Signs and stages of labour
How do you tell Braxton Hicks from real contractions and what should you do when your waters break? Here we take you through each stage of labour and what happens during and after birth.
- What are the early signs of labour?
- What do contractions feel like?
- What should I do if my waters break?
- When should I call the midwife?
- What are the different stages of labour?
- What is the recovery like after a vaginal birth?
- Coronavirus and giving birth
Your body goes through an incredible process when you’re in labour, starting with the dilation of your cervix through to the birth of your baby and delivery of the placenta.
However, early labour is often a very slow and gradual process, and it’s not always clear if you’re actually in labour or if your body’s just gearing up for birth with practice contractions.
Labour can start in many different ways and every birth is different – so even if you’ve already had a baby, your second labour could be completely different from your first.
Some of the most common first signs that your baby is on its way are:
- you’re having painful contractions
- your waters break
- you have a ‘show’ (when the mucus plug comes away from your cervix)
- you experience backache or period-like pains
- you have a strong urge to go to the toilet.
Your womb is one big muscle, and when you get a contraction it tightens up. Having a contraction can feel like someone giving you a really tight hug and if you touch your bump during a contraction, it feels rock hard. After the contraction, the muscles will relax again. Contractions are also painful, like very strong period pain.
In the first stage of labour, contractions push your baby downwards, helping your cervix open up ready for birth.
How can I monitor contractions?
Monitoring your contractions is the easiest way to see how close you are to being in established labour. Keeping track of contractions can be a good activity for your birth partner to be in charge of, so you can focus on managing the pain.
You can either use a pen, paper and a watch, or one of the many apps or websites that are available to help you time contractions. Whichever tools you use, there are just two things to note down:
- the time the contraction starts
- the time the contractions ends
Once you have noted down a few contractions, you or your birth partner can calculate:
- the duration of each contraction – the time between the contraction starting and it ending.
- how close together the contractions are – by checking how many minutes there are between the start time of each contraction.
How can I tell the difference between Braxton Hicks and real labour contractions?
Braxton Hicks contractions can be an uncomfortable symptom in the second half of your pregnancy. These ‘false’ contractions are your womb’s way of practising before the birth, but they don’t mean that you’re going into labour yet.
Just like with contractions when you are in labour, your uterus tightens and then relaxes when you have a Braxton Hicks contraction. However, there are some differences between Braxton Hicks and labour contractions that can help you identify if you are about to give birth.
First, put on a maternity pad so you can collect any leaking fluid. Your midwife may want to take a look to check that it is amniotic fluid and that there’s no meconium in the water. Then, call your midwife or maternity unit to see what you should do next.
If your waters break before you go into labour, there’s a 60% chance you’ll go into labour spontaneously within 24 hours, but your midwife may want to monitor your temperature and the baby’s movements in the meantime to make sure that you’re both doing OK and aren’t developing an infection.
If your labour doesn’t start on its own, your midwife will talk to you about your options for having an induction, as the risk of infection to the baby increases the longer your waters have been broken.
How do I know if my waters have broken?
In most cases, you’ll probably know when your waters break as there’s a gush of warm water. Some women also report hearing a bit of a ‘pop’ when it happens.
However, it’s also possible for your waters to break only partially, with water coming out very slowly, and it can then be hard to know for sure if your waters have broken.
If you suspect you may be leaking water, it’s always best to have a midwife or doctor check you over so you can get the care you need.
At your antenatal appointments, your midwife will talk to you about when you should call them or when to travel to the hospital or birth centre once labour has started.
There are a few cases where you should contact your midwife immediately to get advice:
- if you’re less than 37 weeks pregnant
- if your waters break before labour starts
- if you have vaginal bleeding
- if your baby is moving less than usual.
Otherwise, the general rule of thumb is that it’s time to contact health care professionals when you’re in established labour. This is usually when you have contractions that last 60 seconds each and come every five minutes.
Labour is often split up into three distinct phases.
Early labour: up to 4 cm dilated
The latent phase of labour (also known as pre-labour or early labour) is the time when your cervix softens, thins and reaches a dilation of four centimetres.
It’s not unusual for early labour to last for several days, or for contractions to start and stop again a few times before you go into active labour, which can be both frustrating and tiring.
The first stage of labour: 4-10 cm dilated
The first stage of labour, also known as active labour, starts when you’re four centimetres dilated and are having regular, painful contractions. It’s very individual how long this stage lasts, but it can take from five to 18 hours.
