The stages of labour

Labour is divided into first, second and third stages. The first stage of labour results in the neck of the womb - the cervix - dilating to a full 10 centimetres and consists of early, active, and transitional phases.

Early phase

The early phase is sometimes called the latent period or pre labour. The uterus starts to contract or tighten regularly. The contractions gradually become more painful, unlike your Braxton Hicks contractions which were irregular and didn't hurt. Each woman has her own rhythm and pace of labour. Some may not even be aware of the very early contractions and are several centimetres dilated before they realise they're in labour. As the cervix begins to open, its position in your pelvis changes, moving forwards. It softens and effaces which means that it gets thinner and springier. Feel your nose: it's firm and muscular. Now feel you lips: they're soft and stretchy. Your cervix starts out firm like your nose, and has to become soft and stretchy like your lips.

What you can do

You'll probably be able to potter around the house, go for a walk, watch a DVD, take a warm bath, or have a nap. Relax as much as you can. Have light snacks and plenty of fluids. Try to remember to pass urine regularly. If you find the contractions are hard work, try using massage, relaxation techniques, a warm bath and experiment with positions that you find comfortable. If you want to use a TENS machine, put it on during this early phase as it seems to work best when used from the very start of labour.

Active phase

Doctors say you are in active labour when your cervix has dilated, or opened, to four centimetres. Your contractions will be getting stronger and more frequent. They're also getting longer. Eventually they may be coming as frequently as every three to four minutes and lasting about 60 seconds - and feel very tense indeed.

What you can do

The time to go to hospital is when you and your birth companion feel you would be more relaxed there than at home. Contractions may start to feel as if they are coming one on top of another. Try to work with your body. What is it telling you to do? Would you be more comfortable in a different position? Do you need a drink or some food to give you energy? Would it help to go to the toilet? Do you need more information from your doctor to reassure you?

Breathing exercises and relaxation techniques really come into their own at this point, and your husband can help you remember how to use them. You could try some gas and air to see if it takes the edge off the contractions.

If your waters have not ruptured, consider taking a warm shower or bath - warm water can really help ease the pain of labour.

Sometimes, women reach a point in labour when the rate at which their cervix is dilating slows or even stops. Try a change of scenery; a walk down the hospital corridor may help (you may need help walking, and will likely need to lean on something during a contraction). If you are too tired to walk, you could also ask your husband to give you a massage to help you relax. Sit or lie down on your side. Sometimes a good cry releases the emotional tension and helps you "let go". If your waters haven't broken yet, your doctor may suggest breaking them to see if this will speed labour up. Be aware though that you may find contractions tougher once the waters have gone.

If you find that the things you can do to help yourself aren't making contractions manageable, you can choose to have pethidine or an epidural.

Transition

During the transitional phase, the cervix dilates from eight to 10 centimetres. Contractions may last as long as one to one-and-a-half minutes and occur every two to three minutes. You might feel shaky, shivery and sick. (Or you might feel none of these things!) Many women report very intense contractions, rectal pressure and an urge to push down. It is usually at this stage that many also start to lose faith in them even if they were determined to have an active or natural birth. This is when lots of encouragement from your labour companion will be crucial.

What you can do

Hang on to the thought that you are nearly there. Make the most of the time in between contractions to rest and relax. During contractions, find the position that suits you best. Keep your breathing as rhythmical as possible (breathe in through your nose and blow out through a soft mouth), and if you want to shout, groan and make a lot of noise - go for it!

Second stage

Once the cervix has dilated to 10 centimetres, the work and excitement of the second stage begin. This is the stage of labour when your womb pushes your baby down the vagina (sometimes called the birth canal) into the world and, at long last, you meet him or her for the first time. There's often a lull at the end of the first stage when the contractions stop or come further apart, and you and your baby can rest for a while. When the contractions start again, you'll feel the pressure of your baby's head between your legs. With each contraction and every push, your baby will move down through your vagina a little, but at the end of the contraction, he'll slip back up again! Don't despair. As long as the baby keeps on moving on a little further each time, you're doing fine. When your baby's head is far down in your pelvis, the perineum (the area between the rectum and vagina) will begin to bulge. With each contraction the pressure of baby's head will further stretch the perineum and the opening of the vagina. You'll probably feel a hot, stinging sensation and your doctor will tell you that your baby's head has "crowned". As your baby's head begins to be born, your doctor may ask you to stop pushing and gently pant. This helps make sure that your baby is born gently and slowly, and should reduce the risk of you tearing.

If you have had a baby before, the second stage may only take five or 10 minutes. If this is your first baby, it usually takes an hour, but your doctor will likely want to actively manage this stage so you don't have to wait for an hour.

What you can do

Listen to your body and push when you get a strong urge. Try not to hold your breath when you're pushing. Push for as long as you want to. Then push again. You'll find that you push several times (not just once) with each contraction. Find a position you feel comfortable in, but remember to try to use gravity to help you by standing up, kneeling or squatting. You will most likely be very tired by now. If you need to lie down, lie on your left side. This makes more room in your pelvis for your baby than sitting on the bed because you're not pushing your coccyx (tail bone) forwards.

If you've had an epidural, listen to your doctor who will tell you when to push. She may suggest not pushing until she can actually see your baby's head.

Third stage

What happens?

In the third stage, you deliver the placenta - the baby's life-support system that has supplied your baby with nutrients, and taken waste products away. After the baby is born, contractions resume after a few minutes, but at a much lesser intensity. These contractions cause the placenta to peel away from the wall of the uterus and drop down into the bottom of your womb. You will probably feel that you want to push, but let your doctor or midwife guide you. The placenta, with the membranes of the empty bag of waters attached, will pass down and out of your vagina. Your doctor will carefully examine the placenta and membranes to make sure that nothing has been left behind. She will also feel your tummy to check that your uterus is firmly contracted in order to control the bleeding from the place where the placenta was attached.

Delivering the placenta usually takes from five to 15 minutes, as your doctor is most likely to actively manage this stage in order to avoid too much bleeding. Most women are surprised at how much easier it is to deliver the placenta than to push the baby out. You may like to have a look at this organ that has supported your baby throughout the pregnancy.

What you can do

You may hardly be aware of the third stage, as your focus has probably shifted to your baby. Seeing and handling your baby, and offering him or her breast will stimulate hormones that help the placenta to separate.

Now that the birth is over, you may feel shaky due to adrenaline and the adjustments your body immediately starts to make. Or you may simply be on a high, ready to pick up your baby and dance around the room. Some women find it hard to pay attention to the baby if they have had a long labour. There's nothing wrong with their maternal instincts; they're simply exhausted. If this happens to you, take your time. After a rest you will be much more interested in getting to know your baby. A lot of women are very hungry and ready for some snacks and drinks.

Admire your new baby. Count the fingers and toes. Hold him or her close to your body, preferably skin to skin. If you're too tired, your husband can hold the baby against his chest. If you're going to breastfeed, offer the breast as soon as possible: your nurse midwife will help you. Don't worry if your baby doesn't seem very interested. Even if he's only touching and nuzzling you, this will help you to get going with breastfeeding.