The First Stage of Labour

To bring a child into this world, a mother needs to go through labour and childbirth. Officially, the process of labour is divided into three stages. Understanding how these are broken down can help you to get through your own labour once the big day arrives.

Remember that just as every pregnancy is different, so is every labour. You are unlikely to follow a textbook step by step set of signs and symptoms during your labour, so the most important thing is that you watch for changes as they come along. The easiest way to do this is to have a small notebook on hand to note the duration of your contractions and the timings between them, and any other noticeable changes in your level of pain or discomfort.

Your midwife should have discussed with you when to make your call to the hospital or birthing centre and when to travel there. If you are at all unclear about this once labour begins then call your midwife or the hospital and they will be able to advise you.

What happens during the first stage of labour?

The first stage of labour is where your cervix effaces (thins) and begins to dilate (open). This first stage is sub-divided into three phases:

1. Early Labour (latent phase)
2. Active Labour
3. Transitional Labour

The first stage of labour is the longest, but fortunately, the least intense in terms of exertion and pain. By the end of the first stage of labour your cervix should be fully dilated (about 10cm). Your contractions will be between 60-90 seconds long and have about 2-3 minutes between them.

Find out all about the first stage of labour with these articles:

• Inducing Labour
• Having Your Waters Broken
• Breathing Techniques During Labour
• Birth Positions

The first stage of labour: Phase 1) early labour

How will I know that early labour has begun?

While you might have been experiencing mild to moderate contractions in preparation for the birth (known as Braxton Hicks), you should notice that once "real" labour begins, these contractions become more regular, more frequent and more intense. Usually, during early labour the contractions are approximately 30-45 seconds in length and might be around 20 minutes apart, with considerable variations across different women. You should find that the length of time between contractions gradually reduces, although not necessarily consistently. Very often, contractions during this phase are not accompanied with severe pain, but they are likely to be uncomfortable. Many women describe them as being like strong menstrual cramps. For some women this stage of labour is complete within a matter of hours. However, remember that it can also take days, if not weeks, to pass.

Other signs that may indicate that you are in labour include backache, diarrhoea, indigestion, a bloody show or your waters breaking. However, it is quite possible that you could progress all the way through early labour without experiencing any of these. In most cases, the waters break during active labour.

What should I do during early labour?

Firstly, while this does mean that the little one is on its way, it could still take some time. Don't overexcite yourself as you need to conserve your energy. Unless there are any specific reasons why you need to be in hospital ahead of time (your antenatal team will have discussed this with you), you have probably been advised to stay at home until you are well into active labour.

If you have gone into early labour during the night then it would be wise to try to get some sleep, if that is possible. The chances are that the anticipation of meeting your baby soon will overcome your urge to sleep. Just try to get as much rest as you can. If the onset of early labour happens during the day then you will probably find that continuing with a few routine activities around the house can help to distract you. Being on your feet can also help to bring the baby down further into your pelvis. However, it is important that you don't overdo it. Relaxation techniques can be very useful at this stage but don't worry too much about your breathing exercises, they will be more important further down the line.

You might have a long labour ahead of you, so make sure that you keep your energy levels topped up with food and drink. Light snacks, such as toast and honey, or having a banana are a good idea, but don't eat a big heavy meal as this might be hard to digest. Indigestion can be a problem at this stage so avoid acidic foods.

If your partner is not with you, contact them to let them know you're in early labour. While you might be at home for several hours, it is still helpful to have your partner with you for support.

The pain of contractions or backache can be eased with a warm shower or bath. If your GP has agreed then you may be able to take paracetemol, but do not take any painkillers unless they have been approved for you and your pregnancy.

To see how your labour is progressing, you can time and record your contractions and the duration between them. If your partner is feeling a bit helpless then give them record-taking as their job! Your midwife will find this information helpful if you need to call them.

The first stage of labour: Phase 2) active labour

How will I know when I am in the active phase of the first stage of labour?

Although every labour differs, this phase should be easier to distinguish from what you have been experiencing before. Active labour will be more strenuous, and contractions more painful. However, this stage of labour will be over faster. It usually lasts in the region of 2 to 3 hours. The duration between contractions will reduce to around 40-60 seconds and you should notice that the intensity of the contraction builds up to a "peak" around the middle, before subsiding. You can usually expect the gap between contractions to be about 3 or 4 minutes by this stage. It is also quite common for your waters to break during the active phase of the first stage of labour, if they haven't done so already.

By the end of the active phase of labour your cervix is usually dilated to about 7cm - only 3cm more to go before you are ready to deliver your baby!

What should I do during the active phase?

