What are the stages of labor

Labor also called childbirth, is the process of your baby leaving the uterus (womb). Every woman’s labor is unique, even from one pregnancy to the next. Sometimes labor is over in a matter of hours. In other cases, labor tests a mother’s physical and emotional stamina.

You won’t know how labor and childbirth will unfold until it happens. You can prepare, however, by understanding the typical sequence of events.

Labor (childbirth) is divided into three stages:

1. First stage: The time of the onset of true labor until the cervix is completely dilated to 10 cm. The first stage is when your contractions increase, and your cervix begins to open up (dilate). This is usually the longest stage.
2. Second stage (pushing and birth): The period after the cervix is dilated to 10 cm until the baby is delivered. The second stage of labor is when your cervix is fully open. This is the part of labor where you help your baby move through your vagina by pushing with your contractions.
3. Third stage (delivery of the placenta): The third stage is the delivery of the placenta and is the shortest stage. The time it takes to deliver your placenta can range from 5 to 30 minutes. The third stage is after the birth of your baby, when your womb contracts and causes the placenta to come out through the vagina.

Every woman’s labor is different. And your labor may be different each time you have a baby. But there are patterns to labor that are true for most women. Learning about the stages of labor and what happens during each one can help you know what to expect once labor begins.

You’re in labor when you have regular contractions that cause your cervix to change. Contractions are when the muscles of your uterus get tight and then relax. Contractions help push your baby out of your uterus. Your cervix is the opening to the uterus that sits at the top of the vagina. When labor starts, your cervix dilates (opens up).

As you get closer to your due date, learning the signs of labor can help you feel ready for labor and birth. If you have any signs of labor, call your doctor.

As you approach your due date, you will be looking for any little sign that labor is about to start. You might notice that your baby has “dropped” or moved lower into your pelvis. This is called “lightening.” If you have a pelvic exam during your prenatal visit, your doctor might report changes in your cervix that you cannot feel, but that suggest your body is getting ready. For some women, a flurry of energy and the impulse to cook or clean, called “nesting,” is a sign that labor is approaching.

Some signs suggest that labor will begin very soon. Call your doctor or midwife if you have any of the following signs of labor. Call your doctor even if it’s weeks before your due date — you might be going into preterm labor. Your doctor or midwife can decide if it’s time to go to the hospital or if you should be seen at the office first.

You know you’re in true labor when:

• You have strong and regular contractions. A contraction is when the muscles of your uterus tighten up like a fist and then relax. Contractions help push your baby out. When you’re in true labor, your contractions last about 30 to 70 seconds and come about 5 to 10 minutes apart. They’re so strong that you can’t walk or talk during them. You have contractions get stronger and closer together over time with increasingly shorter intervals.
• You feel pain in your belly and lower back (backache). This pain doesn’t go away when you move or change positions.
• You have a bloody (brownish or reddish) mucus discharge. This is called bloody show, when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away. Losing your mucus plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away.
• Your water breaks (rupture of membranes). Your baby has been growing in amniotic fluid (the bag of waters) in your uterus. When the bag of waters breaks, you may feel a big rush of water. Or you may feel just a trickle.
• You have an urge to go to the toilet, which is caused by your baby’s head pressing on your bowel

​If you think you’re in labor, call your doctor, no matter what time of day or night. Your doctor can tell you if it’s time to head for the hospital. To see for sure that you’re in labor, your health care provider measures your cervix.

Remember, no one knows for sure what triggers labor, and every woman’s experience is unique. Sometimes it’s hard to tell when labor begins.

Don’t hesitate to call your health care provider if you’re confused about whether you’re in labor. Preterm labor can be especially sneaky. If you have any signs of labor before 37 weeks — especially if you also experience vaginal spotting — consult your health care provider.

If you arrive at the hospital in false labor, don’t feel embarrassed or frustrated. Think of it as a practice run. The real thing is likely on its way.

What is the longest stage of labor?

The first stage of labor is the longest and involves three phases:

• Early Labor Phase –The time of the onset of labor until the cervix is dilated to 3 cm.
• Active Labor Phase – Continues from 3 cm. until the cervix is dilated to 7 cm.
• Transition Phase – Continues from 7 cm. until the cervix is fully dilated to 10 cm.

Each phase is characterized by different emotions and physical challenges. For first-time moms, first stage of labor can last from 12 to 19 hours. It may be shorter (about 14 hours) for moms who’ve already had children. It’s when contractions become strong and regular enough to cause your cervix to dilate (open) and thin out (efface). This lets your baby move lower into your pelvis and into your birth canal (vagina). This stage of labor ends when you are 10 centimeters dilated.

