Signs and stages of labour

[Image - Emily Cahal]
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Written by Tim Barnes-Clay

You’re unlikely to mistake the signs of labour when the time comes, but if you’re in any doubt don’t hesitate to contact your midwife.

nhs logoThe main signs of labour starting are strong, regular contractions, and a ‘show’. A show is when the plug of mucus from your cervix comes away. Other signs that you are going into labour can include your waters breaking (rupture of the membranes), backache and an urge to go to the toilet caused by your baby’s head pressing in your bowel. 

Regular contractions

When you have a contraction, your womb (uterus) gets tight and then relaxes. You may have had contractions throughout your pregnancy, particularly towards the end. During pregnancy, these painless tightenings are called Braxton Hicks contractions.

When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labour may have started. As labour gets going (gets established) your contractions tend to become longer, stronger and more frequent.

During a contraction, the muscles in your womb contract and the pain increases. If you put your hand on your abdomen, you can feel it getting harder. When the muscles relax, the pain fades and your hand will feel the hardness ease. The contractions are pushing your baby down and opening your cervix (entrance to the womb) ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions are frequent. When your contractions last 30-60 seconds and come every five minutes, call your midwife for advice. Or, if you’re planning to have your baby in hospital, phone the hospital.

You may or may not also have the following signs:


You may have either backache or the aching, heavy feeling that some women get with their monthly period.

A ‘show’

While you are pregnant, a plug of mucus is present in your cervix. Just before labour starts, or in early labour, the plug comes away and you may pass this out of your vagina. This small amount of sticky, jelly-like pink mucus is called a show.

It may come away in one blob, or in several pieces. It is pink in colour because it’s blood-stained, and it’s normal to lose a small amount of blood mixed with mucus. If you’re losing more blood, it may be a sign that something is wrong, so telephone your hospital or midwife straight away.

A show indicates the cervix is starting to open, and labour may follow quickly, or it may take a few days. Some women do not have a show.

Your waters breaking

Most women’s waters break during labour, but it can also happen before labour starts. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it’s time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out, and put a plastic sheet on your bed.

Amniotic fluid is clear and a pale straw colour. Sometimes it’s difficult to tell amniotic fluid from urine. When your waters break, the water may be a little blood-stained to start with. Tell your midwife at once if the waters are smelly or coloured or if you are losing blood, as this could mean you and your baby need urgent attention.

If your waters break before labour starts, phone your midwife or the hospital for advice. Without amniotic fluid your baby is no longer protected and there is a risk of infection.

Stages of labour

There are three stages to labour:

the first stage, when the cervix gradually opens up (dilates)

the second stage, when the baby is pushed down the vagina and is born (this is sometimes separated into two phases – the passive or descent phase with no pushing, and the active or pushing phase)

the third stage, when the placenta comes away from the wall of the womb and is also pushed out of the vagina

Coping at the beginning of labour

At the beginning of labour:

You can be up and moving about if you feel like it.

You can drink fluids and may find isotonic drinks (sports drinks) help keep your energy levels up.

You can also snack, although many women don’t feel very hungry and some feel sick.

As the contractions get stronger and more painful, you can try relaxation and breathing exercises – your birth partner can help by doing them with you.

Your birth partner can rub your back as it may help relieve the pain.

The first stage of labour – dilation

The cervix needs to open about 10cm for a baby to pass through. This is called ‘fully dilated’. Contractions at the start of labour help to soften the cervix so that it gradually opens.

nhs signsof 002Sometimes the process of softening can take many hours before you’re in what midwives call ‘established labour’. Established labour is when your cervix has dilated to more than 3cm. If you go into hospital or your midwifery unit before labour is established, you may be asked if you’d prefer to go home again for a while rather than spending many extra hours in hospital or the midwifery unit. If you go home, you should make sure you eat and drink, as you’ll need the energy.

At night, try to get comfortable and relaxed. If you can, try to sleep. A warm bath or shower may help you to relax. During the day, keep upright and gently active. This helps the baby to move down into the pelvis and helps the cervix to dilate.

Once labour is established, the midwife will check you from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker for subsequent pregnancies.

Your midwife will tell you to try not to push until your cervix is fully open and the baby’s head can be seen.

To help you get over the urge to push, try blowing out slowly and gently or, if the urge is too strong, in little puffs. Some people find this easier lying on their side, or on their knees and elbows, to reduce the pressure of the baby’s head on the cervix.

Foetal heart monitoring

Your baby’s heart rate will be monitored throughout labour. Your midwife will watch for any marked change in the rate, which could be a sign that the baby is distressed and that something needs to be done. There are different ways of monitoring the baby’s heartbeat:

Your midwife may listen to your baby’s heart intermittently, but at least one minute every 15 minutes when you are in established labour, using a hand-held ultrasound monitor. This method allows you to be free to move around.

Your baby’s heartbeat and your contractions may also be followed electronically through a monitor linked to a machine called a CTG (cardiotocograph). The monitor will be strapped to your abdomen (tummy) on a belt. You can get up and move around with a CTG. How far you can move will depend on the type of machine.

If the midwife cannot get a good trace of your baby’s heart rate through your abdomen, they may recommend putting a clip on the baby’s head to record the heart rate. The clip is put on during a vaginal examination and your waters will be broken if they have not already done so. Ask your midwife or doctor to explain why they feel that the clip is necessary for your baby.

