What should I expect during birth?

You might have ‘a show’. This is also known as your ‘mucous plug’ which sits inside your cervix during your pregnancy to keep your baby safe from infection. It’s a sticky, jelly-like mucous. It’s pink in colour because it is blood stained – which is completely normal – however, you should contact your midwife if you are losing more blood.  

Losing your mucous plug indicates that your cervix is starting to open up – it may come away in one or a few pieces.  

Not everyone will have ‘a show’ – or you may not even notice you’ve had one as it could get flushed away in the toilet.  

Labour might not start immediately after you lose your mucous plug, it can take a few days for some people. 

Your waters are the fluid held inside the bag surrounding your baby during your pregnancy. The fluid keeps your baby safe from knocks and bumps during pregnancy – it’s also called amniotic fluid or liquor.  

The bag often breaks when your baby is ready to be born – this is when you might notice water draining. 

When your waters go it could be a gush or a trickle. Normally pale or straw like in colour. 

Most people’s waters don’t break until labour has started. 

If you think your waters have broken, pop on a maternity pad and call your midwife. The pad will help your midwife check if your waters have gone. Do not use a tampon. 

If your waters are smelly, coloured or if you are losing blood, please call your midwife immediately. 

Contractions are the tightening of the womb which help to open your cervix and to push your baby down through the pelvis. 

Contractions come in waves. As labour progresses, your contractions will become longer and stronger. These early contractions are called the latent phase, or early labour. As your contractions become stronger, you might find it harder to talk. When your contractions are regular, lasting around 60 seconds, and coming every 5 minutes, you should call your midwife or maternity unit. 

One of the symptoms you may experience towards the end of your pregnancy is Braxton Hicks contractions. They are also known as ‘false’, or ‘practice’ contractions or practice surges’, as they are not true contractions that happen in labour.   

Braxton Hicks are a sign that your body is preparing itself for labour and will commonly occur before you experience true contractions, though not everyone will experience Braxton Hicks.  

They can begin as early as 20 weeks of pregnancy, however, they are most experienced in the third trimester, after 24 weeks gestation. They can be painless, and you may not even realise they are happening, but they can increase in intensity as pregnancy progresses. 

A Braxton Hick contraction or surge is when the muscles of the uterus tighten for approximately 30-60 seconds and might last as long as two minutes, but generally they are irregular and brief. When labour first starts (known as the latent phase of labour), early contractions can often be mistaken for Braxton Hicks, as both appear sporadically.  However, unlike labour contractions, Braxton Hicks do not become stronger and longer over time. 

Braxton Hicks contractions do not dilate your cervix, but they do help circulate blood to the placenta. You will usually only feel them at the front of your tummy, and they will go away with change of position or activity. 

To help ease Braxton Hicks contractions, you can: 

• empty your bladder, as a full bladder can stimulate contractions. 
• change your activity, for example, if you have been moving around a lot, maybe try resting – if lying down, lie on your left side. 
• go for a walk. 
• keep hydrated. 
• have a bath. 

These contractions are not necessarily a sign that labour is starting, but if you are concerned about pain or how often they are coming, please call your maternity team, especially if you are less than 37 weeks pregnant. 

Staying at home for as long as possible can help you through the early stage of labour. There are also many other ways you can help yourself: 

• Try and stay mobile and upright – gravity will help your baby’s head move down into the pelvis. 
• Keep moving – rocking your hips, pacing, or moving position can help you cope with pain. 
• Drink water – to keep your energy levels up. 
• Eat or snack – your appetite tends to reduce when in labour, but snacking can help your keep your energy levels up. 
• Rest – during early labour and between contractions.  
• Go to the toilet regularly – a full bladder can prevent your baby from moving down the pelvis. 
• Stay calm and relaxed – will help the hormone Oxytocin to flow and this is responsible for labour progress.  
• Take mild painkillers – like paracetamol which you can take 1g (which is usually 2 tablets) 4-6 hourly and no more than 4g or 8 tablets in 24 hours. 

Choose a supportive birthing partner who can be with you throughout your labour. It’s good to have someone you can trust and feel comfortable with. They will be able to encourage and reassure you throughout your birthing journey. It will be an unforgettable memory you both hold dear to your hearts. 

The Latent phase is the early part of your labour and can consist of irregular contractions that can come and go.  The contractions can settle down for long periods of time and you will be able to rest in between. 

It might feel like you are experiencing period-like pain or backache to begin with, and usually means that changes are starting to happen to your body. The cervix, or womb, is like a long tube (2-3cm long), and during these early stages of labour, it begins to shorten and go from being thick to paper thin. During this phase your cervix will open from 0 – 4cm. 

