moKee Birth School online:
stages of labour
by Suzi Smith •
Read the blog post or listen to the podcast on Spotify:
Welcome to our second moKee Birth School online where we had Sophie Martin, The Infertile Midwife. Join us to run through the stages of labour.
First up is a bit of anatomy about the cervix. This is the neck of the womb and it opens up for the baby to be delivered. Before labour your cervix is quite firm and closed and sits high up in the vagina. The firmness is as thick as your nose. So that the baby can pass through the cervix it needs to get nice and soft and stretchy.
How Midwives and Doctors track changes to your cervix is called the Bishop’s Score- this helps to determine at what stage the labour is at. The cervix will start to shorten and thin out at around 36 weeks and continue until birth. It softens and stretches and most of the changes happen through contractions.
Early stage of labour
This is sometimes called the latent phase. This is where the softening happens and thinning and shortening. You might see a mucus plug or a show. This is a jelly-like substance which sits inside the cervix and it acts as a protective barrier stopping bacteria getting into the womb. As the cervical changes happen, the mucus plug starts to come out. It can come out in one big blob or it can come out in several smaller pieces. It looks like snot, really sticky and it can have pink and red blood through it. If you see heavy blood, call your maternity unit. Some people don’t have a show and it doesn’t necessarily mean that you’re going into labour immediately. It’s a sign that cervical changes are happening.
Braxton hicks happen in the early stages of labour when your uterus contracts and releases. Your tummy will go hard and then soft. They are uncomfortable but not painful and they are a sign that your body is getting ready for birth. They tend to be irregular and they can sometimes be stimulated through dehydration or your baby moving.
Cramping is also common during labour, similar to a period cramping, under the bump, or on the back.
Diarrhoea and vomiting are also common in the early stages of labour and are very normal. Labour uses a lot of energy, so processing like digestion isn’t a priority for your body, it gets rid of food so your body can focus on the labour. Not everyone will experience this. If you are experiencing this over a long period of time, call your maternity unit. Keep hydrated- little and often.
Contractions are when the tummy goes hard for a few seconds and then releases. They can be sporadic in early labour and they are intense and can be painful. As the labour progresses they become longer, more regular and more intense. By the time you’re in active labour, you’ll be having 3-4 contractions during this time. If you are still able to talk, it is likely that you’re experiencing braxton hicks rather than contractions. It’s not uncommon to start contractions and then to stop. Quite often people notice that they start having pains during the nights and then the next day it will stop. This is completely normal. First babies, can take quite a long time to arrive. Throughout this stage, you’ll feel your baby like usual. If your baby isn’t moving, call your maternity unit.
In this period, rest your body and this doesn’t mean sleeping. Laying on your left side with your eyes closed to help save your energy for labour. Keeping hydrated is important as dehydration can stop labour. Isotonic drinks are good with lots of electrolytes which are good for your body. Ask your birth partner to be in charge of encouraging you to drink. Remember to empty your bladder in early labour. Full bladders stop baby moving down. It can also damage your bladder if the baby keeps pressing on it.
Some people find it difficult to rest, so sometimes moving around and keeping active is good. Use a birthing ball with your knees really wide open. Rocking your hips from side to side will help to give baby lots of room to move down.
In early labour, if you’re planning on having a TENS machine, make sure that you use in the early stages. It sends mild electrical impulses and it’s great pain relief. Buy or rent them and then build up the impulses as labour progresses.
Relaxation is great for you and baby. If you’re trying hypnobirthing, get your music on. Use headphones as it will get you more in the zone rather than listening to it in the room. Breathing exercises are great and a warm bath or showers will help provide great pain relief. Sometimes this also slows the contractions down and this is very normal. It’s safe to take paracetamol in the early stages of labour too.
Nourishment is really important, snack little and often and this is a job for your birth partner to ensure that you’re fuelling your body. Fruit seeds and nuts are good as they’re high in energy. Don’t have heavy food.
Call your midwife when you’re in early labour to get reassurance or to see if you can come in for a check-up.
Active Labour is when you are over 4cm dilated and having strong regular contractions.
Contractions have to build up, so by the time you’re in active labour they’ll be really regular- 3-4 in a ten minute period lasting around 60 seconds each. Contractions can wane in early labour, in active labour they are very regular and you should feel this being more intense. Often people talk about them being painful but sometimes people describe them as really intense surges.
