Giving birth - stages of labour

There are 3 stages that can help describe the process of labour and childbirth.

Understanding these stages helps you, your midwife and doctor communicate well and prepare for what you and your baby need before, during and after birth.

Some hospitals consider the recovery period to be a fourth stage.

While these stages are common to all labours, remember that labour and birth is experienced differently by everyone in each pregnancy. If you've had a baby before, remember that this birth may be different, and will progress at its own pace.

Preparing for labour can help you feel more confident. You may find it useful to attend antenatal classes, talk with your midwife or doctor and write your birth preferences or birth plan.

The first stage of labour is divided into 2 distinct phases — the latent phase and the active phase. Most labouring mothers and midwives recognise a third phase, called the 'transition phase'. This happens at the end of the active phase, just before the second stage of labour begins.

The latent phase

• This is the first and longest phase and can last for hours or even days.
• During this phase, your cervix thins and starts to open.
• You may have regular or irregular contractions or you might not notice them.
• You can usually stay at home during this stage of labour.
• Try to rest and relax using gentle stretches, mindfulness, meditation or other calming techniques in this phase.

The active phase

• Your cervix becomes fully dilated, opening from 4cm to 10cm, wide enough for your baby to pass through.
• Contractions will become stronger and more regular.
• Your contractions may be around 3 or 4 minutes apart, each lasting 40 to 60 seconds.
• If you are planning to give birth in a hospital or birthing centre, you may be advised to go there during this phase.
• Contact your midwife if you are having a homebirth, Birthing on Country, or in a rural or remote setting.

The transition phase

• This phase is experienced right before the second stage begins.
• Your cervix will be around 8 to10cm open.
• You may feel pressure in your bottom or the urge to push.
• You may feel that it is difficult to communicate, shaking legs or that you 'can't do it anymore'.

The second stage of labour begins when your cervix is fully dilated to 10cm and ends when your baby is born. Your midwife or doctor will monitor for signs and behaviours to understand what stage of labour you are in.

They may recommend a vaginal examination to check how dilated your cervix is. There are signs and behaviours your midwife and doctor can assess for them to know if you may be in the second stage of labour — some of these do not involve vaginal examination. You can talk with your midwife or doctor about how you prefer to be assessed during labour.

There are two phases of the second stage of labour:

• a passive phase where you are fully dilated but do not feel an urge to push
• an active phase when you have the urge to push. This stage ends when your baby is born.

You may also feel:

• pressure in your bottom
• a stretching or burning feeling in your vagina
• the baby's head moving down

The second stage can also be recognised by:

• a natural 'purple line' that may appear between your buttocks in some births
• involuntary pushing or bearing down
• the baby's head becoming visible
• changes in behaviour, such as grunting during contractions
• the length and frequency of your contractions

There are several different pain relief options, including medicines and non-medical treatments. Discuss them with your doctor or midwife during pregnancy to help make informed decisions.

The second stage of labour can last up to 3 hours. If you have given birth before, it is often shorter.

The exact length of the second stage can vary greatly between pregnancies. If you have an epidural, it could make this stage longer.

After your baby is born, the third stage of labour begins with delivery of the placenta and the membranes that surrounded your baby in your uterus.

You have 2 options for this stage or a combination of both:

• Active management which involves medical support from your doctor or your midwife. You will receive an injection of synthetic oxytocin to help the uterus contract and expel the placenta.
• Physiological or expectant management where you are not given an injection and the placenta is delivered without medical intervention, relying on the natural contractions of the uterus.

Your midwife may ask you to push gently to help deliver your placenta during this stage.

The third stage of labour can take up to 30 minutes if you opt for active management. It can take up to one hour if you decide to have a physiological third stage.

Discuss your preferences with your midwife or doctor during pregnancy and consider including them in your birth preferences.

During the third stage of labour the umbilical cord is clamped and cut. If you would like the umbilical cord to be left intact, to be clamped later, or if your birth partner would like to cut the cord, let your midwife know ahead of time.

After labour is complete, you will be able to rest, get to know your baby and begin to recover your strength.

In the recovery stage your midwives will:

• monitor you and your baby, including checking you and your baby's vital signs such as heart rate, respiratory rate, blood pressure and temperature
• help you with breastfeeding, if you choose to do so
• feel your abdomen to check the top of your uterus and check that it has started to contract back to its original place in your pelvis below the umbilicus (belly button) level
• check your perineum for tears or bruising and to make sure you are not bleeding excessively
• suturing tears, if needed

You may feel emotional in the first few days after labour. If you feel tearfulness, anxiety or irritability it is often called the 'baby blues' or 'postnatal blues'. Some hospitals or birthing units offer counselling or a birth debriefing service for new parents and their partners to support their emotional wellbeing.

You may especially benefit from this service if your labour did not go as expected, or if your baby needed any special care.

If you'd like more information or support, the following organisations and services can help:

• The Australian Government has a range of pregnancy information resources, including brochures and a fact sheet on types of pregnancy care.
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has a pamphlet on labour and birth.