The first stage of labour has two phases: latent and active. You will have regular contractions, which start off like strong period pains and gradually become stronger and more frequent. The contractions gradually dilate your cervix (the entrance to your womb) until it is 10cm wide and fully dilated.
What is the latent phase?
The latent phase is the start of your labour. This phase can last anywhere from 6-10 hours up to 2-3 days, although it is often much shorter for second and subsequent babies. It can be a tiring and exhausting time but it is completely normal. It helps to remain relaxed and to stay at home in your own surroundings as long as you can, unless you have been advised to attend hospital as soon as your labour starts.
Some women will experience backache and cramps, or episodes of contractions that could last a few hours, but then stop and start again the next day.
In this phase, you’ll experience uncomfortable contractions which are often irregular. They may feel sharp but they are usually short. These first contractions help to soften and dilate (open) the cervix which has been closed throughout your pregnancy. As the contractions become closer together, longer and stronger, the cervix will begin to shorten and open up (dilate).
You may have a “show” which means losing some or all of the mucous plug from your cervix. This may be streaked with blood, which is perfectly normal. A show is a good sign as it means your cervix has started to change, and your body is preparing for active labour, but it doesn’t necessarily mean that active labour will happen that day.
We do not need to see you when you have a “show”, but you should call Labour Line on 0300 369 0388 if:
You feel that the blood is more than a streak
You are unsure whether your waters might have broken
You are concerned
When the cervix is 4cm dilated and the contractions are regular (approximately 4 in 10 minutes, lasting at least 45 seconds), labour has progressed to the active phase.
Coping with the latent phase
Relax as much as possible, you can do this by trying a bath, as warm water is known to benefit in this stage of labour
Some women find massage relaxing as this involves the use of therapeutic touch to relax you, both emotionally and physically. It can help backache, ease swollen ankles, lowers blood pressure and relaxes stiff muscles. We know that touch impulses reach the brain quicker than pain impulses, so massage helps by releasing “feel good” chemicals, which act as natural pain killers, also reducing stress hormones
Paracetamol can help when in the latent phase – always check the packaging and do not exceed the recommended dose
Take long, deep, slow breaths during the contractions, this helps reduce pain and gets you into good habits for when you are in active labour
Try and have regular rests and naps. You may not sleep deeply or for long if your contractions are regular but rest at this time is important
Listening to your favourite relaxing music, perhaps with candles can create a feeling of calm
Eat and drink regularly. You need to keep well hydrated and have good energy levels on board. Try eating small, light meals containing carbohydrates and consider energy drinks as well as plenty of water
Distract yourself as much as possible. Find a good book to read, music to listen to or film to watch. If possible, sit on a birthing ball whilst doing this as this can help the baby get into a good position and alleviate some of the discomfort you are feeling
If you have a TENS machine, this is a good time to use it, particularly if you are suffering with back pain
Empty your bladder regularly. A full bladder can push against your womb and affect your contractions, sometimes causing them to stop. It can also mean the baby has less room to move about and get into a good position. Additionally, it is good to empty your bowels if you feel the need.
Stay at home. The best place for any woman in the latent phase of labour is at home in familiar surroundings, supported by people she trusts. It is a good idea for you to stay at home for as long as possible where you are more likely to remain relaxed and comfortable. Staying at home will encourage the production of oxytocin (the hormone required to get into labour) as well as endorphins (the body’s own natural pain relievers). There is also evidence to show that the further on in labour you are when you come in to hospital, the more likely you are to have a normal birth
When to get help
If you think your waters may have broken, you should always call Labour Line on 0300 369 0388 for assessment.
If you attend the maternity unit for assessment and you are in the latent phase, you will be given advice on pain relief and coping strategies and advised to return home. Research suggests that labour wards are not the best place for women who are in the latent phase of labour.
It is important that you monitor your baby’s movements during this stage, as you normally would at any other time. Some women find it difficult to know if their baby is moving when they are contracting and tired.
If you are not sure whether your baby is moving as they normally do, you must phone Labour Line (0300 369 0388) for advice.
The active phase is usually considered to start when:
Your contractions are strong and regular
Your contractions last for at least 60 seconds
Your cervix is at least 4cm dilated
During the active phase of your labour, your contractions will become stronger and closer together, and lasting longer, as they work to open your cervix. Continuing to use all your coping mechanisms will help you through this last part of the first stage, which can vary in length. Speak to your Midwife about further pain relief if you feel you need it.
Remember, you should phone Labour Line on 0300 369 0388 if:
Your waters break
You are bleeding
Your contractions are coming around every 5 minutes and lasting 60 seconds
You are worried and need advice or support
You are not coping
As your labour progresses, your team midwife will be there to support and advise you. They will assess how your labour is progressing by offering you vaginal examinations every few hours, or as needed. Your midwife will also palpate your tummy (feel your tummy to see how the baby is positioned), check how well you are contracting, and check how you and your baby are responding to labour. These things will show the whole picture of how your labour is progressing. The team will share this information with you and your birth partner at all times and give you the opportunity to discuss any worries or questions you may have.