The Latent phase can take a few days, particularly if it’s your first-time giving birth, as the contractions slowly start to build up, becoming more regular and more painful as the cervix begins to stretch and open up to 4cm.  

If you’ve had a baby before, this phase can be much quicker, lasting around 6 hours or even shorter. 

You will hear the phrase ‘tightenings’, which refers to the mild contractions of the muscle in your uterus that you begin to experience as you start in labour.  They are infrequent to begin with, occurring around every 20 minutes and lasting around 20 seconds during the latent phase.   

You will feel these contractions begin at the top of your uterus and spread out, almost like a wave across your uterus, slowly becoming stronger. These muscles contract, but they do not relax completely after each contraction, resulting in the cervix being gently pulled upwards, which makes it dilate. At the same time, the contractions slowly push the baby further down the pelvis and the pressure of baby’s head against the cervix encourages your body to release more Oxytocin hormone.   

Oxytocin is a hormone produced by the brain as well as the placenta and membranes surrounding your baby and it helps your labour to progress. Its production is inhibited by stress, which is why it is important to remain as calm as possible throughout labour, taking time to remember that you are in control. 

The latent phase is followed by the active phase of the first stage of labour, which is more intense and is normally shorter than the latent phase. You will hear staff call this ‘established labour’ when you reach this phase. 

During this phase, your cervix opens from 4cm to 10cm to allow the baby to pass through.   

If this is your first baby, the active first stage of labour will last on average 8-10 hours (maximum usually less than 18 hours) and will be shorter if you’ve given birth before, at around 5 hours (maximum usually less than 12 hours). 

During this active phase of labour, contractions become more powerful, stronger, more regular, and longer lasting.  They normally last about 60 seconds each, with at least 2 contractions in a ten-minute period, and there should be time to rest between contractions. 

The muscles of the womb contract, but they do not relax completely after each contraction, resulting in the cervix being pulled upwards which makes it dilate.  At the same time, the contractions slowly push the baby further down the pelvis and the pressure of baby’s head against the cervix encourages your body to release more Oxytocin hormone to keep your labour progressing.  

The waters around baby often break during established labour, but they may have already broken and sometimes do not break at all until the baby is born. 

Once you are in the Active first stage of labour, the midwife will want to check you and your baby, to make sure that you are both okay. She will offer to take your observations, such as your temperature and blood pressure etc; this will indicate whether everything is as expected. She will ask about your baby’s movements and will listen to baby’s heart rate, using a hand-held machine called a doppler or the larger fetal heart monitor (CTG machine) that is used on the Consultant obstetric Labour ward.

The midwife will also offer to monitor your progress in labour by analysing the contractions to see how strong, long, and regular they are.  Progress in labour can also be monitored by vaginal (internal) examination. The vaginal examinations consist of an initial assessment and then repeated every four hours during active labour to see how soft, thin, and open your cervix is.  

All monitoring will be offered to you with an explanation of why it is being offered and it is your choice whether to accept.  It is important to remember to ask questions if you are unsure of anything.  

You can ask about the benefits and risks of any interventions offered to you, and you can ask about possible alternatives or what happens if the internal examinations are not done.    

Once your cervix is fully dilated (10cms open) there can be a period of transition or change, where contractions may ease off a little as baby begins its final descent within the pelvis and gets into the correct position.  

At this stage you may begin to feel overwhelmed and agitated, but this tends to only last around 15 minutes or so and your midwife will support you through this – it can be a good sign that your baby is almost here!  

As the contractions continue, you may begin to experience an urge to push and usually that is when the second stage of labour is commenced.  Occasionally, some people will experience the urge to push before the cervix is fully dilated and the midwife may ask you to change positions and try other approaches to reduce the urge to push. 

In early labour, you may feel restless and want to move around and keep busy as a way of distracting yourself from your contractions. 

However, during this time you should try your best to get as much rest as possible before the contractions become stronger and more frequent. You will need plenty of energy later on. 

Once your contractions become more regular, you may wish to stay mobile and upright. This may help you to cope with the contractions, and it is also beneficial in helping your baby to move further down the birth canal in preparation for birth, thus helping to progress labour. 

Sitting upright on a birthing (exercise) ball does help your baby to move down further down the pelvis, as well as easing back pain and increasing the blood flow to your pelvic area. 

Any upright birthing positions are recommended for the same reasons. It is important that you move into any position you find comfortable, and this may change throughout labour. 

