What to expect during labour

It’s natural to be concerned about how you will cope with labour, but one of the best ways to overcome any anxieties you may have is to find out as much as you can beforehand. Here we explain what happens during labour and tell you about your pain relief options.

How long does labour last?

A first labour usually lasts for anything between 6 and 20 hours, while any subsequent labours are often much shorter.

During labour you will go through several stages and it helps to know what happens in each so you can recognise the signs that you are progressing.

Early labour (latent phase)

Sometimes referred to as ‘slow’ labour, this can take hours, or even days as contractions start to build up. Unless there’s a medical reason for you to go early to hospital, you’ll be much more comfortable at home during this stage.

Initial contractions are short and irregular. During this time you may experience a ‘show’.

Try to rest and stay relaxed when you are in early labour, even if you can’t sleep. Having a warm bath should help to relax you and using a TENS machine should ease any discomfort. You need to continue to eat and drink normally.

Be aware of your baby’s movements – they should be the same as usual. Contact your midwife if you need any advice.

First stage labour

Strong, regular contractions, lasting about 45–60 seconds and coming every three to five minutes, indicate that you are likely to be in ‘established’ labour.

This is when the cervix thins (effaces) and opens up (dilates). You will need to ring the maternity unit to talk to the midwife so that between you, you can decide whether you should stay at home a bit longer or go to the maternity ward.

If you are having a home birth now is the time to call your midwife.

Once in the maternity unit the midwife will go through your birth plan and feel your abdomen to establish which way your baby is lying. She will listen to your baby’s heartbeat, and will continue to do this every 15 minutes, and will check that your blood pressure, pulse and temperature are normal.

She may ask to do a vaginal examination to assess how far your labour has progressed – the cervix has to dilate to 10cm during the first stage – and your options such as remaining upright, being active, using a ball or water  and the use of pain relieving drugs will be discussed.

You will be encouraged to eat light snacks and to drink isotonic drinks* to maintain your body’s energy to cope with the physical demands of labour

As labour progresses your contractions will become really intense with virtually no gaps in between them. During this stage any pain relief you are having will be monitored.

Your partner can help by offering you lots of encouragement and support. Sips of water, a cool flannel on your face or a massage may all help, but equally you may ‘go into yourself’ to gather your strength and will hate any fussing. You may start to feel the urge to push

Second stage labour

The cervix is 10 cm or fully dilated now. It will help to think of this second stage, which can take up to two hours of active pushing, as the final countdown to meeting your baby.

Yes, it’s painful and pushing the baby out is very hard work – but the end is in sight and your midwife will help you through it.

Your contractions will become even stronger and closer together and you will feel the urge to bear down and push with each one.

With every push your baby will move further down the birth canal and is closer to being born. You will need to remain focused and work hard, but the time will go very quickly.

Eventually the baby’s head will ‘crown’, passing through the perineum and you may feel an intense burning sensation. The midwife will encourage you to ‘pant’, a succession of quick, short breaths to allow the perineum to stretch and not tear.

In some cases you may tear or your midwife may need to perform a small cut – an episiotomy (this can be repaired with stitches after the birth). Once your baby’s head is born, when you push with the next contraction your baby will turn to allow one shoulder to come out, followed by the other. The feeling of relief is immense and the pain stops immediately; many women also feel an intense ‘high’ at their achievement.

Your newborn will be given to you so you can have skin-to-skin contact and then the cord will be clamped and cut - in some cases the new dad wants to do this.

Third stage of labour: delivery of the placenta

The placenta (or after-birth) now has to come out and in most cases this is quite straightforward. If you consent, your midwife will offer you an injection of oxytocin just as your baby is being born, or immediately afterwards, to speed up the delivery of the placenta (to between five and 20 minutes after the birth) and to reduce the risk of heavy bleeding. Your midwife may gently pull the cord to help to remove it while you relax your tummy. 

A natural third stage, where no injection of Oxytocin is given, is an option for some women, but isn’t suitable for everyone.

Pushing the placenta out yourself without the aid of drugs takes up to an hour and you may bleed more. Breastfeeding or skin-to-skin contact will help to speed up the delivery process.

In rare cases the whole or part of the placenta is retained and this may cause heavy bleeding and requires removal under anaesthetic.

After the birth

You and your partner will be given time alone with your baby before you are cleaned up and given stitches if they are needed.

The area to be stitched will be numbed first and you will be offered analgesia afterwards to reduce any inflammation.

Your baby will be checked over to make sure he’s healthy and you will be offered help with breastfeeding.