Some women have clear plans of what they do and don’t want to happen during their labour. These plans can change as labour progresses. The midwife caring for you will support you and explain any changes to your birth plan. Try not to feel bad if things change. Talk things through with the midwife and/or obstetrician caring for you, so that you understand why the changes are advised.
Your midwife will confirm when your cervix is 10cm – this means you have reached the second stage of labour, and you will be meeting your baby soon!
The second stage of labour is when your baby is born. Just like the first stage, everyone experiences the second stage of labour differently. This stage can last from a few minutes (especially in second or subsequent labours) and up to three hours. Don’t worry, this doesn’t mean you will be pushing for three hours straight!
Some women won’t feel the urge to push when they are fully dilated. This can be due to your baby’s position and how high they are in the birth canal. Often your baby just needs a bit of time – sometimes changing your position can help your baby to move lower and trigger the urge to push.
The length of the second stage of labour will also depend on how your baby is reacting to the pushing, which position they are in, how well you are, and how effective your contractions are. There are times when your baby will need help to be born, either through an assisted delivery or by caesarean. If your team thinks this is necessary, they will discuss this with you.
During the second stage, women often feel that they can’t carry on, but most women find new strength, determination and energy to continue pushing. If your labour has been very long and you really are struggling to keep going, the staff will talk to you about your options to help deliver your baby safely.
You will be supported by your team midwife to breathe slowly or pant as your baby’s head is being born to try to prevent any tearing. They will then help you birth your baby by delivering their shoulders if necessary. Once your baby is born, you should be able to hold them right away, as long as they are well.
Birth partners often cut the cord. The midwife will guide you through this, so don’t worry.
All babies are encouraged to have skin-to-skin contact with their parents as soon as possible. This promotes bonding between you and your baby. If you plan to breastfeed, you should be able to try feeding your baby right away.
Not all babies are born a pink colour, and some may not cry immediately. Try not to worry if this is the case, this can be normal. Your midwife may tell you that your baby needs some help to take their first breath. Midwives and neonatologists (doctors who specialise in caring for babies) are highly experienced in dealing with these situations.
The third stage of labour is when your placenta (also known as “afterbirth”) is delivered. There are two ways of managing this stage:
Physiological: Delivering the placenta without intervention. This takes longer than active management and can last up to an hour. During this time, you can usually relax and cuddle with your baby.
Active: You will receive intervention from the medical staff to speed up the process. If you choose active management of the third stage, your midwife will give you an injection of a hormone called syntometrine or oxytocin into your thigh after your baby is born. This reduces bleeding by helping the blood vessels in the womb to contract, and sealing over the placenta’s blood supply. It usually takes 5-10 minutes to deliver the placenta after the injection has been given but can take up to 30 mins.
There are lots of factors to consider when deciding on a physiological or active third stage, and if you’ve decided before labour you may change your mind when it comes to it.
It is usually completely your choice. However, if you have had a long labour, if you are bleeding heavily or have had some form of assisted delivery, you will be advised to have the injection to reduce risk of more bleeding.
After your placenta has been delivered, your midwife or doctor will check your perineum (the area between your vagina and rectum) to see if you need any stitches. If you do, they will give you a local anaesthetic to numb the area before they start suturing (stitching). You can continue to use the gas and air for this part if needed. If you already have a working epidural in place, you may not need any additional anaesthetic as the area will still be numb.
Once this has been done, you will be offered a shower if you are able to walk, or a chance to freshen up and change your clothes. You will be offered refreshments and given time to enjoy relaxing with your baby.
The midwife will give your baby an initial check, weigh them and offer to give your baby Vitamin K. This helps to prevent a rare bleeding disorder called haemorrhagic disease of the newborn. You should have been given information about this during your pregnancy. It is usually given as in injection – if you are not comfortable with this it is possible to give Vitamin K orally, but more doses will be needed.
Some women will contract and go into labour spontaneously within a few hours after their waters have broken. If this doesn’t happen within 24 hours, you will be offered the choice of an induction of labour due to increased risk of infection.
Remember to always call the Labour Line for advice when your waters have broken. Report any signs to the Labour Line midwife straight away if you are feeling unwell. You should also check your temperature every 4 hours.
Contact Labour Line on 0300 369 0388 if:
Your temperature is 37.5 degrees or more
Your waters change from a clear colour to coloured and/or are smelly
Occasionally, babies are born with their amniotic sac intact so intervention may not be necessary. When you are in established labour and your waters haven’t broken naturally, your team midwife may offer to break them for you when she performs a vaginal examination. They may recommend this if your labour is slowing down. Some women choose to wait and not have their waters broken artificially. You will be able to discuss how your waters are managed in labour with the midwife caring for you.
Sometimes things can slow down during the first or second stage of labour, meaning that your contractions can become less regular, or reduce in strength or length. If this happens you will be offered a synthetic drug version of the nature hormone called oxytocin. This is given via a small plastic tube (cannula) placed into your vein, usually in the back of your hand. This is connected to a small electric pump that regulates the dose of the oxytocin. You will be advised to have continuous monitoring if you are given oxytocin, as the midwife needs to see how your baby reacts to this.
You will be assessed by a senior obstetrician who will examine you and discuss the safest and best way to deliver your baby. This might be an assisted birth or a caesarean but the team will discuss your options with you.