You may wish to lean against a wall or the back of a chair, kneel on a cushion, sit on a chair, or birth ball, go on all fours, or lean on your partner. You may wish to try these with your partner at home if it helps you to experience it, ready for when your day arrives. 

You may also wish to go and look at some pictures online that demonstrate the many different positions which may help you in labour. 

If you have a bath, make sure your bump is under the water if you can. The warm water will interfere with the nerve signals that carry the pain to your brain – this will relieve the pain and make you feel relaxed and calm. 

If you have a shower with an attachment, let the warm water flow over the area that feels sore. When you’re in pain, your muscles tense up and the warm water will help to relax your muscles to make your contractions easier to manage. 

When you focus on your breathing, your mind will be taken off your pain. It will also help you feel more in control.  

When you are in early labour – the latent phase – the main thing is to try and breathe slowly and rhythmically. Rhythmic breathing will help you conserve energy and ease your pain.  

As soon as you can feel a contraction starting: 

• Breathe in slowly through your nose – drawing air deep into your lungs.
• Pause for a moment.
• Breathe out slowly through your mouth – trying to relax your muscles and let go of any tension. 

Relax as much as possible between contractions to conserve your energy. 

TENS stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine can help you in the early stage of labour. They can be bought or hired.  

A TENS machine works in a similar way to acupuncture, as it helps by interfering with the painful nerve signals caused by contractions.  

TENS machines are battery operated and work by attaching sticky pads to your body which hold the electrodes to your skin on your lower and mid back. 

When you turn the TENS machine on, you will feel small electrical impulses which may feel like a tingling sensation. You are completely in control of the settings, which can be altered based on the strength of your contraction. 

TENS also relieves pain by stimulating the body’s natural pain killer known as endorphins and will not affect or harm your baby. The TENS machine cannot be used in water as it is an electrical device.  

Some people find hypnobirthing a useful pain management technique and report positive experiences using it. 

You can learn about hypnobirthing during antenatal classes and there are lots of podcasts and resources available to help you. 

Hypnotherapy works by changing how you perceive pain. Breathing techniques are used with relaxation, visualisation, and mindfulness to help you focus on yourself and your baby during your labour and delivery.  

You will learn and practice deep relaxation techniques repeatedly during pregnancy in advance of your labour. By the time labour and contractions start, you will have taught yourself to relax, rather than to be frightened or anxious.  The more relaxed you are, the easier it is to cope with labour. 

Hypnotherapy can be done in partnership with your birth partner, potentially making your experience more intimate and positive.  

At this stage your contractions are frequent and strong.  They will have done their job by thinning and opening your cervix fully so that baby can pass through.  As your cervix has been opening, the contractions have also been gently pushing baby down into your pelvis and baby’s head is usually quite low in the pelvis at this stage. 

Sometimes this can give you an urge to push or bear down and might feel a bit like you need to poo. Don’t worry, this is exactly what should be happening as it helps you to direct your pushing into the right place. Sometimes you might feel like pushing before your cervix is fully dilated and the midwife might try to support you to try other positions so that the urge lessens until the cervix is ready. 

Many women will require pain relief during the second stage and this can vary from a warm water bath or pool to an epidural – please see our other topics on the website for further details. If you have had an epidural, you may not feel an urge to push at all once the cervix is fully open, but the midwife will be able to guide you. 

It is important to find a comfortable position for the pushing part of the second stage as this will help you to get the most out of your contractions and pushes.  Your midwife will help you find a comfortable position to give birth in. You may want to sit, lie on your side, stand, kneel, or squat, although squatting may be difficult if you’re not used to it.  If you’ve had lots of backache while in labour, kneeling on all fours may help. It’s a good idea to try some of these positions before you go into labour. Talk to your birth partner so they know how they can help you. 

If you’re having your 1st baby, this pushing stage should last no longer than 3 hours. If you’ve had a baby before, it should take no more than 2 hours.  This stage of labour is hard work, but your midwife will help and encourage you. Your birth partner can also support you

The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes away from your womb.  As it comes away, your midwife will pull on the cord – which is attached to the placenta – and pulls the placenta out through your vagina. This usually happens within 30 minutes of your baby being born. 

There are two possible ways to manage this stage of labour: 

• ‘Active third stage’ – where a drug is given by your midwife by injection to make the process happen faster, between 1 and 5 minutes after your baby is born. 
• ‘Physiological third stage’ – where you have no treatment, and this stage happens naturally at a slower pace. 

Your midwife will explain both ways to you while you’re still pregnant or during early labour, so you can decide which you would prefer. 

There are some situations where physiological management is not advised – but your midwife or doctor will explain if this is the case for you.