by walking around, but try not to tire yourself out. If labour starts at night, try to get some sleep.
You can also contact your midwife at this point. But, if you are more than 37 weeks with an uncomplicated pregnancy, they are likely to advise you to stay at home until your labour is established.
It can be hard to say how long the latent phase will last. It can take hours or even days. It tends to be longer in a first pregnancy.
There are things you can do to ease the pain, stay relaxed and get ready for stronger contractions. Find out more about the latent phase of labour.
Contact your midwife, maternity unit or labour ward again if:
- you are having regular contractions, around 3 every 10 minutes
- your waters break
- you have any bleeding
- your contractions are very strong, and you are in too much pain to rest – your healthcare team may be able to give you pain relief
- you are worried about anything.
Your midwife will tell you if you need to go to the maternity unit or hospital, or if they need to come to you for a home birth.
Established labour
Established or active labour starts once your cervix opens (dilates) to at least 4cm and your contractions become stronger and more regular.
Your midwife will check on you often once you're at the maternity unit or during a home birth. They will see how your labour is progressing and talk to you about how you are feeling. They will also ask if you need any pain relief. Your midwife will aim to:
- check your baby's heartbeat every 15 minutes
- check how often you are having contractions every 30 minutes
- check your pulse every hour
- check your temperature and blood pressure every 4 hours
- check how often you empty your bladder
- offer vaginal examinations to see how dilated you are – at least every 4 hours.
If your labour is going well, you should not need extra monitoring, but your midwife will be there to support you. Your cervix needs to open to about 10cm for your baby to be able to get through. This is called being fully dilated.
If you are having your first baby, the established phase tends to be around 8 hours, and rarely longer than 18 hours. If you have had a baby before it may well be shorter, lasting from around 5 hours to around 12 hours.
Transition
Towards the end of the first stage you start to become fully dilated and your contractions will tend to get stronger and more intense. This is known as transition. It’s different for everyone. You may get a strong urge to push or it might feel like a lull and a chance to rest. It might be overwhelming, in which case you’ll need support from your midwife and your birth partner to get through it.
Watch our fruit comparison to see how the cervix dilates in labour
The second stage of labour
The second stage starts when your cervix is fully open. It ends once your baby is born. Inside your womb the muscles will be tightening and loosening and you will be focusing your energy on pushing your baby down and out.
If you do not feel an urge to push straight away this is called the passive second stage. Once you have the urge to push, you’re in the active second stage.
Many people describe the urge to push as pressure in their bottom, a bit like the feeling of really needing a poo. It is likely you will feel 2 or 3 strong urges with each contraction. Usually, you will have a break between contractions, so you can rest a little.
Pushing can be hard work, but your midwife and birth partner can give you lots of support. During this stage, your midwife will monitor you and your baby closely and can help you to find a more comfortable position.
If you would prefer to follow your instincts and push when it feels right, tell your midwife. If not, they can guide you through each push. There is no right or wrong way and the choice is yours.
An epidural can stop you from feeling contractions or getting an urge to push. If you have had one, it's normal to wait an hour or longer once you're fully dilated, before you start pushing. When it’s time to push, your midwife will encourage you if you do not get the urge yourself.
Every labour is different. But once you start pushing, you are likely to give birth within 3 hours if it is your first baby, and within 2 hours if you have had a baby before.
Once your baby’s head is nearly ready to come out your midwife may ask you to stop pushing and take some short breaths. This is so your baby can be born slowly, which gives your skin and muscles more time to stretch. Once your baby’s head is out the hardest work is over. The rest of their body will normally slip out during the next contraction.
The second stage if you're having twins
It will take the same amount of time to push out your first baby as it would if you were just having one. After your first twin is born, your doctor will check on your second baby.
If your second twin is in a good position, they will often arrive much more quickly than the first. But, if they are in a tricky position, they may need extra help to be born.
It's likely you'll be offered an epidural during the first stage of labour to help prepare for this. Some people need to have a caesarean for their second twin despite having a vaginal birth for their first twin.
The third stage of labour
The third stage of labour is when you deliver the placenta, usually while you are snuggling with your newborn. If you have an uncomplicated labour, and a vaginal birth, there are 2 options for delivering the placenta:
- active management – you have an injection that helps your womb to contract and deliver the placenta
- physiological management – you wait for your womb to contract itself and deliver the placenta.
The injection works within around half an hour. It reduces your risk of heavy bleeding, but it can make you feel a bit sick, so you will also be offered anti-sickness medicine.
It is a good idea to write whether you want the injection, in your birth plan, as it is offered as standard. If you try to deliver the placenta without the injection it can take up to an hour. If you change your mind, you can still have the jab at any time.
Find out more about delivering the placenta.
Cord clamping
It’s recommended that the umbilical cord, which links your placenta to the baby, is not clamped and cut until at least 1 to 5 minutes after you give birth. This is known as delayed or optimal cord clamping. It lets the blood from the placenta carry on flowing (pulsating) to your baby after they are born, which helps with their iron levels and blood system.
If you want to wait, and clamp the cord after it has stopped pulsating, you could also write that in your birth plan. Your midwife or doctor should be happy to do it, but sometimes there will be a medical reason why they need to cut the cord sooner.
What happens when there is a delay in labour?
You and your baby will be monitored during labour to make sure all is well. Sometimes, labour slows down or there may be problems. You might need help because you have been in labour for a long time and you are too tired. Or your baby’s heart rate might drop, and your doctor may think it is safer for them to be born quickly.
When this happens, there are a few different ways for your baby to be delivered safely.
Delays during the first stage
If the first stage of labour is slow, your midwife or doctor may suggest breaking your waters (also known as artificial rupture of the membranes) if they have not broken yet.
This does not hurt your baby, but as with any intervention there are risks. Having your waters broken may make your contractions stronger and more painful. You might want to talk to your midwife about pain relief before you go ahead. Find out more about what to expect when your waters break.
You may be offered a drip with oxytocin (a drug that makes your contractions stronger). This can be painful, so you should be offered an epidural too.
If you have your waters broken, or go on the drip, you will be asked to have regular vaginal examinations to check your progress. You may also need continuous electronic monitoring. This means wearing a little belt around your bump, which will keep track of your baby's heartbeat and your contractions.
Delays during the second stage
If you are having your first baby, and your contractions are weak during the second stage, your healthcare team may offer to break your waters or give you oxytocin. You should be offered a vaginal examination and pain relief too.
If this stage goes on for longer than is right for you and your baby, your midwife or doctor may offer you an episiotomy, or an assisted birth with forceps or ventouse. If that does not work, they may suggest that you have a caesarean section.
If your baby needs to be born quickly
Sometimes, your healthcare team will decide that your baby needs to be born quickly if they are worried about you or your baby’s health. This might mean an assisted birth, or a caesarean section, based on how fast things need to move.
Your midwife and doctor should always try to explain why your birth needs to happen sooner and what your options are.
If you have a birth partner they may be able to help you make sense of what’s going on, if you are not feeling well or are very tired. They can also speak on your behalf and make choices for you if needed.
Read more about what to expect during labour and birth.
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NHS (2023) The stages of labour and birth. Available at: www.nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/ (Accessed 27 March 2024) (Page last reviewed 09/11/2023. Next review due 09/11/2026)
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