What is the first stage of labor?

The first stage of labor is your body preparing for giving birth, with signs such as your waters breaking, the start of contractions, and a ‘show’. The first stage of labor is the longest stage of labor. For first-time moms, it can last from 12 to 19 hours. The first stage of labor may be shorter (about 14 hours) for moms who’ve already had children. It’s when contractions become strong and regular enough to cause your cervix to dilate (open) and thin out (efface). This lets your baby move lower into your pelvis and into your birth canal (vagina). This stage of labor ends when you are 10 centimeters dilated. The first stage is divided into three parts: early labor, active labor and transition to stage 2 of labor.

The first stage of labor involves three phases:

• Early Labor Phase –The time of the onset of labor until the cervix is dilated to 3 cm.
• Active Labor Phase – Continues from 3 cm. until the cervix is dilated to 7 cm.
• Transition Phase – Continues from 7 cm. until the cervix is fully dilated to 10 cm.

The first stage begins with the onset of labor and ends when the cervix is fully opened to 10 cm. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. You might want to rest, watch TV, hang out with family, or even go for a walk. Most women can drink and eat during labor, which can provide needed energy later. Yet some doctors advise laboring women to avoid solid food as a precaution should a cesarean delivery be needed. Ask your doctor about eating during labor. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby’s position and station (location in the birth canal). Most babies’ heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother’s abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. Many of the positioning and relaxation tips you learned in childbirth class can help now. Try to find the most comfortable position during contractions and to let your muscles go limp between contractions. Let your support person know how he or she can be helpful, such as by rubbing your lower back, giving you ice chips to suck, or putting a cold washcloth on your forehead.

Sometimes, medicines and other methods are used to help speed up labor that is progressing slowly. Many doctors will rupture the membranes. Although this practice is widely used, studies show that doing so during labor does not help shorten the length of labor.

Your doctor might want to use an electronic fetal monitor to see if blood supply to your baby is okay. For most women, this involves putting two straps around the mother’s abdomen. One strap measures the strength and frequency of your contractions. The other strap records how the baby’s heartbeat reacts to the contraction.

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

Figure 1. First stage of labor 

Footnote: Most babies’ heads enter the pelvis facing to one side, and then rotate to face down.

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 (false labor).

When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labor may have started. As labor 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 or doctor will probably advise you to stay at home until your contractions are frequent. When your contractions are coming every 5 minutes, it’s time to go to the hospital.

Backache

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 labor starts, or in early labor, 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 color 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 labor 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 labor, but it can also happen before labor 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.

When this happens, call your midwife or doctor, so they can ask you some questions and check your condition.

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 should be clear or slightly pink. If it appears greenish or bloody, see a doctor or your hospital immediately, as this could mean you and your baby need urgent attention.

If your waters break before labor 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.

Coping at the beginning of labor

At the beginning of labor:

• You can be up and moving about if you feel like it.
• You can drink fluids and may find isotonic drinks (some 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.

Dilation

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

Sometimes the process of softening can take many hours before you’re in what midwives call ‘established labor’. Established labor is when your cervix has dilated to more than 3cm. If you go into hospital or your birth center before labor 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 birth center. 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 labor is established, the midwife will check you from time to time to see how you are progressing. In a first labor, the time from the start of established labor to full dilation is usually between 6 and 12 hours (about 8 hours on average). 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.

Fetal heart monitoring

Your baby’s heart rate will be monitored throughout labor. 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.

Speeding up labor

Your labor 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 labor 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 synthetic version of the birth hormone oxytocin (a drug called syntocin), 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 will be continuously monitored with a cardiotocograph (CTG).

Early labor

For most first-time moms, early labor lasts about 6 to 12 hours. You can spend this time at home or wherever you’re most comfortable. During early labor:

• You may feel mild contractions that come every 5 to 15 minutes and last 60 to 90 seconds.
• You may have a bloody show. This is a pink, red or bloody vaginal discharge. If you have heavy bleeding or bleeding like your period, call your doctor right away.

