The 3 stages of labour

What happens in the 3 stages of labour? 

This ‘stages of labour’ module covers the following topics:

What can you do during early labour (The first stage)?
What happens as the first stage of labour progresses?
What can they do during the second stage of labour?

What can they do during early labour?

Labour can start any time of the day or night and they may feel unsure about whether they have really started the first stage of labour. As a fully qualified midwife you will become an expert in normal labour so the pregnant woman will either call you or the labour ward at any time for information or advice. There are also lots of things they can do at home to help them through the early first stage of labour:

• Time their contractions occasionally to see if they are becoming more consistent and frequent.
• Gentle exercise, such as a walk or stretching will help them relax.
• A warm bath or shower can be soothing.
• If you they a TENS machine, early labour is a good time to use it.
• Try to rest in a comfortable position (they could be kneeling, sitting or leaning on support) and think about positions they have learnt to encourage a straight forward birth.
• If they want, eat small light meals containing carbohydrates (such as bread, cereal and pasta), avoiding fatty food. Drink as much as you wish.
• Practise breathing techniques.

They should call a midwife if:

• They have a heavy ‘show’ of bright red blood,
• They feel your waters breaking (this is when the amniotic fluid leaks out through your vagina),
• Their baby’s movements slow down and/or
• They feel feverish or have severe headaches.

As a qualified midwife you are there to support, therefore they will most likely call you as and when they need to.

What happens as the first stage of labour progresses?

their contractions will become stronger and more frequent, maybe lasting 20 to 40 seconds every 5 to 10 minutes. When they meet the midwife at hospital, or at their home, you may offer an internal examination to see how dilated they are. They must be prepared for a stronger and perhaps more painful contraction after an internal examination.

As a qualified midwife you will want to check the baby’s heartbeat from time to time. This can be done with a hand-held device. If they do need any continuous monitoring of their contractions and baby’s heartbeat, they can still wear the monitor while standing or kneeling. As their contractions get stronger, their cervix may open more rapidly.

Here are some things to keep in mind to help them through this stage of labour:

• An empty bladder is more comfortable and gives their baby more space to move down so they should try and take regular trips to the toilet.
• Ask someone to massage their back.
• Sometimes the monitor will need to be left on – leaning forward positions are often the most comfortable in this case.
• Breathing slowly can help release tension, so sigh out slowly (SOS) through a relaxed, open mouth. Sipping water or sucking ice or something cold will help keep theirr mouth moist.
• Drink if they feel thirsty and eat if they are hungry.

Upright, forward-leaning or kneeling positions tend to help their baby into a good position and can ease pain. There is evidence to show that remaining upright means less need for pain relief, and a shorter first stage in labour. It is a good idea to stay active if they can and try different positions to find what’s most comfortable for them.

Second stage of labour

The second stage of labour (also called ‘the pushing stage’) starts when your cervix (the opening of your womb) is fully open (10cm dilated) and ends when their baby is born. At this stage, their baby is moving from their uterus into their vagina and out into the world. The second stage can last from minutes to two hours (usually second or subsequent babies are quicker than the first). Contractions during this stage may be several minutes apart.

What can they do during the second stage of labour?

In the second stage of labour, they should push when they have a contraction and relax when they don’t. There are number of things they can try:

• It is more effective to get two or three short pushes in with each contraction rather than one long push.
• Whilst they push, try holding their breath for short periods, or blowing out steadily. Try both techniques to see which is best for them.
• Try saying Yes!
• In terms of the best birthing positions in the second stage of labour: being upright allows gravity to help encourage their baby to move down the birth canal.
• Being upright allows gravity to help them.
• Try and not hold their breath for long periods because this decreases the amount of oxygen available for their baby and uterus.
• Relax their pelvic floor (the muscles around the vaginal opening).
• Some mums find it helpful to reach down and feel how near their baby is – it gives them encouragement and extra energy.

Third stage of labour

The third stage of labour is when they deliver their placenta after the birth of their baby and the umbilical cord is clamped. They may also experience some bleeding.

What is the third stage of labour?

After their baby has been born the placenta, which has sustained their baby throughout pregnancy, is no longer needed; they need to push it out along with the remaining part of the umbilical cord that runs between the placenta and their baby.

What happens to the umbilical cord?

If there are problems – for example, the cord is wrapped tightly around the baby’s neck – the cord may need to be cut straight away. In most cases, they can decide, with their midwife, how long they want to leave before the cord is cut. The cord is normally just long enough for them to hold their baby with the cord still attached to the baby and to the placenta which is still inside them.

Whether the cord is cut straight after the birth or when the flow of blood from the placenta to the baby slows down and stops before it is cut, the midwife will:

• clamp the umbilical cord about 3-4cm (1½-2 inches) from their baby’s navel (belly button) with a plastic clip and
• place another clamp at the other end of the cord, near the placenta.

The cord will then be cut between the two clamps, leaving a stump about 2-3cm (1-1½ inches) long on the baby’s belly button.

There are no nerves in the cord, so cutting it isn’t painful for them or their baby. They can usually hold their baby while the cord is cut, assuming the cord is long enough to allow this.

The video below will explain the 3 stages of labour