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Phases of labour and birth

During labour and birth, your cervix stretches and shortens until it disappears and opens – growing from the size of a grape to the size of a grapefruit. At the same time your baby’s head moulds to fit through your pelvis and help your baby make its way out of your body. The labour and birth processes are divided into four stages - the first, where the cervix softens and opens (dilates), the second, where the baby is pushed out, the third, between the birth of the baby and the birth of the placenta and membranes and finally the fourth, lasting a two or three hours after birth. We’ve also added a zero stage, because realistically, everyone goes through it.
What happens during the zero stage (waiting)
The zero stage of labour is basically when you are at term and waiting for something - anything to happen. You are aware of even the slightest changes and wonder whether this is IT. Well- meaning friends and family are calling and texting to ask if anything is going on and probably driving you crazy. You might start to retreat into your own little bubble at the end of pregnancy, preferring being quiet, doing things alone or spending time alone or with only one other person (that’s part of your hormonal orchestra starting up!). At the same time your body is busy getting ready - your cervix is getting softer, it starts to point towards your front as opposed to your back, and it starts to become thinner and shorter. In some cases, it also starts to dilate (open). The zero stage is easiest if you have a project - something not too difficult or stressful that will take your mind off the fact that your labour can start at any time. Preparing meals to freeze for postpartum is a great activity, taking long (but not too strenuous) walks or doing something artistic or creative are activities you can try. Turn your phone on silent, only speak to the people you want to speak to and concentrate on yourself and your own needs. Above all, get lots of rest - you never know when labour will begin.

What happens during the first stage (opening your cervix and getting the baby in a good position)
The first stage of labour is usually the longest, especially for first time mums. During this stage your cervix will continue to become thinner and shorter and slowly open. As your cervix opens your baby will find its best way to move into your pelvis, tuck her head onto her chest and turn her head to pass through your pelvis, moving lower and lower until she is born. The first stage is so long that it is divided into three phases - we will call them first phase, or Something is Happening, second phase or This is for Real, and transition or I Don’t Know if I Can Do This.
Phase One – Something is Happening
The first or latent phase starts with noticeable but mild labour waves that can feel like menstrual cramps or a backache. These last about 30 seconds and are far apart (15 minutes or more between labour waves) or irregular. This phase of labour can last from a few hours to a few days or weeks - for some women the labour waves come every day for a few days in a row (noticeable or even painless), while for others this phase lasts a day or a few hours before the next phase. The labour waves do not require all your attention and you can usually talk through them. During this phase, it’s important to get as much rest as you can and to go about your daily life as usual. Keep your routine normal and don’t pay too much attention to the labour waves, the more you think about them (and release adrenaline because of the excitement and nervousness) the longer this phase of labour can last. It’s also a good idea to have a light snack for energy, stay hydrated and to urinate often (a full bladder can slow labour, too). Don’t check numbers, measure labour waves or anything else. Occupy yourself with something else. You’re usually at home during this stage, and that’s ok, there’s no need to rush anywhere.
Phase Two – This is for Real
The second, active phase of first stage begins when your labour waves become longer and more regular, with a shorter time between the beginning of one and the beginning of the next one. Now your labour waves require your full attention and you may need to use some coping techniques to get through them. It is very important to keep moving in this phase of labour, stay hydrated and urinate often. During this phase your cervix opens quickly (compared to the previous phase).
Phase Three (transition) – I Don’t Know If I Can Do This
Transition is one of the most intense phases as your cervix opens fully and your body gets ready for the pushing stage. Think about it as your body switching gears and moving from one activity to another. During transition you may feel hot and sweaty, cold and shaky, nauseous (maybe even vomiting), sometimes alternating between these. As baby’s head moves lower and puts pressure on your bowels, you will feel like you have to poo – this is a good sign. Psychologically, this is the
phase where you might feel like you cannot handle labour any longer, where you sometimes say crazy sounding and strange things. It’s all a normal part of transition.