Don’t hold your breath when you’re having a contraction. It’s really common to clench everything and your uterus is going to squeeze down. Blood flow is temporarily reduced so we want lots of oxygen to go to the baby. It’s really important to keep breathing to give lots of oxygen to the baby. Start timing your contractions when you get more regular. A watch is fine and it doesn’t have to be exact.
When should I go to the hospital?
If you have a high-risk pregnancy you should call as soon as you have regular contractions. Also if you’re in labour and it’s less than 37 weeks. Second babies don’t hang around and the latent phase doesn’t tend to be too long. Call your midwife as soon as you start regular contractions. First babies can take a little longer so come in when you have regular contractions. Call your midwife first and you can go earlier to get extra pain relief if you need it.
If your waters break it’s important to phone your midwife. It can happen at any time, either at the beginning or at the end of labour. Waters can be a big gush or it can be a little trickle and this happens if the waters have happened at the top of your stomach. It is quite common to get a watery discharge towards the end of pregnancy but this is quite normal. If you’re having to wear a pad, and you're constantly wet, it’s more likely to be your waters breaking. Waters continue until your baby arrives.
The waters can be straw and clear colour or also pink. If they are green or a brown or an offensive smell, it’s important that you should call your midwife as it’s a sign that your baby has done a poo.
During this active stage of labour, midwives do observations- they take blood pressure, pulse, respiration rate, all at regular intervals. Vaginal examination happens when two fingers are inserted into the vagina to check how dilated the cervix is. This can also check the position of the baby. We try not to do this too often, so ask your midwife why they are recommending this.
Midwives will also use a doppler to measure the heart rate of the baby. A CTG machine might also be used and make sure that you ask for a wireless one so that you can still move about.
Midwives note how much fluid you’re taking on and off and if you’re emptying your bladder. Midwives will also look out for a purple line which appears in between your bottom cheeks when you are in advanced labour. This indicates that the baby is really low down the vaginal canal. If you want to go for a poo, this also means that your baby is soon to be born. Midwives actually get very excited about this stage!
You can request pain relief throughout your labour. Move about as much as possible, keep trying different positions. Upright positions are great as gravity is on your side. There will be lots of toys and equipment for you to use at hospital- bean bags, stools, balls. Ask if they have a peanut ball as it’s good to have between your legs during labour.
The next stage is a short transitional stage, it’s the point in when you are coming up to fully dilated. This is usually when you have a feeling of loss of control. This stage is very short. Focus on each surge as it comes. Each contraction brings you closer to meeting your baby. It means that things are cracking on! Birth affirmations really motivate you to carry on; buy or draw them and put them up in the room. For example, ‘my body knows how to birth my baby’ Warn your birth partner about this sign of labour. If they know what to expect, they will be able to support you better.
You’ll then be in the second stage. This is where you are fully dilated, and lasts until your baby is born. It involves pushing and it can take a few hours. Your cervix is fully dilated and the baby begins going down the birth canal. Contractions become more intense and you have a real urge to push, lots more pressure on your bowels. If you have an epidural, the midwife will guide you when to push. If not, your body will tell you exactly when to push. It will become so overwhelming you just have to push. Baby’s head rocks back and forth round the U bend of the birth canal. It starts to stretch the outside of the vagina and your midwife will start to verbally give instructions. Maybe asking you to pant and this is so that your baby can be born in a slow controlled way to reduce the risk of tearing. Midwives might put their hand on the perineum to protect it. Listen to your midwife so that it is a slow controlled birth.
Once the baby is born they quickly check that baby is ok and give them to you for a cuddle- congratulations!
Delivery of the placenta.
This is the third stage of labour and you have two options to deliver the placenta.
Active management- certain women will have risk factors for bleeding so this is safe for them. In this, we give an injection into your thigh and it contracts your uterus so that the placenta can move down. It risks the reduction of bleeding as it contracts all the blood vessels. Side effects such as nausea and vomiting can happen and the placenta will be delivered within 30 minutes.
The other method is physiological management which is only suitable for women who have no risk factors for bleeding. Midwives wait for the placenta to leave the body. Stand up and gravity helps push it out. If you do decide to have active management you can do this at any point.
by Suzi Smith •