Labour: what to expect

Whilst every woman has a completely different experience of childbirth, she will still go through the three stages of labour, unless she has an elective caesarean before labour begins.

It can also be helpful to view them in stages, so that once you reach the end of one stage, you know you have achieved a lot and you are getting closer to meeting your baby.

What are the stages of labour?
Your cervix lies at the top of your vagina, and must open, or fully dilate in order for your baby to come out. In the first stage your uterus will tense and relax and cause a contraction, which is rhythmical and will get more intense with fewer gaps in between as labour progresses. When the cervix widens and thins enough for the baby to pass through, the second stage begins and your baby in born. The third stage is the delivery of the placenta, your baby’s life support system in your womb. These make up the three stages of labour.

Stage 1 of labour
Stage 1 begins when you have regular contractions, until the cervix has got gradually softer and thinner and has dilated to 10cm or 4 inches.
Even though this stage is the longest stage, do not be disheartened. One misconception about labour is that you spend hours and hours in pain, but between contractions, especially in the first stages of labour, you will probably be able to read a magazine, eat some lunch or chat happily to your birth partner. There will also be time to rest and gather your strength for the second stage of labour which is a bit more challenging. It is easier to see stage one further divided into three sections:

The latent stage
Many women will have regular contractions as the cervix gets softer, and these can vary between mild contractions where you can carry on chatting or having lunch, or they can be strong and painful. The latent stage can last for around eight hours for first labours. Most women describe early labour pains as being like heavy menstrual cramps that get stronger and more intense as labour progresses. It’s important to note the length and strength of your contractions, rather than the time between them. If they last 30-40 seconds and you are able to have a cup of tea in between, you are unlikely to be in established labour.
Most women are told to stay at home during the early part of labour, until their irregular contractions are replaced by more consistent ones, which get stronger, come every five minutes, and last roughly 45-60 seconds. This is when you are in established labour, or the active stage.

The active stage
This stage is shorter and lasts about three to five hours on average. Here your contractions get longer, with a shorter gap in between. They can be painful, and it is at this stage that you may require pain relief. By the end of this stage, your cervix will be either fully dilated or almost fully dilated.
See our pain relief article for more details on what your options might be at this stage of labour.

Transitional stage
The transitional stage is almost the bridge between stages one and two. You will now be fully dilated and are entering the ‘pushing’ stage. For some women the transitional stage is a period of rest, and the contractions can ease whilst your body prepares for your baby to come out. For others, this stage makes them behave irrationally, and they lose heart. With encouragement this stage will pass and your baby will be born very soon. The midwives will recognise the signs if you are in the transitional stage, and will probably tell you how close you are to meeting your baby. You may feel a very strong urge to bear down or push, but if your cervix hasn’t fully dilated, you will be encouraged to breathe through the contraction and wait until your cervix has completely dilated.

Stage 2
Contractions
Stage two begins when you are fully dilated and ends with the birth of your baby. It roughly lasts an hour for first pregnancies but can take longer. The contractions you feel in stage 2 are different to those experienced in stage 1, as they cause an overwhelming feeling to bear down and push out your baby. Sometimes the cervix has not dilated fully and if you push it will swell and take longer to dilate. This is why your midwife will only allow you to push once you are fully dilated. If you breathe slowly through each contraction and use gas and air it can help to open up the cervix. See our video on breathing techniques in labour for more advice.

At this stage most women do not need to be guided, and they will go with what their body is telling them to do. Some women worry about the sounds they will make during this stage, but if grunting and groaning (or screaming at your partner) help you to deal with each contraction, they are helping to make the birth easier, and again you should go with them.

Pushing
If you can, try to keep your pushing smooth, and make your muscular effort slow and steady to avoid putting pressure on the perineum. Most women prefer to be in a more upright position at this stage as gravity helps the baby move downwards and you don’t have to do as much work. It is also helpful to relax your pelvic floor muscle and anal muscles as much as possible as you are pushing. This may make you urinate or pass a stool, but this is nothing to be embarrassed about. It happens to lots of women and those around you will have seen it happen plenty of times, in fact, you probably won’t even notice.

Crowning
When your baby is about to be born, your anal area and perineum may bulge a little, and your baby’s head will be visible at your vaginal opening and this is called crowning. Your baby's head may slip back up the birth canal between contractions. It can take a couple of contractions after it has crowned for the head to emerge, usually pointing downwards, and the baby will twist so that the shoulders are in a better position to come out. The rest of the body should slip out easily once the head and shoulders are out, but some women may need forceps or a ventouse to help them. An episiotomy may also be necessary to widen the vaginal opening and help the baby to come out, but there are pre-labour steps you can take to try to avoid this happening.

Once your baby is born
Your baby will be delivered onto your chest and will be covered in blood and vernix, which has protected your baby’s skin while she was inside you. She will be covered in towels to keep her warm, whilst the mucus is wiped from her nose and mouth, and her airways checked. If everything is straightforward and your baby is doing well, you can relax, cuddle and introduce yourself to your newborn baby. If you are planning to breastfeed your baby, with a little help from your midwife, now is a good time to try.

Stage 3
Stage 3 is from the birth of your baby to the delivery of the placenta, which is expelled by the uterus once the baby has been delivered. Some women prefer to wait for the placenta to deliver naturally, which can take slightly longer than if drugs are used. If you put your baby to your breast or you empty your bladder it can help to speed things along. Blood loss can be a little heavier if you are having a natural stage 3, but this should not be a problem if you have had a straightforward delivery and are healthy.

You can also choose to be injected with a drug called Syntometrine, which contains oxytocin and ergometrine and is a synthetic hormone that encourages the uterus to contract and expel the placenta. You will feel a contraction and the midwife will gently tug on the cord until the placenta comes out. If you had an induction, an epidural or a forceps or ventouse delivery it may be advised that you manage the third stage with drugs. If you definitely do not want a managed third stage, remember to include this in your birth plan and let the midwives know.

What do contractions feel like?
Labour pains, or contractions can feel different from women to women, but they are mostly described as a tightening sensation that spreads around your lower abdomen. You might also feel a hardening of the uterine muscle at the peak of the contraction, and they can be accompanied by backache. Most women describe contractions as being like very intense period pains. If you imagine them to be a bit like walking up a very steep set of hills, which are hardest to climb at the very top, but when you reach the peak you can walk back down the other side easily (till you reach the next hill).

If you want to chat about the stages of labour see our Birth and Labour Chat Forum.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.

All Third Trimester articles are relevant to the UK medical health system and may differ from the experience of having a baby in other countries.

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Last Modified: 09/12/2008

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