Opening cervix

What happens during the second stage (pushing)
During second stage, baby’s head moves down into the pelvic outlet and often turns so that he is facing your back. Your body switches from opening to working with the baby to help him to be born. It can be short or long, lasting from a few minutes to two or three hours. It is shorter for women who have already given birth and longer for women who are using pain relief. Some signs that second stage has begun are increased mucous with streaks of blood called bloody show, passing stool, the urge to push during labour waves. We’ll divide second stage into four phases – the first one, or Rest, the second, Helping Baby Out, the third, Ring of Fire and the fourth, Birthing the Baby’s Head and Body.
Phase One - Rest
Sometimes you have a chance to get some rest between the opening and pushing phases, because labour waves slow down or stop for a few minutes. It is short, lasting between 5 and 30 minutes (although it can be longer). Some women may have a nap between labour waves during transition, gathering up the energy for the next phase.
Phase Two - Helping Baby Out
This very active part of second stage happens when you get the urge to push, an urge you can’t stop that moves the baby through your cervix and into your vagina. You might feel pressure on your bowels and your perineum, and have the urge to poo (and you might poo or pee during this phase – that is totally normal and is a good sign). Your labour waves may become less frequent, but also stronger.
Upright positions in second stage help you cope with labour waves, and generally make the second stage shorter. Position changes can also help your baby take a position that is easier to birth. Try to drink in between labour waves, at least one or two mouthfuls of water during each break.
The urge to push may be overwhelming and you might be scared and want to fight it off instead of working with it. Know that this is a normal and important part of the birthing process and that you can do it. When you feel the urge to push during a labour wave, listen to it and put your energy downwards, helping your baby move down and out. if you have a
Phase Three – Ring of Fire
You might also feel the “ring of fire” as your baby’s head stretches the elastic tissues of your perineum. Baby’s head comes out slowly, moving forward during pushes and coming back in between labour waves, slowly moving more out than in. If baby is coming very quickly, your midwife or doctor might try to slow it down and give your tissues time to expand, or may suggest that you push more slowly by gently blowing or panting – this helps reduce tearing.
Phase Four – Birthing the Head and Body
Baby’s head is visible (you can reach down to feel it!) and doesn’t move back into the vagina after a labour wave. Normally, the baby’s forehead is born, followed by its nose, mouth and chin. As the baby comes out it turns and allows the shoulders and body to be born. Your labour waves might stop for a bit as the baby’s head rotates, and you might feel the baby kick and move as it is born. Once the head and shoulders are out, the rest of baby’s body slides out. If the baby’s umbilical cord is wrapped around its neck, at some point after the head is born the midwife or doctor will slide it over baby’s head. As long as the cord is not tight and blood is still flowing well, this is not a problem. Remember, baby isn’t breathing until it is born, and even then it is still receiving oxygen rich blood from the placenta.

One in three babies have their cord wrapped around their neck (sometimes two or three times) - the cord is covered in Wharton’s Jelly, which prevents the umbilical cord from being pulled too tightly (even in the case of a knot) and almost always allows blood to move freely.

What happens during the third stage (birth of the placenta)
As your baby is born and your oxytocin levels surge, your uterus begins to contract and the placenta comes off the uterine wall. Labour waves continue and help the placenta come out. Sometimes women feel the urge to push the placenta out, while other women stand up or squat and the placenta slides out. Birthing the placenta is much easier than birthing a baby, since it is soft and much smaller. Some women describe it as a nice feeling, or a relief as it slides out.
The third stage can last between ten and sixty minutes; however in many hospital settings the policy is that a woman is given an injection of synthetic oxytocin immediately after baby is born to help keep her blood loss low and help birth the placenta. While this may be a good policy in hospitals where the environment might not support the hormonal orchestra for a physiological third stage, you can ask to delay the injection and have it only in the case of a placenta that is slower to birth or in the case of greater blood loss. At birth centres or at home, midwives usually work hard to create an environment that supports the hormonal orchestra (dark, warm and calm environment with baby and mother skin to skin) to support a physiological third stage. They wait and give synthetic oxytocin only if it is needed.

The surge of oxytocin you get when your baby is born will never happen again - spend your time looking into your baby’s eyes and falling in love. Phone calls and photos can wait an hour or two - keep your mobile phones away.

What happens during the fourth stage
Your midwife or doctor will check your perineum and monitor your bleeding during fourth stage. Your uterus will now begin shrinking to its pre-pregnancy size, a process that will take a few weeks – by six weeks will be back to its pre-pregnancy size. In addition to this, the separation of your placenta leaves behind a wound on your uterus about the size of a dinner plate (about 18cm in diameter). Your midwife or doctor will continue to check and massage your uterus to make
sure it remains firm and contracted. Your legs may begin to shake, this is normal and a warm blanket can help. Once the fourth stage is over, about two or three hours after birth, if you are at the hospital you will be moved to a room on the ward. At home or at a birth centre your midwives will make sure that you are comfortable and well before leaving at the end of fourth stage, returning in a few hours for your first postpartum visit. If you had a perineal tear that requires stitching this will likely happen between third and fourth stage, or after fourth stage is over. You will be given local anaesthetic before any stitching takes place.