The Stages of Labour

Early signs of labour

You may think it’ll be obvious when you go into labour, but it isn’t always what you see in the movies. Here are a few common early signs of labour to look out for:

• Tightening feeling around the belly. They might feel like really intense period pains.
• Backache - contractions don’t just happen in the bump area.
• Mucus or jelly-like substance in your pants - this is called a “show”.
• A sudden urge to use the toilet. This is caused by the baby’s head pressing down on your bowel.
• Your waters breaking. This might not happen before labour. But if it does call the hospital straight away.
• Call the hospital if you’re unsure or worried about anything. For example, if you’re bleeding or your baby is moving less than usual.
• Don’t forget to have your hospital bag packed and ready to go! See our checklist of essentials to include.

The First Stage of Labour

There are three stages of labour overall starting from your first contraction and ending with the birth of your baby and placenta. The first stage of labour is usually the longest part of labour and starts at home.

The first stage of labour starts with contractions and ends with complete dilation of the cervix:

• Contractions – As your labour progresses, your contractions will speed up, your cervix will continue to dilate, and your baby will gradually descend. Early in this first stage of labour, often referred to as the ‘latent’ phase, contractions are often not that painful and are like strong menstrual cramps. There is often much variability in the contraction length and time between contractions. Contractions increase in rhythm, strength and duration until eventually they last as long as 60 seconds and come every few minutes. By this stage you may already be at the hospital.
• Dilation - Is the opening of your cervix. At the end of the ‘latent’ phase, the cervix will dilate to about 3cm. When contractions increase in intensity and occur more frequently, often referred to as the ‘active’ phase, your cervix dilates more toward 8-10cm.
• Effacement - Your uterus and cervix, which together look like an upside-down pear, are rearranging themselves. The cervix, or neck of the pear, is getting shorter and dilating or opening so your baby’s head can get through. This change is called effacement.

Tips and coping mechanisms to manage discomfort and pain during the first stage of labour:

• Stay calm and on track – have your birth plan in place, consult it regularly, however on medical advice you may need to be flexible and change it as needed.
• Deep breaths – Your breathing pattern will become more and more critical as you progress from the ‘latent’ phase to the ‘active’ phase of contractions. Try to breath out for a little longer than you breath in.  Breathing is something you can control (or try to!).
• Pain control – If breathing isn’t cutting it, it’s time to consult your birth plan for other pain management options. This could be using a TENS machine, warm shower, or massage.  If you want to start some pain relief medication, you could start with over-the-counter pain relief such as paracetamol at home, but anything more will need medical supervision.
• Time to go to hospital? Deciding when to go to hospital will be up to you and your medical team. Stay in contact with your hospital for advice. The ‘active’ phase often pushes mums-to-be into feeling they no longer can cope at home and seek medical advice and support. Once in hospital your medical team, will check your labour signs – including the dilation of your cervix and the position of your baby. They will monitor the baby’s state of health and especially their heartbeat. It is at this time also that your birth plan and pain relief plan may kick in.

The Second Stage of Labour

The second stage of labour begins when the cervix is fully dilated and ends with the birth of your baby. By the second stage of labour, your cervix dilates fully to 10cm and your contractions are strong and very frequent, it may even feel they’re one continuous long cramp. By this stage you are most likely already in hospital.

Once you’re at this stage it is not long now until it’s time to push with the contractions. Depending on the type of pain medication you are using, you may feel a strong urge to push, which is the sign you are now entering the second stage of labour, bringing your baby into the world with the help of your medical team.

As natural as it might feel to push, there are safer and more effective ways of pushing – ask your medical team or your support person to guide you through this stage and utilise breathing and any other techniques you learned during any antenatal classes.

Different positions for labour

Pain Management

As this second stage of labour progresses, you may find you need extra pain management.  Your birth plan may help you make quick decisions as you need to, otherwise consult the medical team for options. This may include nitrous oxide gas, morphine, or an epidural.

Near the end of childbirth, the baby’s head can be seen during and after a contraction. That’s called crowning. At this point in your labour the doctor may do an episiotomy – a shallow cut into the lower vagina to keep your tissue from tearing. Where necessary, the medical team may also use forceps. Now for the part you’ve been waiting for… Your baby will emerge, and give their first cry! That’s it: you’ve given birth. Congratulations!

The Third Stage of Labour

The third stage of labour begins after the birth of the baby and ends with the delivery of the placenta.  This stage is very carefully monitored and supervised to avoid excessive bleeding. There are two ways you can deliver the placenta – ‘Actively’ or ‘Expectantly’.

Active Management is quite common in Australia. This is when the mum is given an injection of the hormone oxytocin, the medical team clamps and cuts the umbilical cord, and then gently helps remove the placenta. It is common because it has been found to reduce blood loss at this stage of delivery.

Expectant Management is when the placenta is delivered without any assistance, usually by gravity or when your baby first breastfeeds. After your baby is born, contractions may have stopped but will restart, lasting for 5 to 30 minutes until the placenta is delivered.

Once the placenta is delivered, your doctor or midwife will inspect it to ensure that it is all intact and nothing remains inside you.

Here is a rough sequence of things that will happen after your baby is born:

1. The doctor will assess your baby to make sure your baby is breathing freely;
2. The umbilical cord will be cut. You or your partner may be allowed to assist here;
3. The doctor will evaluate the baby’s condition and may inject the baby with vitamin K to aid in blood clotting;
4. As soon as possible hold your baby on your chest or abdomen for skin-to-skin contact. This is a special bonding moment as you and baby meet for the first time.
5. The nurse or doctor will issue an ID bracelet – one for you and one for your newborn and transfer you to your room.
6. While you’re in hospital, the medical team will be on call for you as you need them. They can help with initiating breastfeeding, postpartum care, and general newborn baby care.
7. The length of stay in hospital will vary and may depend on whether you’re in a private or public hospital; the type of delivery; or even whether you’re a first-time mum.

Labour and Delivery Tips

• Don’t underestimate the significance of emotional support from your support person during labour. Whether it’s your partner, a doula, a close friend or a family member, they should be aware of your birth plan and help you implement it at different stages of your labour.
• Be prepared for the unexpected – quite a contrasting concept, but it’s so true. Having a birth plan that addresses a number of different scenarios will help you navigate through them in the middle of labour when your attention is somewhat elsewhere.
• Vary your labour position as you progress through the stages of labour, to remain as comfortable as possible.
• There are a number of factors that can influence the duration and progression of labour, being aware of these won’t make them so daunting when they’re happening to you:
  • Maternal health – Once you are in hospital, the medical team monitor you as much as they do your baby. This may include your heart rate and blood pressure; and any pre-existing conditions that may cause complications for you or your baby. Any pre-existing conditions would already have been discussed with your medical team prior to labour and should form part of your birth plan.
  • Baby’s position – There are a number of positions your baby can get into which may slow your progression, or result in close monitoring by your medical team. This could include your baby being in breech position; if they are lying sideways or diagonally; or they’re continually moving positions.
  • Previous childbirth experiences – if this is your first baby, on average it will progress a little slower, and take a little longer than subsequent births.