Depending on the advice that you were given by your midwife, you probably need to contact the hospital if you have not done so already. You may already be in hospital, depending on what stage you were advised to contact them and to make your way in. If you are having a home birth then the midwife may already be with you, or should be on their way.

Stay positive. Every woman handles labour differently, but remind yourself that it is normal to feel frightened, anxious or even the complete opposite to these. Many women find that they feel elated knowing that things are properly underway. The pain will differ for all women and obviously the level of pain will depend on what pain relief you opt for. Remind yourself of the breathing techniques you may have learned during your antenatal classes. Experiment, where possible, with different positions. Positions worth trying include leaning forward against the wall, bed or your partner, as well as squatting or kneeling. See what feels the most comfortable for you. If your preferred position involves using your partner as a body support then use them as that's what they're there for. Don't worry if you haven't learned any breathing exercises or practiced any labour positions, your midwife will be able to offer advice should you need it.

It is really important that you try to relax between contractions. This will conserve your energy and help you to get through the next stage of labour. You might not feel like eating or drinking but it is important to keep your energy levels up, so have light snacks to hand - even if you are only able to nibble on them occasionally. It is important to stay hydrated so sip on clear fluids when you can - many women find that it is easier to drink from a cup or bottle with a straw so that their birthing partners can hold it for them.

Although it might be the last thing on your mind, you should try to pee occasionally if you can. A full bladder can impede the progress of the labour, even though you may not be able to feel that it is full.

Provided your labour is progressing smoothly you might find that the midwives leave you to your own devices throughout this phase, especially if you seem to be coping well. Most women appreciate this as it allows them to focus their energies better. However, try not to get annoyed when the midwife insists on making various checks. It is essential that they check you regularly to monitor your blood pressure, the baby's heartbeat, the duration and strength of contractions and also how dilated your cervix is. They will also be on hand to administer any pain relief if you chose to have it. Never be embarrassed to ask them any questions that are bothering you and let them know if you are worried about anything. They should be able to put your mind at rest and they will almost certainly have heard the same concerns before.

Keep an open mind. You may have set yourself expectations of getting through labour without any pain relief or assistance but nobody can foresee how their labour is going to proceed and how they are going to cope with it. Talk to your midwife (or just listen to their advice if you are unable to hold a conversation) and go with your feelings at the time.

The first stage of labour: Phase 3) transitional labour

How will I know when I am in the transitional phase of the first stage of labour?

By this stage it is likely that you won't be able to talk too much and your midwife will be spending more time with you. Your contractions will become very strong, probably around 60-90 seconds long and around 2 or 3 minutes apart. The "peak" of the contraction will become more noticeable and women who have had babies before may notice more than one peak in each contraction. Whereas in active labour you should have been able to relax between contractions, during transitional labour this might be hard to do. Some women feel that there is no noticeable "down time" between the contractions.

Stay focused, as intense as this period may be, it is usually over quickly. For many women this phase of labour is over within as little as 15 - 45 minutes, occasionally it lasts as long as 2-3 hours but rest assured, it will end. Listen to your midwife and follow their instructions. If you are unhappy or unclear about anything then it is perfectly acceptable to ask questions.

Is this when I start pushing?

Probably not. Usually you don't start pushing until the second stage of labour. In some ways this is what makes it hard, going through the intensity of the transitional stage but without being able to start pushing. This is normal, and the urge to push will come soon enough. Pushing too early will waste energy and could result in a lengthier labour. You will know when you need to push as you will have an uncontrollable urge to do so.

What is expected of me during transitional labour?

One of the hardest parts of this stage of labour is keeping your concentration on the labour without getting upset, frustrated or losing your temper. Remember, that as hard as it may be to put into practice, the more you conserve your energy now, the more reserves you will have to get you through the pushing and delivery stage.

Unless your midwife gives you the green light, do not push. Remember that pushing before the cervix is fully dilated can cause unnecessary discomfort and may actually slow the labour process as it can cause the cervix area to swell under the pressure. Try to use your breathing exercises to get you through the contractions. If you feel the urge to push but your midwife has asked you not to, then try blowing or panting when the urge strikes - it is difficult to do this and push at the same time.

Be clear with your partner, but try not to be rude. If their efforts to make you comfortable, such as a gentle rub or a comforting hair stroke previously helped but now make you feel worse, then tell them. Remember that they don't have a crystal ball, and, no matter how much you might wish they could share the pain with you, they cannot be expected to know how you are feeling at each and every step of labour unless you communicate this to them.

Whenever the shadow of self-doubt casts itself over you, or you feel you are overcome by the pain or emotion, remind yourself of the ultimate goal here - you will soon be meeting your long-awaited baby. Whilst the cliche may be hard to accept at this point, it will all seem worth it once you get to hold your baby in your arms.