Because the first stage can last quite a while, it’s important to try to eat and drink regularly to keep your energy levels up, so remember to pack some snacks in your hospital bag.
It’s also good to keep active, and it can help to adopt different upright or kneeling positions to use gravity to push the baby down on your cervix. Labour wards and birth centres have a range of equipment that can help you with this, for example:
- birth ball
- supporting rope
- bean bag
- birth pool.
If you want to have a home birth, your midwife can show you different ways you can use this environment in the first stage to keep active and upright, for example:
- walking up and down stairs
- leaning on chairs
- kneeling in front of a sofa or bed.
Use our home birth checklist for more tips on things to have ready before you go into labour to help you in the first stage.
The first stage of labour is also when you’ll have the most need for, and the greatest choice of, pain relief methods. Make sure you’ve talked your preferences through with your midwife in advance and have noted these down in your birth plan, so you both have an idea of what you may like to use on the day.
Transition: the last part of the first stage
When you’re around 7-8 centimetres dilated, you’re entering the transitional phase which lasts until you’re fully dilated. This is the very end part of the first stage of labour and many women find it the most intense and painful part of the birth.
However difficult you’re finding this stage, it’s a sign that the long first stage of labour is coming to an end, and you’re very close to meeting your baby.
The second stage of labour: birth of the baby
The second stage of labour is when your baby is born and it starts when you’re fully dilated and need to push.
The part of birth when you’re pushing your baby out can last from a few minutes to a couple of hours. Just like with the first stage of labour, the second stage usually takes longer if you’re a first-time mum.
If you’re in a birth pool for pain relief, you may choose to stay in it to have a water birth. Out of water, you can stand, kneel, lean, sit on a birth stool or lie down – there are many different positions to give birth in and it’s all about finding which one is right for you.
Your midwife will help you find the best position while also keeping an eye on your baby’s heart rate to make sure you’re both coping well through the contractions.
If you have specific thoughts about birth positions you’d like to try when giving birth, how you want your baby’s cord clamped and whether you’d like them skin-to-skin immediately, it’s a good idea to write it down in your birth plan in advance, so your midwives are aware of your preferences.
The third stage of labour: delivery of the placenta
After your baby’s been born, the placenta and the remaining parts of the umbilical cord need to be delivered. This can happen within a few minutes or up to an hour after your baby is born.
You’ll have two choices for how you want to deliver the placenta:
- Physiological third stage: You wait for the placenta to be delivered naturally, either through you pushing it out or from it sliding out when you stand up.
- Active/managed third stage: You’ll get a hormone injection in your thigh that helps your uterus contract and detach the placenta from your uterus.
Hospitals often recommend a managed delivery as there is some evidence to suggest you’re slightly more likely to suffer from heavy blood loss with a physiological third stage. However, the choice is yours and many midwives are very supportive of a natural delivery of the placenta.
What if things don’t go to plan?
Above we’ve outlined what you can expect in an uncomplicated vaginal birth. There are many things that can happen during labour to make it less straightforward, so you may find it useful to also read our advice on interventions and c-sections to feel prepared for all eventualities.
No two births are the same and postpartum recovery is also specific to the individual, so there’s no way of knowing in advance how long it will take your body to heal.
In general, if you have an uncomplicated vaginal birth, you can expect any pain or soreness around your perineum to subside a month after the delivery. You may find it takes longer to recover if you experience any birth complications, for example extensive tearing, or if you had an assisted delivery.
If you do have any concerns about your recovery, you can always contact your midwife, health visitor or GP for advice.
Healing from tears and stitches
Tearing happens when the skin between your perineum and vagina stretches to allow your baby to be born. Most women have some tears and require stitches after a vaginal birth, but the good news is that most new mums only have minor tears and heal well.
It will take between one and two weeks for your tears to heal after the birth, and it’s normal to feel pain during this time and still be sore for some weeks after that.
You’re likely to be in more pain and take longer to recover if you have more severe tearing that requires stitching in theatre, or an episiotomy. There is pain relief you can take, so don’t be afraid to ask for advice if you find you’re in a lot of pain.
After the birth, your womb immediately starts to shrink back to its pre-pregnant state through contractions known as afterpains. There is pain relief you can take if you find the contractions too painful, so make sure you talk to someone at the postnatal ward or your community midwife if you’re struggling to cope.