When experiencing contractions, notice if they are:

• Growing more intense
• Following a regular pattern
• Lasting longer
• Becoming closer together

When your water breaks (amniotic sac rupture), note the following:

• Color of fluid
• Odor of fluid
• Time rupture occurred

What to expect during early labor:

• Early labor will last approximately 6-12 hours
• Your cervix will efface and dilate to 3 cm
• Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions
• Contractions are typically mild and somewhat irregular but become progressively stronger and more frequent
• Contractions can feel like aching in your lower back, menstrual cramps, and pressure/tightening in the pelvic area
• Your water might break – this is known as amniotic sac rupture and can happen anytime within the first stage of labor.

Tips for the support person:

• Practice timing contractions
• Be a calming influence
• Offer comfort, reassurance, and support
• Suggest simple activities that draw her focus from the labor
• Keep up your own strength. You will need it.

What you can do in early labor:

This is a great time for you to rely on your doula or labor support person. Try the methods you learned about in childbirth education classes about how to relax and cope with pain. During early labor:

• Rest and relax as much as you can.
• Take a shower or bath.
• Go for a walk.
• Change positions often.
• Make sure you’re ready to go to the hospital.
• Take slow, relaxing breaths during contractions.

Active labor

This is when you head to the hospital or birth center. Your contractions will be stronger, longer and closer together. It is very important that you have plenty of support. It is also a good time to start your breathing techniques and try a few relaxation exercises between contractions.

You should switch positions often during this time. You might want to try walking or taking a warm bath. Continue to drink plenty of water and urinate periodically.

Active labor usually lasts about 3 to 8 hours. It starts when your contractions are regular and your cervix has dilated to 6 centimeters. In active labor:

• Your contractions get stronger, longer and more painful. Each lasts about 45 seconds and they can be as close as 3 minutes apart.
• You may feel pressure in your lower back, and your legs may cramp.
• You may feel the urge to push.
• Your cervix will dilate up to 10 centimeters.
• If your water hasn’t broken, it may break now.
• You may feel sick to your stomach.

What to expect:

• Active labor will last about 3-8 hours
• Your cervix will dilate from 4 cm to 7cm
• Contractions during this phase will last about 45-60 seconds with 3-5 minutes rest in between
• Contractions will feel stronger and longer
• This is usually the time to head to the hospital or birth center

Tips for the support person:

• Give the mother your undivided attention
• Offer her verbal reassurance and encouragement
• Massage her abdomen and lower back
• Keep track of the contractions (if she is being monitored, find out how the machine works)
• Go through the breathing techniques with her
• Help make her comfortable (prop pillows, get her water, apply touch)
• Remind her to change positions frequently (go with her on a walk or offer her a bath)
• Provide distractions from labor such as music, reading a book or playing a simple card game
• Don’t think that there is something wrong if she is not responding to you

What you can do in active labor:

• Make sure the hospital staff has a copy of your birth plan.
• Try to stay relaxed and not think too hard about the next contraction.
• Move around or change positions. Walk the hallways in the hospital.
• Drink water or other liquids. But don’t eat solid foods.
• If you’re going to take medicine to help relieve labor pain, you can start taking it now. Your choice about pain relief is part of your birth plan.
• Go to the bathroom often to empty your bladder. An empty bladder gives more room for your baby’s head to move down.
• If you feel like you want to push, tell your doctor. You don’t want to start pushing until your doctor checks your cervix to see how dilated it is.

Transition phase

Transition to the second stage of labor can be the toughest and most painful part of labor. It can last 15 minutes to an hour. During the transition phase:

• Contractions come closer together and can last 60 to 90 seconds. You may feel like you want to bear down.
• You may feel a lot of pressure in your lower back and rectum. If you feel like you want to push, tell your doctor.

During the transition phase, the mother will rely heavily on her support person. This is the most challenging phase, but it is also the shortest. Try to think “one contraction at a time” (this may be hard to do if the contractions are very close together). Remember how far you have already come, and when you feel an urge to push, tell your health care provider.

What to expect:

• The transition will last about 30 minutes to 2 hours
• Your cervix will dilate from 8 cm to 10 cm
• Contractions during this phase will last about 60-90 seconds with a 30 second-2 minute rest in between
• Contractions are long, strong, intense, and can overlap
• This is the hardest phase but also the shortest
• You might experience hot flashes, chills, nausea, vomiting, or gas

Tips for the support person:

• Offer lots of encouragement and praise
• Avoid small talk
• Continue breathing with her
• Help guide her through her contractions with encouragement
• Encourage her to relax between contractions
• Don’t think that there is something wrong if she seems to be angry – it is a normal part of the transition

What is the second stage of labor?

