Three Stages of Labour

three stages of labour

Three stages to becoming a mummy

Our step-by-step guide to what giving birth is really about and a discussion of the three stages of labour

by Health Editor Radhika Holmstrom

If you’re reading this feature early on in your pregnancy, it may seem virtually impossible to get your head round the fact that yes, you really will end up giving birth to a baby. In fact many of us go on feeling that way for quite a long time – sometimes up to the moment when we first set eyes on our newborn. It’s not just the mechanics of birth (daunting though they are – even when your body’s made to accommodate the exit of a baby). It’s also the mind-boggling move from being a ‘non-parent’ to ‘parent’, with a whole new person in your life, for life. But the fact remains that the day will come only too soon.

The course of how you get there isn’t always predictable. “Things can change rapidly in labour,” says antenatal teacher Rachel Francis. “You can plod along slowly and then speed up: you can be going along swimmingly and suddenly there’s a need to get the baby out.”

Overall, labours follow a set of distinct stages. We’ve focused both on what happens to your body and on how you feel as you go through those stages.

The run-up

It’s easy to tell if you’re in labour, right? We’ve seen it on television – your waters go pop, your contractions start and it’s time to be whizzed to hospital, giving birth in minutes and only breaking into a light sweat. In real life, it doesn’t always work that way. With first pregnancies, it’s a pretty clear sign when the baby’s head ‘engages’ (and your bump drops into the tell-tale silhouette of late pregnancy) that labour’s drawing near; but that doesn’t necessarily mean it’s imminent.

Some of us go straight into a very recognisable labour (although it’s not usually over in 40 minutes). Others have days of wondering “is this it?” with intermittent backache and regular trips to the loo (caused by the baby’s head pressing against your bowel). If you’ve had Braxton Hicks (‘practice’) contractions, they may well escalate, and in fact for some women it’s hard to tell when these stop and ‘real’ contractions take over. It can be very stop-start.

“If you don’t get real pain – and some women don’t – you may not realise that you’re in labour,” advises Mars Lord, a Doula with Birth in the City. “Do you feel any different? Is there a niggling feeling in your back, for instance? My biggest tip is to listen to yourself.” You may feel different emotionally too – some women don’t want to leave the house and want to ‘nest’ (if you’re not usually the housework type, this is a giveaway).

And of course, you can call your birth team at any point to check. Good professionals will be happy to hear from you. You don’t have to get in touch with your birth team or go to hospital till you feel ready – but once things are under way, it’s good idea to let them know, even if you don’t want to go in yet. “Think about the logistics of getting
to hospital,” Francis says. “How far do you have to go? How are you getting there and what’s the traffic like? If you’re pottering around at home quite happily, you’re doing really well. You don’t need to go in till you are ready.”

If your waters break but contractions don’t start, or if at any stage you start bleeding, get hold of them immediately.

Stage One – getting going

First stage labour, as it’s called, is what’s really unpredictable. This is when your baby really starts moving down, pushed by the contractions, which get closer together, stronger and more painful as labour progresses. Rather unkindly, you’re only considered to be in ‘established labour’ when your cervix has dilated to three centimetres, but in reality you may well have been contracting quite strongly for some time up till now. Before that, you’ll be told you’re “not really in labour” and may even be sent home from hospital.

But each woman feels each labour differently, depending on the position your baby’s in, your own body and of course your own ability to tolerate pain (which is also connected to how long you’ve been going already). You may also surprise yourself by re-thinking your birth plan. “Sometimes you realise that you don’t want to be in any of the positions you chose before,” says Lord. “You won’t know what you want in advance and when you do it, it may feel wrong.“ And that applies to more than positions, she adds: “Even your gorgeous caring partner, who’s doing everything they can to help, can start getting on your nerves. Lots of us just go into our primal selves, wanting privacy and security rather than lots of people around us.”

Interestingly, Francis points out that often women who’ve been the most worried during the course of their pregnancy surprise themselves by how calm they are when they’re finally in labour. “There’s no one size fits all,” she says. “It’s such a uniquely personal experience – you can’t imagine it till you do it.”

This stage, too, can be quite stop- start, with contractions slowing down or even halting for a while. Again, if the professionals are worried, they’ll start discussing taking action.

Transition Phase

Between stages one and two is the famous ‘transition’, when your cervix dilates from around seven to ten centimetres. It’s the hardest part of labour – yes, even harder than pushing the baby out – and it’s when you also feel quite weird physically and emotionally. “Some women feel nauseous or sick. It’s a sign of what’s going on. It means birth is really quite imminent and the second stage is very close if you just hang on in,” Francis says.