As your womb contracts, you’ll also experience vaginal bleeding known as lochia. It can be very heavy at the start, so stock up on plenty of maternity pads in advance and make sure you put a pack (or two) in your hospital bag ready for after the birth. The bleeding usually lasts for two to six weeks, but can carry on for a bit longer without there being a problem.
It’s very common to leak a bit of wee when you laugh, cough or move suddenly, but this usually gets better within a few weeks. To speed up the process, it’s important to do pelvic floor exercises to help strengthen your pelvic floor muscles.
Many women get piles after giving birth – thankfully they usually go within a week. To make yourself more comfortable, and not worsen the piles, try to loosen your stools by eating lots of fresh fruit and vegetables, drinking plenty of water, and avoid pushing or straining on the toilet.
Exercise after a vaginal birth
While you can go for walks and do things around the home as soon as you want to following a vaginal birth, it’s a good idea to wait until your six-week postnatal GP check-up before starting any new exercise regime, just to make sure your body has healed fully.
Having sex after birth
How soon you’ll feel ready to have sex again after giving birth is very personal, and there isn’t a set amount of time that you should or shouldn’t wait. It’s important to listen to your body and to take things at your own pace.
Medically, you should wait to have vaginal sex until your bleeding has stopped, to minimise the risk of infection. It’s also important to use a method of birth control right from the start if you don’t want to get pregnant again.
Having a baby doesn’t only affect you physically, there is also a psychological and emotional impact. As well as reaching out to your midwife, health visitor or GP, you can also find information and support through these organisations:
- The Birth Trauma Association has peer support groups for people affected by birth trauma and post-traumatic stress disorder.
- Make Birth Better has a map of NHS and private practitioners who work with women and their partners after a difficult birth.
- PANDAS has a helpline and peer support groups for parents with antenatal and postnatal depression.
If you go into labour, call your maternity team for advice. Let them know if you have suspected or confirmed coronavirus.
If you have mild symptoms and are self-isolating, you will be encouraged to remain self-isolating at home in early labour, in line with standard practice.
If you have suspected or confirmed coronavirus, when the time has come to go to hospital, you are advised to get there by private transport where possible.
When you arrive you should notify them of your attendance but before entering the hospital.
You will be met at the maternity unit entrance and be provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room.
Your maternity team have been advised on ways to ensure that you and your baby receive safe, quality care that respects your birth choices as closely as possible.
As long as they don't have coronavirus symptoms, your birthing partner will still be able to stay with you throughout your labour and birth, although they might not be allowed to stay with you on antenatal or postnatal wards.
There will also be restrictions on them staying with you if you are being induced in a bay on the labour ward rather than in a single room.
If you have a caesarean or instrumental birth under a spinal or epidural anaesthetic, they should be allowed to stay with you but if it's an emergency procedure with a general anaesthetic they won't.
In these instances, your maternity team will do everything they can to ensure that your partner can see you and your baby as soon as possible after the birth.
Check with your maternity team for more information.
As it stands, if you have suspected or confirmed coronavirus infection, there is currently no evidence to suggest you can't give birth vaginally or must have a caesarean.
When it comes to how you will give birth if you have suspected or confirmed coronavirus, it isn't recommended you use a birthing pool in hospital as the virus can sometimes be found in faces.
Not only that but it may also be difficult for healthcare staff to use adequate protection equipment during a water birth.
If you have chosen a home birth or one in a midwife-led unit that isn’t co-located with an obstetric unit, it’s important to understand that these services rely in the availability of ambulance services for rapid transfer to hospital if needed and the right number of staff to keep you safe.
If these aren’t in place, it’s possible your local health trust or board might not be able to provide these services.
You can still have an epidural or spinal analgesia or anaesthesia (a spinal block) if you have suspected or confirmed coronavirus.
In fact, The Royal College of Obstetricians and Gynaecologists (RCOG) says an epidural should be recommended before or in early labour to these women to minimise the need for a general anaesthetic if urgent delivery is needed.
Entonox is still an option, too.
It had previously been suggested that the use of Entonox might increase aerosolisation and spread the virus but this has now been disproven and it can be used.
An RCOG spokesperson said: 'Women’s birth plans should be followed as closely as possible. Please check with your local maternity as to the birthing options available.'
Page last updated 06/04/20. Please check out Royal College of Obstetricians and Gynaecologists for any more recent updates.