The stages of labour

Your labour has three stages, from the first twinges to delivering the placenta.

Every labour and birth are different but labour is generally split into three separate stages.

Before labour gets going: the latent phase

The latent phase of labour is when your cervix becomes soft and thin as it gets ready to open up (dilate) for your baby to be born.

You’ll start having contractions, but they won’t be regular at this point. You may get a good run of regular ones and then, just when you think you are getting somewhere, they may slow down or stop completely.

The aim during the latent phase of labour is to stay as calm and comfortable as possible. It’s a good idea to contact your midwife at this point so they can assess you. If you are more than 37 weeks with an uncomplicated pregnancy, you’ll probably be advised to stay at home until your labour is ‘established’'. This is when your cervix opens (dilates) to at least 4cm and your contractions become stronger and more regular.

It can be difficult to say how long the latent phase will last. It can take hours or, for some women, days. The latent stage tends to be longer in the first pregnancy.

There are lots of things you can do to ease any pain, stay relaxed and get ready for the next stage. Find out more about the latent stage of labour.

If you have been advised to stay at home in the latent stage, contact your midwife, maternity unit or labour ward again if:

  • your contractions are regular and coming about 3 in every 10 minutes
  • your waters break
  • you have any bleeding
  • your contractions are very strong and you feel you need pain relief – if you are in severe pain during the latent stage you can ask for an epidural
  • you're worried about anything.

The first stage of labour

The first stage of labour is also known as established labour. This is when your cervix opens (dilates) to at least 4cm and your contractions become stronger and more regular.

Your midwife will talk to you throughout the first stage about how you’re feeling and whether you need any pain relief. They will also:

  • listen and monitor your baby's heartbeat
  • check how often you are having contractions
  • measure your pulse every hour
  • measure your temperature and blood pressure every 4 hours
  • check how often you empty your bladder
  • offer vaginal examinations.

If your labour is going well, you shouldn't need any more monitoring, though your midwife will also be there to support you emotionally throughout your labour and birth.

If you’re having your first baby, this stage will probably last about 8–18 hours. If you’ve had a baby before it may last 5–12 hours.

Transition

Towards the end of the first stage, when the cervix is nearly open, contractions get stronger. This is known as 'transition'. You may not notice when you’re moving from the first to the second stage.

Watch our fruit guide to how the cervix dilates in labour

The second stage of labour

The second stage starts when your cervix is fully open (dilated) and the muscles of your womb are tightening and loosening to push the baby down and out. 

You may not feel an urge to push straightaway, which is called the passive second stage. It becomes the active second stage when you have the urge to push. It ends when your baby is born.

Your midwife will monitor you and the baby closely at this stage, as well as support you as you push. They’ll also help you to find a comfortable position.

Every labour is different. But, on average, once you start actively pushing you’ll probably deliver within 3 hours if it’s your first baby, and within 2 if you’ve had a baby before.

The second stage if you're having twins

If you have your babies vaginally, it will take the same time to push out the first baby as it would if you were just having one baby. After your first baby has been born, doctors will check on the position of the second baby.

If your second baby is in a good position, he or she will usually arrive much more quickly than the first. If the second baby is in a trickier position, you may need extra help for the birth.

The third stage of labour

You’re in the third stage of labour when you’ve had your baby but need to deliver the placenta. Your midwife will speak to you during your pregnancy about the 2 options for delivering the placenta and the pros and cons of each.

You can have active management, which means you’ll have an injection that helps you deliver the placenta or you can try physiological management. This means that you will deliver the placenta without any injection.

It’s a good idea to write your choice in your birth plan. If you want to try to deliver the placenta without the injection, you can change your mind and have the injection at any time if you want to.

NICE guidance recommends that the umbilical cord, which links your placenta to the baby, is not clamped and cut until at least 1–5 minutes after you give birth. This allows the blood from the placenta to continue being transferred to the baby even after they are born, which helps with their growth and development.

You may want to find out if the place where you want to give birth practices delayed cord clamping and include a request for this to happen in your birth plan.

If there is a delay in labour

You and your baby will be monitored throughout your labour to make sure everything is okay. Sometimes labour slows right down or there may be problems. You might need help because you’ve been in labour for a long time and you are exhausted. Or your baby’s heart rate might drop and the doctors might want them to be born quickly.

When this happens, there are a few different ways that your baby can be delivered the baby 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 haven’t broken already.

Having your waters broken doesn't hurt your baby, but there are risks as with any intervention.

Having your waters broken may make your contractions stronger and more painful. It may be worth talking to your midwife about pain relief before your waters are broken. Find out more about what to expect when your waters break.

You may also be offered a drip with oxytocin (a drug that makes your contractions stronger), which will help labour to progress. If you have oxytocin, you should be offered an epidural. You will also be encouraged to have electronic monitoring, which involves being attached to a monitor that continuously monitors your baby's heartbeat and your contractions. You may also have regular vaginal examinations at this point.

Delays during the second stage

If you are having your first baby and your contractions are weak, you may be offered an oxytocin drip. You should be offered an epidural at the same time.

If the second stage of labour is slower than normal, you should be offered a vaginal examination. You may also have (with your agreement):

  • your waters broken (if they haven’t already)
  • an oxytocin drip to help your labour progress (and an epidural)
  • more pain relief.

If the second stage of labour goes on for longer than expected, you may be offered an assisted birth. If a vaginal birth is not possible, you will be advised to have a caesarean section.

If your baby needs to be born quickly

Your baby may need to be born quickly if there are any concerns about their health or yours. This might mean an assisted birth or a caesarean section, depending on how quickly your baby needs to be born. Your midwife and obstetrician should explain why the birth needs to happen soon and what the options are.

You may need your birth partner to help you understand what’s happening and what your options are, especially if you are not feeling well or are very tired. They can also take control and make any decisions for you if you need them to.

 

 

Sources

NICE (2017). Intrapartum care for healthy women and babies National Institute for health and care excellence https://www.nice.org.uk/guidance/cg190

The Royal College of Midwives (2012) Evidence based guidelines for midwifery-led care in labour. Latent phase. https://www.rcm.org.uk/sites/default/files/Latent%20Phase_1.pdf

NHS Choices. Signs that labour has begun https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/#latent-phase-of-labour (Page last reviewed: 09/11/2017. Next review due: 09/11/2020)

NHS Choices. What happens during labour and birth https://www.nhs.uk/conditions/pregnancy-and-baby/what-happens-during-labour-and-birth/#first-stage-of-labour (Page last reviewed: 30/04/2017. Next review due: 30/04/2020)

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Last reviewed on June 5th, 2019. Next review date June 5th, 2022.

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