What Are The Stages of Labour?
In this blog post, I will describe the labour process and what you can roughly expect. But, firstly, I want you to remember that you are an individual. You and your baby are unique, and your labour will be different from every other birth. Even if you have already had a child/children, this birth will be different!
In midwifery textbooks, labour is defined in stages, and there are further stages within those stages. But since labour is different for every woman, should we still box women into these stages? I think not! If you have a hospital birth, you will most definitely be assessed based on whether you are in the early, active or transition stage of labour, so I will explain each stage to you.
Please be aware that labour is not lineal - it is normal for it to start and stop or ebb and flow. No one can tell you how long your labour will be; you are the only one who can define your labour. If you find out that your cervix is 5cm dilated, all you know is that you are 5cm dilated - it does not mean that you are halfway there - it could mean that you are nearly done! I've been at births where women have dilated from 5-10cm in less than an hour.
Your pregnancy is the perfect time to learn and educate yourself about your body's innate ability to birth as nature intended. Physiological labour and birth mean you allow your body to go through labour under its own natural power. It is the ideal functioning of childbirth and is a safe process that includes labour, birth, and the first hour after birth for both you and your baby. A healthy birth does not routinely require medical intervention.
Physiological labour requires surrender, patience, trust, encouragement and safety. You need to know that your body is designed for birth; it is a natural process that women have been going through since the beginning of time. In unmedicated labours, a woman's body provides pain relief and support in the form of hormones - without her needing to do a thing.
So, here are 3 stages of labour, as your care providers would define them.
The first stage is when the cervix opens (dilates) to 10cm.
The second stage is when the baby moves down through the vagina and is born.
The third stage is when the placenta is birthed.
Stage one can be broken down into smaller parts too. The first part is early labour (or warm up labour) This is where everything is getting ready, the cervix starts to efface (thin) and dilate (open). The contractions can be strong and “grippy” but there is generally not really a regular pattern to the contractions.
In early labour, your body is preparing for birth and you’ll notice some changes such as a mucus discharge called a ‘show’ which could be clear or tinged pink or blood-stained - it looks like the kind of mucus you get from your nose when you have a cold. You could have lower back pain and/or period-like pain that comes and goes. Some women get loose bowel motions (which is great because it clears out the bowels in preparation for birth). You might have a sudden gush or a slow leak of fluid from your vagina if your waters break or your membranes rupture. The ‘waters’ should be clear or slightly pink. (A greenish or bloody colour can indicate that there is meconium in your waters so call your midwife if this is the case). Some women have an urge to vomit, that sounds strange too, but don’t worry, it is quite common to vomit during labour.
The early part of labour is a good time to keep busy in between the irregular contractions. Please stay at home for as long as you can, have regular snacks (pasta is good as the carbohydrates will give you energy) You can get some jobs done that you need to do or go for a walk or walk up and down steps if you feel like being active. Bouncing gently on a fit ball is good and light touch massage is lovely bonding time between you and your partner. It’s a great time to watch a movie you love that’ll help with the release of oxytocin and endorphins (feel good hormones). Remember to sit in a way that encourages baby into the optimal birthing position (leaning forward, or side lying, not slouching back).
You’ll probably be really excited but try to rest as much as possible; keep yourself in a dark room and all snug and cosy and ‘nesty”. Put on some gentle, quiet music if you’d like - keeping oxytocin high in the early stages of labour is a great way to keep labour progressing, don’t disturb the space by turning on lights or calling friends to announce you are in labour! If it’s night time try and get some sleep. If it’s day time, shut the blinds/curtains and keep everything calm and quiet and dark. Try relaxing in a bath or a shower.
Some of the signs that you are in warm up labour are period pain like cramping, lower back pain, discomfort in the lower abdomen, perhaps diarrhoea or even constipation. You could feel some pubic bone discomfort too. This stage is all about going with your body and doing what feels comfortable while you’re thinking positively about your cervix effacing and dilating.
Next comes active labour - this is when things start to really heat up!
