Most women are healthy and have a straightforward pregnancy and labour.
There are three stages that you will go through when you give birth vaginally. Labour varies according to a number of factors, such as whether or not it's your first pregnancy, the size of your baby and its position in your womb.
Before active labour starts, your body goes through some changes in preparation, so it's not always easy to tell exactly when labour has started.
When your baby is ready to be born, the balance of hormones (chemicals found naturally in your body) changes and makes your cervix (the neck of your womb) become softer and shorter.
You may also have what is called a show. This is when the plug of mucus that acts as a seal in your cervix during pregnancy falls out as your cervix changes shape. This may happen any time between several days and a few hours before labour starts.
Hormones also cause you to have contractions. The muscles in your womb tense and relax becoming shorter so that your cervix stretches and opens (dilates). Contractions feel like a wave. They start gently and gradually build, becoming intense and then easing off. It may take some time for the contractions to become regular but they will gradually get stronger and closer together.
At first you may only have a contraction every 15 to 30 minutes. After a while, they will be more frequent and stronger, occurring every two to three minutes. The length of time that each contraction lasts is usually between 10 and 40 seconds, but this will be different for every woman.
When you have a contraction, you will feel a build-up of tension across your abdomen (tummy), pain in your back and possibly also between your thighs and low down in your pelvis. You may also find that your waters break. This is a normal part of labour and is when the bag of fluid that surrounds your baby breaks as your cervix widens. It's also referred to as your membranes rupturing. The fluid may rush out in one go or in a steady leak. Your waters can break at any time during labour.
However, if your waters break when you're not in labour and labour doesn't start within the next few hours you should contact a midwife or doctor for advice on what to do next.
The first stage of labour continues until your cervix is fully dilated, about 10cm, allowing the baby to move lower through your pelvis. For women having their first baby, labour lasts on average for about 8 hours, most of which is the first stage of labour. Labour is unlikely to last for longer than 18 hours. It's likely to take less time if it's not your first baby, because your pelvis and vagina have been stretched before.
The second stage of labour is when you give birth to your baby. It usually lasts about one to two hours.
As the baby's head gets lower, you will eventually feel a strong urge to push and this helps the baby to be born. This is a unique feeling which your body does of its own accord. You will still be having contractions to help you push, though they may be less frequent but longer. You may feel more comfortable if you are upright, kneeling, sitting or squatting.
As you push, your baby moves further down through your pelvis until his or her head stays at the entrance to your vagina between contractions. This is called 'crowning' and means your baby is about to be born. Usually, the head is born first followed by the shoulders and the rest of the body.
This is when the placenta and membranes that held your baby in the womb are passed out of your body. This can happen naturally or you may be given a medicine to help the process.
Active management of the third stage by your midwife or doctor
A midwife or doctor may be able to help the third stage to progress more quickly and safely.
As your baby's shoulders are being born, you may be given an injection of a hormone called oxytocin, or a combination of oxytocin and a medicine called ergometrine. Within about two minutes, these cause your womb to contract strongly to help reduce serious bleeding. The umbilical cord is clamped and cut as soon as your baby is born. The midwife or doctor will then deliver the placenta by pulling gently with one hand on the part of the umbilical cord that is still attached to it.
This takes about 10 to 20 minutes. Research has shown that this method reduces your risk of serious bleeding. However, it's possible that you will have some side-effects as a result of the medicines. These can include headache and feeling or being sick if you were given an injection of ergometrine.
Availability and use of medicines may vary from country to country.
Natural (physiological) management of the third stage
You may choose for the placenta to be delivered without any medicines. After your baby is born, you will be encouraged to cuddle him or her and try breastfeeding. This causes hormones to be released which help your womb to contract and push out the placenta. The umbilical cord isn't clamped and cut until the placenta has been delivered. This can take anything from a few minutes to up to an hour.
There are a number of reasons why this type of third stage may not be possible, including:
- if you had an epidural or pain relieving drugs during labour
- if you have had a long labour
- if you had heavy bleeding during this pregnancy or with a previous birth
- if there were problems during labour or if you had an assisted delivery
Your midwife or doctor will give you more information about your options.