Normal labour is classically divided into three stages:
- dilatation
- expulsion
- placental.
During the first stage, labour becomes established as regular contractions occur every ten minutes or so, lasting for a duration of 40 to 50 seconds. Towards the end of this stage, each contraction will last more than a minute and the gap between them may be less than a minute. There are variations to this, however, as not every labour follows the same pattern. Each contraction helps the uterus push the baby out, and at the same time the cervix gradually opens up and becomes thinner. By the end of first stage, the cervix is fully open, and is described as being ten centimetres dilated, or fully dilated, ready for the birth of the baby.
The second stage begins when the cervix is fully dilated and ends with the birth of the baby. With a first baby, the second stage can last between ten minutes and a couple of hours. Second and subsequent babies may be born after just a few pushes and one or two contractions.
The third stage, or delivery of the placenta and the membranes, begins just a few minutes after the baby's birth. In many hospitals, the third stage is 'actively managed', i.e. actions are routinely taken to speed up the progress of this stage of labour. An injection of syntometrine or syntocinon, a form of synthetic oxytocin, is given in the women’s thigh or buttock just as the baby’s first shoulder is emerging. Once the baby is breathing well, the umbilical cord is clamped and cut. After a few minutes, the injection stimulates the uterus to contract very strongly, making it become smaller, harder and tighter. This results in the placenta peeling away from the inner wall of the uterus. Often, the doctor or midwife helps the delivery of the placenta by a manoeuvre called controlled cord traction. They put one hand on the abdomen to protect the uterus, while the cord is kept taut with the other. At the same time that the placenta comes away, the blood vessels which were 'holding on' to it close off to prevent bleeding. An actively managed third stage lasts between 10 and 20 minutes.
There are many issues surrounding labour that parents-to-be may wish to discuss with healthcare workers. These may include:
- where to have the baby (e.g. at home or in hospital)
- preparing for the birth
- recognising when labour starts and when to go to hospital
- induction of labour
- complications of labour
- premature labour
- breech presentation
- foetal monitoring during labour
- pain relief during labour
- water births
- assisted delivery (e.g. ventouse extraction, forceps delivery)
- Caesarean section (elective and emergency)
- partner’s role during labour.
There are numerous on-line resources both for parents and healthcare workers covering all aspects of labour and birth. A selection of websites is outlined below.