Stages of labour Guide
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Baby’s journey of labour
The human pelvis has a complex shape, making your baby negotiate several manoeuvres during labour and birth.
Every mother’s pelvis is widest side to side at the entrance – because of this, most babies enter the pelvis looking left or right. The exit from the pelvis is widest from front to back, so babies almost always turn face up or face down.
These manoeuvres occur from forces of labour and the resistance provided by the birth canal. In addition to making these turning manoeuvres, the baby is simultaneously descending further down the vagina.
Finally, the top of your baby’s head appears (crowns), stretching your vaginal opening. When the vulva has stretched enough, the baby’s head will emerge – usually by extending the head, lifting its chin off the chest and thus emerging from under your pubic bone.
The baby usually emerges face down but will turn to one side very quickly as the shoulders turn to take the same route. The rest of the body is born and then you can hold your new baby!
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Hormones during labour
Oxytocin: Known as the hormone of love, oxytocin is secreted during sex, after ovulation and during labour, birth and breastfeeding. It creates nurturing and loving feelings.
Endorphins: Endorphins are produced in response to pain and stress. Endorphins have calming and pain-relieving effects. As labour progresses and pain intensifies, endorphin levels steadily increase in unmedicated labours.
Adrenaline: Adrenaline is also known as the ‘fight or flight’ hormone. Adrenaline is secreted in response to stress, fear and extreme pain. If a woman experiences these feelings during labour, too much adrenaline may be produced which can slow labour.
More information: Hormones in labour: oxytocin and the others – how they work
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Stages of labour
Labour is divided into four stages.
- The first stage of labour is the slow opening of your cervix.
- The second stage is the birth of your baby.
- The third stage is separation and birth of the placenta.
- The fourth stage is the first two hours after birth.
The main signs of labour starting are:
- contractions
- a ‘show’ (a mucous blood-tinged vaginal discharge)
- waters breaking.
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First stage of labour
The first stage of labour is made up of three different phases and involves the thinning of the cervix and its dilation to around 10 centimetres.
Latent phase
- Generally, this stage is the longest and the least painful part of labour.
- The cervix thins out and dilates from zero up to four–six centimetres.
- This may occur over days or hours and be accompanied by mild contractions.
- The contractions may be regularly or irregularly spaced, or you might not notice them at all.
Active phase
- The next phase is marked by strong, painful contractions that tend to occur three or four minutes apart, and last from 30 to 60 seconds.
- The cervix dilates from four–six to eight centimetres.
Transition
- The cervix dilates from eight to 10 centimetres (that is, fully dilated).
- These contractions can become more intense, painful and frequent. It may feel as though the contractions are no longer separate but running into each other.
- It is not unusual to feel out of control and even a strong urge to go to the toilet as the baby’s head moves down the birth canal and pushes against the rectum.
Throughout the first stage of labour, careful monitoring and recording of your wellbeing, your baby’s wellbeing, and the progress of your labour, is important. This helps us to know whether your labour is progressing normally, to recognise any problems early and for clear communication. Ideally, you will experience the latent phase in the comfort of your home. You may wish to come to hospital as you move through the active phase.
More information: Queensland Clinical Guidelines parent information – Early labour
What can I do in the active stage of labour?
Birth partner’s role
- Remind your partner to go to the toilet.
- Help her with changing positions.
- It might help to dim the lights or play some music.
- Support her in any decisions she makes about pain relief.
- Keep yourself relaxed as possible and look after your needs.
- Sometimes humour can lighten the atmosphere when appropriate.
Helping yourself in first stage
- Stay well hydrated.
- Eat lightly during labour; your digestive system naturally moves more slowly, and you may find that you become nauseated. Some easily digested foods include fruits, yogurt or toast.
- Choose positions of comfort; you might find that your body instinctively moves to certain positions during contractions.
- Slow swaying movements may also help during contractions.
- Standing helps your body and your baby work with gravity and encourages the downward movement of your baby through the pelvis.
- Remember – an empty bladder is more comfortable and gives your baby more space to move down.
More information: Pregnancy, Birth and Baby – Giving birth - first stage of labour
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Second stage of labour
The second stage of labour is the birth of your baby.
The second stage of labour starts when your cervix is fully dilated, and you will usually have a strong urge to push because of the pressure your baby’s head is placing on your pelvic area.
At this stage your baby is moving from your uterus into your vagina and out into the world.
The second stage can last from 10 minutes to two hours.
What can I do in the second stage?
