Three stages of labour.

Labour is usually divided into three stages. The first stage is the longest for almost everyone, but its length is very variable. Anything between one hour and 20 hours is normal. Labour begins as a response to hormonal triggers coming from the baby. The baby's adrenal gland matures and starts to secrete the hormone ‘cortisone’. In response to this, the mother produces hormones called ‘prostaglandins’ - and it's these that stimulate the uterus to start contracting.

Stage 1

With each contraction:

• The uterus pushes the baby down.
• The cervix opens up and becomes thinner.
• By the end of first stage, the cervix is fully open; enough to allow the baby to pass through and into the birth canal (the vagina). This is described as being 10 centimetres dilated or fully dilated.
• How contractions change at the beginning of labour, contractions last about 40 seconds, once every 10 minutes. By the end, each contraction lasts longer than a minute, with a gap of no more than a minute between each one.

Labour tends to speed up as it progresses. It normally takes far less time for the cervix to dilate its second five cms, compared to its first five. Most women cope best with this stage of labour, if they feel free to move into whatever position feels best. These may include:

• Kneeling
• Leaning forwards on a floor cushion or your partner's lap
• Leaning against a wall
• Resting on all fours or anything else that helps - different positions may work better for you at different times.

Monitoring your baby’s heart…

• During labour, a foetal monitoring keeps a close watch on your baby's health by measuring its heart rate.
• The nurse or doctor may use a Pinard stethoscope, which looks like a sort of ear trumpet. They’ll place it against your abdomen and listen to the baby's heart.
• You may be linked to an electronic foetal monitor which picks up and displays the baby's heart rate as a number on a screen.
• Alternatively, a small electrode, clipped onto the baby's scalp picks up the heartbeat, and the result is transmitted to the machine. This form of monitoring can be continuous.
• A doppler machine uses ultrasound for monitoring. A small transmitter-receiver is placed on your abdomen to pick up the heartbeat.

Stage 2

The second stage of labour begins when the cervix is fully dilated, and ends with the birth of your baby. The stage lasts anything from a few minutes to a couple of hours.

You'll know you're at second stage when you feel a very powerful need to push downwards. If you've had an epidural, you may not feel this as powerfully, or even at all. This pushing is called 'bearing down'. The nurse or your doctor will help you know what to do if you don't feel it.

You may feel the need to hold your breath to bear down; but don't hold it too long. Your nurse/doctor knows best. They may even tell you to not push - maybe because a small 'lip' of cervix is still tucked in. When the lip dilates, you're ready to go!

Or, they may see your perineum - the skin between your vagina and anus - is extremely stretched and want to prevent a tear. You might be asked to 'breathe the baby out' with light, gentle breaths.

Some women just don't feel the urge to bear down, even if they don't have an epidural. The baby just slides out. This is only likely to happen if you have already had a few children.

The first sight of your baby

When the head becomes completely visible at the vulva, it's said to be 'crowning'. You or your birth partner can hold a mirror up if you want to, so you can see this moment. With the next contraction or two, your baby's head emerges first, and then the rest of him or her follows. The concerned doctor or nurse will gently lift your baby and place him or her in your arms or on to your tummy, so you are able to witness this beautiful little miracle.

The best position to be in…

Anything that allows you to feel as comfortable as possible between contractions, and lets your baby emerge safely.

• A supported standing squat allows your pelvis to open wide, and your baby to be born with the help of the force of gravity. You need support for your upper body to help you stay balanced. If your partner's strong enough, he can hold you from behind, under your arms. Your knees shouldn't be higher than your hips (this would strain your joints).
• A stool or chair supports you, in a sort of semi-squatting position. You may also need to be held.
• All-fours allow you to take a rest by leaning forward between contractions.
• Lying flat doesn't really help the birth. There's some compression of your pelvis, and your baby has to travel 'uphill' against gravity. Sitting up in the bed, supported by plenty of pillows and perhaps your partner, is a better option.
• On your side, with your upper leg raised, is restful if you are tired and can't be more upright.

The moment of birth.

Your baby's head usually emerges facing towards your back. The midwife may check the baby's umbilical cord, to make sure it's not round the neck. The shoulders then turn, so the body is sideways on, and the head, now outside of you, turns to the side as well.

Sometimes, forceps are used to get your baby out. Forceps are a set of linked spoons that grasp the baby's head to help it along. A ventouse uses a vacuum pump to help the baby make these last important inches on the journey. A baby might need either of these to be born more quickly, for example:

• If he's distressed' - shown in a slowing heart rate, or if the baby passes meconium (the contents of the baby's rectum) which will stain the liquor (amniotic fluid), or shown in a blood sample taken from the baby's scalp.
• If his way out is difficult, because he is in a poor position, or because the mother's pelvis isn't able to open wide enough.
• If your contractions have weakened, or you're exhausted, then a pair of forceps is the need of the hour.
• If the baby is pre-term, which means his soft skull bones need more protection.

Sometimes, the perineum tears while stretching over the baby's head. Or, the nurse/doctor may ask if they can cut the perineum because they feel you are about to tear badly or the baby needs to be born quickly. You will be cut if you have forceps. This cut is known as an episiotomy. Large tears and episiotomies need stitching up afterwards. You will be given a local anaesthetic while this is done. The stitches should dissolve by themselves; you don't usually need to have them taken out.

Stage 3

• The third stage of labour is the delivery of the placenta (the afterbirth) and the membranes. It begins just a few minutes after your baby's birth, and lasts between 10-20 minutes. You might hardly be aware of the third stage happening.
• Usually, you're given an injection of hormone into your thigh or your buttock, which stimulates the uterus to contract. This injection is given when your baby is being born, usually when the first shoulder is emerging. The nurse should ask you for your consent before she does it.
• Then, as your baby is born, the umbilical cord is clamped, and cut.
• The injection now takes effect. The uterus contracts very strongly, and the placenta peels itself off the inner wall of the uterus. You may be able to push the placenta out, or else the nurse helps the delivery of the placenta by putting one hand on the abdomen to protect the uterus, while the cord is kept taut with the other.
• At the same time as the placenta peels away, the blood vessels, which hung on to it, close off and stop bleeding (though it's normal to bleed a little).
• A physiological third stage - using no injections, and waiting to cut the cord, and without helping the delivery of the placenta – this is when your doctors decide to leave things to happen naturally.
• The action of feeding your baby at the breast, or just simply having the baby there, stimulates the release of the hormone oxytocin. This acts on your uterus, which then contracts, expelling the placenta and membranes. The cord is cut when it stops pulsating, and often after the placenta is delivered.
• If you prefer a natural third stage, tell the people looking after you, and discuss it before you go into labour. If you have had problems during your pregnancy, or during your labour, a natural third stage may not be a safe option.