What happens during labour and birth?
Labour describes the gradual process of the womb contracting
that eventually results in the birth of your baby. Every labour is
different and its pattern and progress can be difficult to predict.
This is a very special and unique time, and here at Saint Mary's we
hope to support you as much as you need through this process.
Please note: Because of the risks of surgery to mum and
baby, Saint Mary's does not offer Caesarean section without medical
or obstetric reason.
In this section we will describe the basics of labour, and what
to expect. More information is available from your midwife and also
from parent education
There are three stages to labour:
- The first stage, when your contractions make the neck of the
womb (cervix) gradually open up (dilate). This is usually the
longest stage. It includes 'early labour' (also known as the
'latent phase') and 'established labour'.
- The second stage of labour is when your cervix is fully open
and you give birth. This is the part of labour where you help your
baby move through the birth canal by pushing with your
- The third stage of labour is after the birth, when your
womb contracts and causes the placenta (or after birth) to deliver.
This is usually the quickest stage and takes less than 1 hour.
How will I know when my labour starts?
The main signs of labour starting are strong, long, regular
contractions and a 'show'. A show is when the plug of
mucus from your cervix comes away. However, it is not unusual
to 'have a show' several days or weeks before your labour begins
and unless it is heavily blood stained, this is nothing to worry
Other signs that labour is beginning include your waters
breaking (rupture of the membranes), or strong intermittent
backache and contractions that become more regular.
You're likely to recognise the signs of labour when the time
comes, but if you're in any doubt, don't hesitate to contact your
midwife for advice.
What are contractions like?
When you have a contraction, your womb (uterus) tightens and
then relaxes, like a stronger version of period pains.
You may have had contractions throughout your pregnancy,
particularly towards the end. During pregnancy, these painless
tightenings are called Braxton Hicks contractions.
When you are having regular, painful contractions that feel
stronger and last more than 30 seconds, labour may be starting. As
labour gets going, your contractions tend to become
longer, stronger and more frequent.
During a contraction, the muscles in your womb contract and the
pain increases. If you put your hand on your abdomen, you will feel
it getting harder. When the muscles relax, the pain fades and your
hand will feel the hardness ease. The contractions are pushing your
baby down and opening your cervix (entrance to the womb), ready for
your baby to go through.
For the majority of women with an uncomplicated pregnancy,
studies have shown that the labour will progress better in your own
environment at home, therefore your midwife will probably advise
you to stay at home until your contractions become and remain
For first-time mums, it is not uncommon for your contractions to
become stronger and regular and then slow down again. This is
simply your body preparing for active labour so take the
opportunity to rest whilst you can. Remember to eat and drink
plenty of water to keep your energy levels up during this
When your contractions last 30-60 seconds and occur every
five minutes, call your midwife for further guidance.
If you're planning to have your
baby in the Midwifery Led Unit contact the unit directly on (0161)
If you have been recommended by
your doctor or midwife to have your baby in the Consultant Led
Unit, please contact Triage on (0161) 276 6657.
If your midwife has advised you to come into the hospital,
please remember to bring your hand-held notes.
Other common symptoms in labour
Lower backache is very common in labour and is part of the
normal processes. You may get backache or the aching, heavy feeling
that some women experience with their monthly period.
What is a 'show'?
While you are pregnant, a plug of mucus is present
in your cervix. Just before labour starts, or in early labour,
the plug comes away and you may pass this into your underwear. This
small amount of sticky, jelly-like pink mucus is called a
It may come away all at once or gradually. It is pink in
colour because it's blood-stained, and it's normal to lose a small
amount of blood mixed with mucus. If you're losing more
blood, it may be a sign that something is wrong, so telephone
Triage on (0161) 276 6567 straight away.
A show may indicate that the cervix is starting to open and
labour may follow quickly, or it may take several days or even
weeks. Some women do not have a show.
What happens when your waters break?
Most women's waters break during labour, but it can also happen
before labour starts. Your unborn baby develops and grows inside a
bag of fluid called the amniotic sac. When it's time for your baby
to be born, the sac breaks and the amniotic fluid drains out. This
is your waters breaking.
You may feel a slow trickle, or a sudden gush of water that you
cannot control. To prepare for this, you could keep a sanitary
towel (but not a tampon) handy if you are going out and put a
protective sheet on your bed.
Amniotic fluid is clear and a pale straw colour. Sometimes it's
difficult to tell amniotic fluid from urine. When your waters
break, the water may be a little blood-stained to begin with.
Tell your midwife immediately if the waters are smelly or coloured,
or if you are losing blood, as this could mean you and your baby
require urgent attention.
If your waters break before labour starts, contact Saint
Mary's hospital on the number you have been given by your midwife.
If you can't find this number, or have not been given it, call
Triage on (0161) 276 6657 for advice. Without amniotic fluid
your baby is no longer protected and there is a small risk of
How to cope when labour begins
At the beginning of labour:
- Walking and moving can help the labour to progress.
- Drink plenty of clear fluids and you may find isotonic drinks
(sports drinks) help keep your energy levels up.
