Labour – first stage
Once your contractions have started getting closer together and more intense, this is known as the first stage. This stage lasts from the beginning of labour until your cervix is fully dilated (open to 10cm). This is usually the longest part of the labour process and can take many hours, particularly if it’s your first baby.
During labour, if it is straightforward, you will be encouraged to mobilise. Unless continuous monitoring of the baby’s heartbeat is necessary, the midwife will monitor your baby’s heart using a handheld ultrasound monitor or a Pinard's stethoscope.
The midwife looking after you will also read your birth plan so that she knows your particular wishes and choices for labour and birth. Your midwife will be happy to discuss these with you.
Labour – second stage
This is the part when the baby is born. It starts when your cervix is fully dilated and you begin to push. This stage can last an hour or more, especially if you have an epidural for pain relief, but is often shorter if you have had a baby before.
Your midwife will help and support you through the birth.
In some cases, due to a complication, a vaginal birth may not be possible. This might be because:
- the baby is breech (coming out bottom or feet first)
- your or the baby develops complications
In some cases, the doctor looking after you may decide the safest way for you to give birth is by caesarean section. A caesarean section operation lasts about 45 minutes and is done either under a local spinal anaesthetic (which means you stay awake), or general anaesthetic (which puts you to sleep).
The surgeon makes a small cut in your abdomen and lifts the baby out. If you are awake, you can have someone in the operating theatre with you.
You won’t be able to see anything as a screen will be placed across your abdomen, but you will be able to see your baby as soon as it is born.
Labour – third stage
Once your baby has been born, the placenta needs to be delivered. If you are healthy and have had a problem-free labour, you may choose to give birth to the placenta naturally. If your baby starts trying to feed at the breast soon after birth, it makes your body release a hormone to speed up the birth of the placenta.
Alternatively, your midwife can offer you an injection in your thigh just as the baby is born which will speed up the delivery of the placenta. The injection contains a drug called syntocinon, which makes the uterus contract.
Coping with pain and pain relief during birth
There are many methods of pain relief available to you during labour, including:
- breathing, relaxation and massage techniques
- having your labour in water, which is recommended for pain relief (for example, a bath or birthing pool)
- pethidine or diamorphine, which are a form of morphine and strong painkillers – these can only be given during the first stage of labour and may also interfere with breastfeeding
- Entonox (gas and air) – a painkiller which you breathe in either through a mask or mouthpiece
- epidurals – an injection in your spine making you numb from the waist down
Twins, triplets or more
If you are expecting more than one baby, labour may start early because of the increased size of the uterus. It is unusual for multiple pregnancies to go beyond 38 weeks.
If there are no complications in your pregnancy, your doctor may offer you a planned birth earlier than 38 weeks. The timing of the planned birth depends on the number of babies and if your babies share a placenta. Your doctor will discuss this with you during your pregnancy.
More health professionals will usually be present during the birth. For example, there may be a midwife, an obstetrician and two paediatricians (one for each baby).
Delivering multiple babies
Your doctor will discuss with you what type of delivery may be best. Although you are more likely to have a caesarean section, in some cases twins can be delivered vaginally.
The process of labour is the same, but the babies will be closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once the waters have broken.
You will be given a drip in case you need it later and an epidural is usually recommended. Once the first baby has been born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination.
If the second baby is in a good position to be born, the waters surrounding the baby will be broken and the second baby should be born very soon after the first because the cervix is already fully dilated. If contractions stop after the birth, hormones will be added to the drip to restart them.
Triplets or more are almost always delivered by elective caesarean section.
Your birth partner
Whoever your birth partner is, you should discuss your birth plan with them, so they can support your decisions.
There are a few practical things they can do to help you during labour, including:
- keep you company
- help you to move or get more comfortable
- encourage you as labour progresses
- remind you to use relaxation and breathing techniques
- help you to discuss your options with your midwife or doctor
- tell you what is happening if you cannot see for yourself