Helping yourself during the second stage
- Push when you have a contraction and relax in between.
- It is more effective to get two or three pushes in with each contraction, breathing in between, rather than one long push.
- Being upright allows gravity to help you.
- Relax your pelvic floor muscles around the vaginal opening.
- Your midwife may apply warm compresses to your perineum for comfort and to reduce tearing.
Birth partner’s role
- Help your partner into a comfortable position.
- Your encouragement is important but avoid cheerleading.
- It can be helpful to repeat the midwife’s advice to your partner in a calm steady voice.
- Offer your partner sips of water or ice.
More information: Pregnancy, Birth and Baby – Giving birth - second stage of labour
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Third stage of labour
After the birth of your baby, your uterus gently contracts to loosen and push out the placenta. This may occur five to 30 minutes after the birth of your baby.
The muscles of the uterus continue to contract to stop the bleeding. This process is always associated with a moderate blood loss – up to 500 millilitres. In this stage of labour, one of the potential problems is excessive bleeding (postpartum haemorrhage), which can result in anaemia and fatigue. This is why the third stage is carefully supervised.
There are two approaches to managing the third stage:
- natural (also known as physiological or expectant) management, or
- active management.
Natural third stage
What is a natural third stage?
A physiological or natural third stage means that you wait for the placenta to be delivered naturally.
After your baby's birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby.
Your uterus (womb) will contract, and the placenta will peel away from the wall of your uterus. The placenta will then drop down into your vagina, ready for you to push it out.
Delayed cord clamping
For baby
The benefits of delayed cord clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells which results in higher iron stores in the baby for up to six months.
For mother
Delayed clamping keeps the mother-baby unit intact and can prevent complications with delivering the placenta.
Active (or managed) third stage
Benefits of an active third stage
The advantage of an active third stage is the lower risk of very heavy bleeding immediately after the birth. Your midwife or doctor will recommend you have an active third stage if you had complications during pregnancy or labour, such as:
- twin pregnancy
- polyhydramnios
- heavy bleeding during pregnancy or in labour
- a history of retained placenta
- a low-lying placenta
- anaemia
- an induced or very long labour
- an assisted birth or caesarean birth.
Active third stage
Immediately after the birth of your baby, the midwife or doctor gives you (with your consent) an injection of oxytocin, clamps and cuts the umbilical cord, and then carefully pulls on the cord to speed up delivery of the placenta.
Modified active third stage
This is a combination of active and natural. It is similar to active third stage but it includes delayed cord clamping.
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The fourth stage
Baby’s birthday
After the birth, you and your partner will be given time with your baby so that you can get to know one another.
- It’s important that you and your baby stay together, skin to skin, ideally for the first two hours after birth.
- Your baby will be examined, weighed, measured and given identification bracelet/s.
- If you consent, baby will also be given vitamin K as an injection or orally.
- Your baby may be dressed and wrapped in a warm blanket.
- You may then be transferred to the postnatal wards or you may request an early discharge if you and baby are well.
Checks after your baby is born
While you are holding your baby, your midwife or doctor will do a check called an ‘APGAR score’.
The APGAR score will be done twice, at one minute and five minutes after birth. You probably won’t even notice it’s being done, as the midwife can do this while baby and mother are skin to skin.
It helps the midwife or doctor to know whether your baby needs additional care following birth.
The APGAR score is based on the baby’s:
- breathing rate
- heart rate
- skin colour
- muscle tone
- reflexes.
Blood loss after birth
Blood loss after birth is normal.
Bleeding in the days or weeks after birth (also called lochia) is completely normal and occurs regardless of whether you have a vaginal birth or caesarean birth.
What is normal blood loss after birth?
Women’s experiences of bleeding after birth vary considerably. In the first few days after birth, most women experience moderate to heavy bleeding. Over the first few days to weeks this bleeding will gradually decrease and will change colour.
Most women will stop bleeding between four and six weeks after birth. It is also common for bleeding to be heavier after breastfeeding.
More information: Queensland Clinical Guidelines parent information – Bleeding after birth
Next section: Birth - frequently asked questions
Stages of labour, 23 Mar 2023, [https://www.qldgovau.staging-services.qld.gov.au/health/children/pregnancy/antenatal-information/stages-of-labour]
This document is uncontrolled when printed. Before using the information in this document you should verify the current content on https://www.qldgovau.staging-services.qld.gov.au/health/children/pregnancy/antenatal-information/stages-of-labour.