- Have regular snacks, although many women don't feel very hungry
and some feel sick.
- As the contractions get stronger and more painful, you can try
relaxation and breathing exercises - your birth partner can help by
doing these with you.
- Your birth partner can rub your back as it
can help relieve pain.
- You can take paracetamol 1g (2 tablets) every 4-6 hours, up to
a maximum of 8 tablets in 24 hours.
- A warm bath or shower may also help.
The first stage of labour
The neck of the womb, or cervix, needs to open fully to about
10cm for a baby to pass through. This is what's called being 'fully
dilated'. Contractions in early labour help to soften
the cervix, so that it gradually opens.
The process of softening can take many hours before you're in
what midwives call 'established' or 'active' labour. Established
labour is when you are having regular contractions and your cervix
has dilated to 4cm or more. If you come into Triage or the
Midwifery Led Unit before labour is established, you may be advised
to go home for a while to wait for your labour to establish. If you
go home, you should make sure you eat and drink, and you can always
contact your midwife for further guidance.
At night, attempt to get comfortable and relaxed. If you can,
try to sleep. A warm bath or shower may help you relax. During the
day, keep upright and active. This helps the baby move down into
the pelvis and helps the cervix to dilate.
Once labour is established, the midwife will examine you
regularly to see how the labour is progressing. In a first labour,
the time from the start of established labour to full dilation is
usually between 6 and 12 hours.
Monitoring your baby in labour
Once your labour has established, your baby's heart rate will be
monitored throughout. There are different ways of monitoring the
baby's heartbeat and these will be discussed by your midwife:
- Your midwife may listen to your baby's heart intermittently,
for at least one minute every 15 minutes when you are in
established labour, using a handheld ultrasound monitor. This
method means you are free to move around. This is the best method
of monitoring for women with healthy pregnancies on the Midwifery
- Your baby's heartbeat and your contractions may also be
monitored continuously using a machine called a CTG
(cardiotocograph). Two monitors will be held onto your abdomen
(tummy) using soft belts. You can still get up and move around with
a CTG, but how far you can move will depend on the type of machine.
On our Consultant Led Unit, we have a wireless CTG monitor which
can be used in the birthing pool.
- If the midwife cannot get a good trace of your baby's heart
rate through your abdomen, they may recommend putting a clip on the
baby's head to record the heart rate. The clip (called a fetal
scalp electrode) is put on during a vaginal examination and your
waters will be broken if they have not already done so.
- Sometimes it is necessary to find out whether a baby is coping
with the contractions and maintaining their oxygen levels. If this
happens, the doctor will talk about an extra test on your baby
called a fetal blood sample (FBS). This involves taking a small
scratch of blood from the baby's head, and is quick and safe to do.
It has been shown to reduce unnecessary interventions during
Speeding up labour
If your contractions are not frequent or strong enough or if
your baby is in an awkward position, your doctor or midwife will
discuss speeding up the labour. The following techniques may be
- Getting up and moving around, drinking more water or isotonic
drinks and/or making sure you have emptied your bladder can often
encourage your contractions to become frequent again.
- Breaking your waters using a procedure called artificial
rupture of membranes, or ARM, is often enough to speed up the
labour. During a vaginal examination, the midwife or doctor makes a
small break in the membranes around your baby.
- A drip containing a drug called Oxytocin or Syntocinon, which
is given into a vein in your arm to encourage contractions. After
the drip is attached, your contractions and your baby's heartbeat
should be continuously monitored with a CTG.
The second stage of labour
This includes the 'pushing' stage. It begins when the cervix is
fully dilated and lasts until the birth of your baby. Your midwife
will help you find a comfortable position and guide you when you
feel the urge to push.
Finding a position to give birth in
Find the position you prefer and that will make labour easier.
You can stand, sit, kneel or squat and an upright position is
recommended as this is the easiest and most effective position to
help the baby be born. Some positions are more appropriate
depending on the position of your baby and your midwife can guide
you to choose the best position for both of you.
Pushing the baby out
When your cervix is fully dilated and your baby moves downwards,
you will feel a very strong urge to push. The midwife will support
you with this. Find out more about
what your birth partner can do.
The third stage of labour
This is the name given to the delivery of the placenta. It is
recommended that you have an injection in your thigh just as the
baby is born, to speed this up and to prevent heavy bleeding. If
you would prefer not to have this injection, please discuss this
with your midwife.
Soon after your baby is born, your midwife will examine your
vagina and perineum for any tears and either your midwife or a
doctor will repair these (if needed) to help the healing
Encourage your baby to lie skin to skin on your chest after
birth - this could also be done by your partner. Skin to skin his
has been shown to encourage parent-baby bonding, regulate baby's
temperature and breathing and will encourage you both to recover
after birth. It also prepares your baby for their first feed,
regardless of feeding method.
It is recommended to let your baby breastfeed as soon after
birth as possible. This helps with breastfeeding later on and it
also helps your womb contract. Most babies start sucking
immediately. However, this sometimes occurs just for a short period
of time - they may just like to feel the nipple in their mouth.
Pain relief in
You Tube video: Pain Relief in Labour