The second stage of labor is when you actually give birth to your baby. The second stage of labor involves you pushing and the delivery of your baby. Until this point, your body has been doing all the work for you. Now that your cervix has fully dilated to 10 cm, it is time for you to help by pushing. The second stage of labor begins when your 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.

In the second stage of labor, your cervix is fully dilated and ready for childbirth. It usually lasts 20 minutes to two hours. The second stage is the most work for you because your doctor wants you to start pushing your baby out. This stage can be as short as 20 minutes or as long as a few hours. It may be longer for first-time moms or if you’ve had an epidural. And epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It’s the most common kind of pain relief used during labor. The second stage ends when your baby is born.

The second stage involves pushing and delivery of your baby. You will push hard during contractions, and rest between contractions. Pushing is hard work, and a support person can really help keep you focused. A woman can give birth in many positions, such as squatting, sitting, kneeling, or lying back. Giving birth in an upright position, such as squatting, appears to have some benefits, including shortening this stage of labor and helping to keep the tissue near the birth canal intact. You might find pushing to be easier or more comfortable one way, and you should be allowed to choose the birth position that feels best to you.

When the top of your baby’s head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy, to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After your baby is born, the umbilical cord is cut. Make sure to tell your doctor if you or your partner would like to cut the umbilical cord.

During the second stage of labor:

• Your contractions may slow down to come every 2 to 5 minutes apart. They last about 60 to 90 seconds.
• You may get an episiotomy. This is a small cut made at the opening of the vagina to help let the baby out. Most women don’t need an episiotomy.
• Your baby’s head begins to show. This is called crowning.
• Your doctor guides your baby out of the birth canal. She may use special tools, like forceps or suction, to help your baby out.
• Your baby is born, and the umbilical cord is cut. Instructions about who’s cutting the umbilical cord are in your birth plan. What you can do:
• Find a position that is comfortable for you. You can squat, sit, kneel or lie back.
• Push during contractions and rest between them. Push when you feel the urge or when your doctor tells you.
• If you’re uncomfortable or pushing has stopped, try a new position.

Pushing and what to expect:

• The second stage can last from 20 minutes to 2 hours.
• Contractions will last about 45-90 seconds at intervals of 3-5 minutes of rest in between.
• You will have a strong natural urge to push.
• You will feel strong pressure at your rectum.
• You are likely to have a minor bowel or urination accident.
• Your baby’s head will eventually crown (become visible).
• You will feel a burning, stinging sensation during crowning.
• During crowning, you will be told by your health care provider to not push.

Pushing and what to do:

• Get into a pushing position that uses gravity to your advantage.
• Push when you feel the urge.
• Relax your pelvic floor and anal area (Kegel exercises can help).
• Rest between contractions to help regain your strength.
• Use a mirror to view your progress (This can be very encouraging!).
• Use all your energy to push.
• Do not become discouraged if your baby’s head emerges and then slips back into the vagina (this process can take two steps forward and one step back).

Tips for the support person:

• Help her to relax and be as comfortable as possible. Give her ice chips if available and provide physical support in her position.
• Encourage, encourage, encourage!
• Help guide her through her contractions.
• Give verbal encouragement by telling her how well she is doing.
• Don’t be offended if she displays anger or becomes emotional.

What your baby is doing:

While you are experiencing labor, your baby is taking certain steps to enter this world.

1. Your baby’s head will turn to one side and the chin will automatically rest on the chest so that the back of the head can lead the way.
2. Once you are fully dilated, your baby’s head leads the way and the head and torso begin to turn to face your back as they enter your vagina.
3. Next, your baby’s head will begin to emerge or “crown” through the vaginal opening.
4. Once your baby’s head is out, the head and shoulders will again turn to face your side, allowing your baby to easily slip out.

Delivery and what to expect:

Keep in mind that your baby has been soaking in a sac of amniotic fluid for nine months.

Following the contractions and passage through your very narrow birth canal, the baby will display the following characteristics:

• Cone-shaped head
• Vernix coating (a cheesy substance that coats the fetus in the uterus)
• Puffy eyes
• Lanugo (fine downy hair that covers the shoulders, back, forehead, and temple)
• Enlarged genitals

Figure 2. Second stage labor

Footnote: The baby twists and turns through the birth canal.

Find a position

Find the position that you prefer and which will make labor 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 labor, 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.

Depending on where you are giving birth, you may be able to go through some or all of labor in a bath, which can help you relax and manage the pain.

