Labour
In this section
Signs and symptoms of labour
Labour can start in different ways, and just as every baby is unique, every labour will start off slightly differently. There are three main signs that labour is starting:
You may notice tightenings in your bump.
You are probably used to practice tightenings (Braxton Hicks) from the last few weeks. These are different. Early labour tightenings develop into longer, stronger and more regular labour contractions. Some women prefer to think of tightenings and contractions as surges or waves as this makes them easier to welcome. Early labour tightenings might be:
More like period cramps than anything you’ve felt in a while
Stronger than practice tightenings
Lasting longer than practice tightenings
Coming predictably after a set amount of time
You may find you need to stop what you’re doing when they come and just give yourself a moment. They might last a few seconds, or they might last half a minute or more. The gap between could be a few minutes, or it could be half an hour or even longer. Contraction tracker apps are useful to keep a note of the pattern.
Early labour tightenings will develop into long, strong, regular labour contractions but this can take up to a couple of days, especially with a first baby. It is also normal for the early labour tightenings to ease off.
This is not unusual, and the important thing is to remind yourself that it won’t last forever. Concentrate on saving your energy for when things do move to the next phase.
The waters may be released
You may get a backache.
What to do when labour starts
Get in contact when:
The contractions are getting longer, stronger and more regular
Or your waters are leaking
Or you have any concerns.
If your waters are leaking, you will be invited for an assessment. If the waters are clear and your baby is moving well, this is reassuring. You can discuss the best timing for the assessment with your team.
If you’re having contractions without water leaking, you will be asked to call back once contractions are long, strong and regular. This is the sign that you are reaching ‘active labour’, also called ‘established labour’. In active labour, the neck of the womb is opening. This is the stage where regular or continuous monitoring of the baby is advised and your midwife will travel to you for home birth, or you will travel to the birth centre or obstetric unit.
Signs you are in ‘active’ labour:
Contractions generally last 45 seconds to one minute or more
It is usually difficult to talk during a contraction
From the start of one contraction to the start of the next will generally have shortened to be just a few minutes.
Call or call back if you think it is ‘active labour’ or if you have any concerns. If you experience any of these, then call your unit urgently:
Signs of labour before you reach 37 weeks of pregnancy
Bleeding from the vagina that is not a show
Waters leaking before you reach 37 weeks of pregnancy
Waters leaking at any time which have a green or brown tint
Pain from your bump which is constant, not coming and going.
Bump, Birth & Beyond have more information here about the early stages of labour, what to expect and how you can cope.
Preparing for planned caesarean
A caesarean section is an operation which means your baby will be born via a cut in your abdomen. The cut is usually just below where your pubic hair starts to grow.
Bump, Birth and Beyond have plenty of information on:
Why you may need a caesarean section
What to expect during a caesarean
Pain relief and anaesthetic
Caesarean risks.
Pain relief
Gas and air
Entonox or Gas and Air is a pain relief that is taken via a mouthpiece and breathed in. It is a very safe method of pain relief, that has no lasting effects. Entonox can make you feel slightly dizzy and lightheaded and some people can feel sick whilst using it, but the effects do not last for long. Gas and air is available at home, at the birth centres and in hospital and is usually recommended when you are in active labour.
Pethidine
Pethidine is an injection that goes into your thigh or buttock to help with the discomfort of contractions. Pethidine is an opioid drug, so it can make you feel drowsy or sleepy after it is given. Your midwife will discuss whether it is suitable for you to have Pethidine when discussing your pain relief options. Pethidine passes in small amounts through the placenta to the baby. This is very unlikely to cause any serious harm, but it can make breastfeeding more difficult to establish. Pethidine can be used in early and active labour and is available at birth centres and hospitals.
Epidural
Epidurals are only offered in an obstetric unit, and usually only once you are in active labour. For an epidural, an anaesthetist puts a needle in the lower part of your back and uses it to place a thin plastic tube (epidural catheter). The needle is removed and the tube left in place next to the nerves in your back. Medication (local anaesthetic) is given through the tube to provide pain relief throughout your labour. Top-ups are given when needed (or you may have a button for top-ups). You may have to wait a short while for the anaesthetist to be available. It can take a while to set up the epidural and around 15 to 20 minutes to start working. You will need to have a drip placed in your arm and continuous monitoring of the baby’s heart rate.
Monitoring during labour
Your midwife will monitor you and your baby regularly throughout labour to make sure you’re both okay and everything's going as it should.
Regular checks can help to pick up any potential issues early.
Your midwife will check:
Your blood pressure, pulse and temperature
Your urine
How often you’re having contractions, how long they last and how strong they are
Vaginal examinations to check how far dilated your cervix is, the position of your baby’s head and how far down the birth canal it is.
Measuring your baby’s heart rate is a good way of checking their health and strength throughout labour and birth.
Your midwife will listen to your baby’s heart every 15 minutes in the first stage of labour and after most contractions once you’re in the second stage.
If you have any complications, continuous monitoring of your baby’s heartbeat may be suggested.
There are different ways to monitor baby, including:
Pinard stethoscope, a type of ear trumpet put on your abdomen to let the midwife hear and count baby's heartbeat
Doppler, a small portable machine using ultrasound through a small transmitter-receiver on your abdomen to pick up baby’s heartbeat
Electronic Fetal Monitoring (EFM)
Telemetry.
Three stages of labour
There are three stages of labour:
The first stage, when the neck of the womb (cervix) opens to 10 centimetres
The second stage, when the baby moves down through the vagina and is born
The third stage, when the placenta (after birth) is delivered.
Before labour starts, the neck of the womb is long, firm and closed. As the latent phase begins, the neck of the womb begins to shorten and soften (known as effacement) and will start to open (dilate) up to four centimetres.
There may be contractions at this point, but they are often irregular, short lasting and not quite as strong as the active phase of labour – although in some cases they can still be quite intense. The active phase is when the labour has become established, meaning that the cervix is open to four centimetres or more and the contractions are regular, stronger and lasting longer than before.
Both the latent and active phases take place during the first stage of labour. Eventually at the end of the first stage, the neck of the womb has opened up to ten centimetres and is described as being ‘fully dilated’.
The second stage of labour lasts from when your cervix is fully dilated until the birth of your baby. When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. You may get an urge to push that feels a bit like you need to poo.
You can push during contractions whenever you feel the urge. You may not feel the urge to push immediately. If you have had an epidural, you may not feel an urge to push at all.
The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.
There are two ways to manage this stage of labour:
Active – when you have treatment to make it happen faster
Physiological – when you have no treatment and this stage happens naturally.
Your midwife will explain both ways to you while you're still pregnant or during early labour, so you can decide which you would prefer.
NHS Choices has information on the three stages, what to expect and when to contact your midwife.