It’s also, the stage where a lot of women feel they can’t do this and try to go home. “That’s the adrenaline rising – it’s primeval and it’s very useful, from this stage right to the end,” Lord explains. And linked to that, it’s when many of us who’ve been relatively in control up till now decide we aren’t up to being in charge any more – and hand over to a professional who can steer us (often quite bossily!) through from now.

Sometimes there’s a brief ‘rest and be thankful’ pause after this but often you’re straight in to the second stage.

Find out more about pain relief in labour

Stage Two – welcome baby

So here it is…your body’s finally pushing the baby out. “Second stage feels quite different,” says Francis.“You’re working with your uterus and you’ve got a job to do. It’s a very active phase of labour. You may want to shift position and just get on with the pushing but the midwives are more in evidence, trying to guide you into position.” They may tell you not to push too early, too, and encourage you to ‘breathe’ the baby out.

Ah yes, pushing. Another thing that isn’t always as obvious as you might think. “We’re told ‘you’ll know when you need to push’ but it takes a few moments. If you can’t do it, don’t assume that you’ve got it wrong. Everything really is about listening to your own body,” reassures Lord. What the ‘urge to push’ does feel like, if and when it arrives (and occasionally it doesn’t) is like an overwhelming need to open your bowels. In fact, it does often feel rather more as if the baby’s emerging from your bottom than your vagina, because there’s so much general pressure on everything in that area.

As your baby’s head ‘crowns’, pushing out of the vagina, there’s another sensation to add to the mix – the stinging and burning of what new mums call the ‘ring of fire’. In between pushes, baby’s head slips back a bit but your body is going to do it, even if it takes a few hours. Once the head and shoulders are through, the rest of your baby’s body will follow pretty quickly.

Stage Three – they think it’s all over

Your baby’s out – but there’s a few final pushes to go. The third stage of labour involves delivering the placenta, that hard-working organ that has been nourishing your baby for the past 40 weeks or so and doing such a fantastic job. These contractions are not nearly as noticeable as previous ones – not least, of course, because your mind by now is on other things, including your brand new baby. Your health professionals may advise that you have a ‘managed’ third stage, giving you an injection of syntocinon into your thigh to make your uterus contract and expel the placenta more quickly, or they may prefer to let this happen on its own, especially if you’re skin to skin and possibly starting to breastfeed your newborn. Do try to get a look at your faithful placenta, though – it’s actually much larger than you’d think and quite startling in appearance. If you have plans for it such as burying it under a tree, now would be the time to say and if you have arranged for stem cells to be taken for storage for your baby’s future health, the phlebotomist will take it away now.

And finally…

So how does it feel, to be in those first few moments of motherhood? We can’t give you a blanket rule. You may be zonked, elated, bewildered, tearful, quite detached, overwhelmed by love or just longing for some sleep…or any combination of these. You may be surrounded by professionals, by your family – or by very few people. And of course there are some births where you’re not with your baby at all for those first few moments, because they need some special care.

What we can say is that this is just the beginning. You’ve made that move into parenthood and it’s the start of a whole life-changing experience. Believe it or not, in just 12 months your precious newborn should be a robust toddler. So welcome to motherhood. And well done, you’ve done an amazing job.

Make a plan – you don’t have to stick to it!

Be prepared for your birth not to stick to plan even if you have made a meticulous one. Sometimes births go partly or completely awry – and many of us do find ourselves faced with options we wouldn’t ideally have chosen, or indeed not much option at all. If that’s the case, of course you may feel panicky and upset. You may even feel that you’ve ‘failed’ in some way.

You can’t prevent an unpredictable labour but you can prepare for it. Find out the whole range of ways in which birth is managed – from an instrumental birth to a Caesarean – however determined you are on one particular route. Don’t forget third stage labour too. “Of course not all women can have a perfect birth. We have doctors for those times when we need them, when things don’t seem to be going according to plan – so make alternative plans. You’re much more likely to feel guilty if you hand yourself over and don’t know what you’re handing yourself over to,” says Lord.

Before the event

Before you are ready for labour, there are a number of things that you need to have done, thought about and organised. Here’s your handy pre-labour checklist.

◗ Pack your hospital bag. Don’t know what to include? See our helpful guide

◗ Make sure you have your hospital notes to hand and always include your birth partner’s number, some loose change for vending machines and car meters, a list of emergency contacts and a spare phone charger.

◗ If you have children already, make sure there’s a plan with a trusted friend or relative to collect them from nursery or school and look after them until you get back home.

◗ Have you thought about how you would like to announce the birth? It might be worth having a few lines written (with parts you can change according to the sex and name of the baby) that you can email or put on social media. Don’t forget close relations like your parents and siblings would probably rather be told first than seeing the news at the same time as everyone else! If you’re old school, some pretty announcement cards are great.

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