This is where your body will be working hard, having good, long, strong, regular contractions - we’ll be really pleased if you’re having 2-3 good strong contractions in a 10 minute period because that signals that your body is doing everything it should be doing and we get happy about that! Don’t be daunted by this, you may have heard that this stage is hard because it’s kind of the marathon stage and sometimes it can feel long - but you’ll have your partner there to support you and if I’m your doula, I’ll be there. We’ll both be right by your side, you can count on us for this stage and we’ll keep you safe and protected. You’ll be getting regular breaks in between contractions. Every contraction you have will be shrinking your uterus and squeezing your baby down into your birth canal so that you can meet it. Every contraction is one step closer to holding your baby, once you’ve had that contraction you get a rest and you don’t have to do that one again. Each one is stepping you closer. Your body knows what to do, just go with it, trust it, it is beautifully designed and you’ll be amazing if you let it do what it knows to do.
We’ll know you are in the active phase when your contractions are lasting longer, and getting closer together, they will start to feel more intense and you’ll be concentrating through each one on your breathing so you wont be able to talk through them. You’ll feel like you need to go to the toilet more and this is great, a good sign because the increased pressure in the rectum and groin area means your baby is coming down just as we want. Don’t be alarmed if you see an increase in bodily fluids, there will be mucus and blood and maybe amniotic fluid released, again this is all good. You will have feelings of being stretched and you might even feel the baby move down.
During this phase I’ll be encouraging you to be upright and slightly forward, like leaning forward onto your partner, or sitting forward on the toilet, or on all fours. Keeping you in an ‘active’ position, means your baby can descend with the help of gravity making your birth easier.
We can try some rocking together or circle work of your hips during contractions, we’ll try lots of things to see what you’re comfortable with - you can try bouncing on the fit ball, we’ll try walking around and we’ll see if stairs are good. The heat of the bath or shower can be really lovely during this stage so we can try that. During your contractions, your partner and I will take in turns to apply counter pressure on your lower back (just above your coccyx bone) or the double hip squeeze - this can relieve a lot of discomfort and can really help loosen the muscles and keep you relaxed and breathing. I’ll give you light touch massage and I’ll show your partner how to do this as well so you will always feel like are supported. I’ll be offering you drinks to keep you hydrated, if you have a long labour and get hungry, I’ll have some tinned peaches or a teaspoon of honey or a square of chocolate to give you some energy. We’ll get you going to the toilet often to keep your bladder empty - a full bladder can stop the baby descending so we’ll make sure you’re weeing. By the end of this phase your cervix will be 7cm dilated.
Next comes transition. Your cervix will open from 7-10cm usually within the hour so it is quite an overwhelming time for most women. Your body will be working really hard at this stage, it is the most physically and emotionally challenging phase of labour and you may start to doubt your body at this time so I’ll encourage you now that your body can do it, you can do it, and you can trust your body to birth your beautiful baby. At this stage of labour, I am really going to ramp up my encouragement to you, because honestly you’ll be nearly there, it is the last hump before you can push your baby out. This is truly an amazing phase, things that you wouldn’t normally do, you can do during this phase - you might feel angry or irrational, you may become demanding or dismissive, you could be emotional and want to give up (if at this point you say something along the lines of “I cant do this” then I’ll be really encouraged as this is one of the best signs that you are in transition - this means we are so close and I’ll be cheering you on for the last bit of the marathon and telling you “You ARE doing it!”) You can feel really hot or really cold, both of these are normal, and you can feel shaky from the hormones but this is great because these hormones will give you the energy you need to get through. You’ll start to feel an uncontrollable urge to push or bear down and you’ll have more intense pressure and strong sensations in the lower back and around your bottom - like you need to do a big poo, this is all excellent and these signs are showing your midwife that you are very close to being able to push. During this time, your partner and I will be reminding you that you are safe and fully supported and we’ll be giving you lots of encouragement, this is where I’ll be encouraging you to drop your shoulders, relax your jaw (by resting your tongue on the roof of your mouth, just behind your teeth) and I’ll tell you to uncurl your fists if they are clenched. I’ll remind you to breathe and let your muscles be loose and relaxed. This is the time that you need to trust your body and believe it can do what it was made to do. When you feel urges to push, go with those urges and you’ll soon be holding your baby.
The final stage of birth is the delivery of the placenta and that’s amazing, but you’ll be so taken up by your new baby that this will just happen spontaneously so don’t worry about it. Again trust your body to do this part because it knows what to do. Have a look at your placenta and see where your baby has been laying, check out the sac that your baby was in and the veins that look like a tree. I’m fascinated by placentas because they are incredible - did you know the placenta is the only organ that the body grows that is disposable? An entire new organ to sustain the baby - amazing!