If you don’t feel comfortable with any of these methods, tell your midwife.

Speeding up labour

Your labour may be slower than expected if your contractions are not frequent or strong enough or because your baby is in an awkward position. If this is the case, your doctor or midwife will explain why they think labour should be sped up and may recommend the following techniques to get things moving:

breaking your waters (if this has not already happened) during a vaginal examination – this is often enough to get things moving

if this doesn’t work, you may be given a drip containing a drug (syntocinon), which is fed into a vein in your arm to encourage contractions – you may want some pain relief before the drip is started

after the drip is attached, your contractions and your baby’s heartbeat should be continuously monitored with a cardiotocograph (CTG)

The second stage of labour

This stage begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push.

Find a position

Find the position that you prefer and which will make labour easier for you. You might want to remain in bed with your back propped up with pillows, or stand, sit, kneel or squat (squatting may feel difficult if you are not used to it).

If you are very tired, you might be more comfortable lying on your side rather than propped up with pillows. If you’ve had backache in labour, kneeling on all fours might be helpful. It’s up to you. It can help if you have tried out some of these positions beforehand.


When your cervix is fully dilated you can start to push when you feel you need to during contractions:

Take two deep breaths as the contraction starts, and push down.

Take another breath when you need to.

Give several pushes until the contraction ends.

After each contraction, rest and get your strength up for the next one.

This stage of labour is hard work, but your midwife will help and encourage you all the time. Your birth partner can also give you lots of support. This stage may take an hour or more, so it helps to know how you’re doing. You and your birth partner can find out more about what your birth partner can do.

The birth

During the second stage, the baby’s head moves down the vagina until it can be seen. When the head is nearly ready to be born, the midwife will ask you to stop pushing, and to pant or puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby’s head can be born slowly and gently, giving the skin and muscles of the perineum (the area between your vagina and anus) time to stretch without tearing.

The skin of the perineum usually stretches well, but it may tear. Sometimes, to avoid a tear or to speed up delivery, the midwife or doctor will inject local anaesthetic and cut an episiotomy. Afterwards, the cut or tear is stitched up to help healing. Find out about your body after the birth, including how to deal with stitches.

Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. You can have your baby lifted straight onto you before the cord is cut by your midwife or birth partner.

Your baby may be born covered with a white, greasy substance known as vernix, which has acted as protection in the uterus.

Skin-to-skin contact

Skin-to-skin contact really helps bonding, so it is a good idea to have your baby lifted onto you before the cord is cut so that you can feel and be close to each other straight away.

The cord is clamped and cut, the baby is dried to prevent him or her from getting cold, and you’ll be able to hold and cuddle your baby. Your baby may be quite messy, with some of your blood and perhaps some of the vernix on their skin. If you prefer, you can ask the midwife to wipe your baby and wrap them in a blanket before your cuddle.

Sometimes mucus has to be cleared out of a baby’s nose and mouth. Some babies need additional help to establish breathing and may be taken to a special area in the room to be given oxygen. Your baby will not be kept away from you any longer than necessary.

The third stage of labour – the placenta

After your baby is born, more contractions will push out the placenta. Your midwife will offer you an injection in your thigh just as the baby is born, which will speed up the delivery of the placenta. The injection contains a drug called syntocinon, which makes the womb contract and helps to prevent heavy bleeding (postpartum haemorrhage).

Let your baby breastfeed as soon after birth as possible. It helps with breastfeeding later on and it also helps your womb to contract. Babies start sucking immediately, although maybe just for a short time. They may just like to feel the nipple in their mouth.

After the birth

Your baby will like being close to you just after the birth. The time alone with your partner and your baby is very special. Your baby will be examined by a midwife or paediatrician and then weighed, and possibly measured, and given a band with your name on it.

Vitamin K

You’ll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you beforehand. If you prefer that your baby doesn’t have an injection, oral doses of vitamin K are available. Further doses will be necessary.


Small tears and grazes are often left to heal without stitches because they often heal better this way. If you need stitches or other treatments, it should be possible to continue cuddling your baby. Your midwife will help with this as much as they can.

If you have had a large tear or an episiotomy, you will probably need stitches. If you have already had an epidural, it can be topped up. If you haven’t, you should be offered a local anaesthetic injection.

The midwife or maternity support worker will help you to wash and freshen up before leaving the labour ward to go home or to the postnatal area.

Postpartum haemorrhage

Postpartum haemorrhage (PPH) is a complication that can occur during the third stage of labour, after a baby is born. PPH is uncommon. Losing some blood during childbirth is considered normal. PPH is excessive bleeding from the vagina after the baby’s birth.

There are two types of PPH, depending on when the bleeding takes place:

primary or immediate – bleeding that occurs within 24 hours of the baby’s birth

secondary or delayed – bleeding that occurs after the first 24 hours, up to six weeks after the birth

Depending on the type of PPH, the causes include:

poor contraction of the womb after the baby is born (uterine atony)

part of the placenta being left in the womb (known as ‘retained placenta’ or ‘retained products of conception’)

infection of the membrane lining the womb (endometritis)

To help prevent PPH, you will be offered an injection of syntocinon as your baby is being born, which stimulates contractions and helps to push the placenta out.