Pushing

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 labor is hard work, and progress is usually slow and steady, especially if you are having your first baby. Your midwife will help and encourage you all the time. Your birth partner can also give you lots of support. This stage can take up to 2 hours, so it helps to have your birthing team keeping you updated on your progress. The best thing you can do during this time is to breathe deeply, try to relax, and follow your body’s natural urges to push.

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 do an episiotomy to make the opening to the vagina bigger. 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 usually 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 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 umbilical cord is clamped and cut, the baby is dried to prevent them 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.

What is the third stage of labor?

The third stage involves delivery of the placenta (afterbirth). The third stage is the shortest stage, lasting five to 30 minutes. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. After your baby is born, the midwife may pull on the umbilical cord to deliver the placenta, and may ask you to help by gently pushing. You may be offered an injection in your thigh just as the baby is born, to speed up the delivery of the placenta. The injection contains a drug called syntocinon (a synthetic version of the hormone oxytocin), which makes the womb contract and helps to prevent heavy bleeding known as postpartum hemorrhage.

After the delivery of your baby, your health care provider will be looking for small contractions to begin again. The contractions signal that your placenta is separating from the uterine wall and is ready to be delivered. Contractions will begin five to 30 minutes after birth, signaling that it’s time to deliver the placenta. Pressure may be applied by massage to your uterus and the umbilical cord may be gently pulled. The result will be the delivery of your placenta, also referred to as the afterbirth. You might experience some severe shaking and shivering after your placenta is delivered. This is a common symptom and not a cause for concern. Labor is over once the placenta is delivered.

Your doctor or midwife will feel to make sure that your uterus is well contracted, take your blood pressure and pulse, and check if you need any stitches.

Your doctor will repair the episiotomy and any tears you might have. Now, you can rest and enjoy your newborn baby.

After completing all the stages of childbirth, you will be monitored for the next few hours to make sure that the uterus continues to contract and that bleeding is not excessive.

During the third stage of labor:

• You have contractions that are closer together and not as painful as earlier. These contractions help the placenta separate from the uterus and move into the birth canal. They begin 5 to 30 minutes after birth.
• You continue to have contractions even after the placenta is delivered. You may get medicine to help with contractions and to prevent heavy bleeding.
• Your doctor squeezes and presses on your belly to make sure the uterus feels right.
• If you had an episiotomy, your doctor repairs it now.
• If you’re storing your umbilical cord blood, your doctor collects it now. Umbilical cord blood is blood left in the umbilical cord and placenta after your baby is born and the cord is cut. Some moms and families want to store or donate umbilical cord blood so it can be used later to treat certain diseases, like cancer. Your instructions about umbilical cord blood can be part of your birth plan.
• You may have chills or feel shaky. Tell your doctor if these are making you uncomfortable.

What you can do:

• Enjoy the first few moments with your baby.
• Start breastfeeding. Most women can start breastfeeding within 1 hour of their baby’s birth.
• Give yourself a big pat on the back for all your hard work. You’ve made it through childbirth!

What happens after my baby is born?

Your baby will like being close to you just after the birth. Skin-to-skin contact is best, as it provides warmth for your baby and encourages your baby to have his/her first feed. Right after birth your doctor places your baby skin-to-skin on your chest and covers him with a blanket. Holding your baby skin-to-skin helps your baby stay warm as he gets used to being outside the womb. It’s also a great way to get started breastfeeding. You can start breastfeeding even within an hour of your baby’s birth. 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. Even if you don’t plan to breastfeed, hold your baby skin-to-skin so you get to know each other right away. Your baby will welcome your gentle touch, and this closeness can help you and your baby bond.

The time alone with your partner and your baby can be very special. Your baby will be examined by a midwife or doctor and then weighed, and possibly measured, and given identity bands with your name on it.

After birth, your body starts to change to help you heal. Your doctor takes your temperature and checks your heart and blood pressure to make sure you’re doing well. If you had anesthesia during labor, your doctor makes sure you’re recovering without any complications.

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 known as hemorrhagic disease of the newborn. Your midwife will have discussed this with you beforehand and sought your consent.

If you prefer that your baby doesn’t have an injection, oral doses of vitamin K are available. The oral doses are given in 3 stages over a 4-week period.

Stitches

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 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 labor ward to go home or to the postnatal area.

Going home

Most women stay in hospital for 1 or 2 days after they have given birth, although if you’ve had an uncomplicated vaginal birth and your baby is doing well, you can sometimes go home as soon as 6 hours after the birth. If you have had a caesarean, expect to stay in hospital for 3 to 4 days.