When it is nearly time for your baby to be born, your body will get ready for labour. Your baby will move down, pressing on your pelvis, so the upward pressure on your ribs will ease. Mood swings are common and you may feel a surge of energy.

Going into labour is exciting, but you may feel nervous. Knowing about the stages of labour and what to expect when the time comes can help you to feel more in control.

Stages of labour

There are three stages to labour:

• first stage – the cervix (entrance to the womb) gradually opens up (dilates)
• second stage – the baby is pushed down the vagina and is born
• third stage – the placenta comes away from the wall of the womb and is pushed out of the vagina

For more information, see Labour – what happens.

For many women, labour lasts a long time. If it is your first pregnancy, labour may last 12 to 24 hours. If you have had a baby before, it may only last around seven hours.

Planning your pregnancy

If you are planning to have a baby or are already pregnant, visit the NHS Choices Pregnancy Care Planner to make sure you get the care that is right for you.

The main signs of labour starting are:

• strong, regular contractions
• a 'show' – when the plug of mucus sealing your cervix comes away
• your waters breaking

These are described in more detail below.

Other signs that you are going into labour can include:

• backache
• vomiting or nausea
• diarrhoea
• an urge to go to the toilet caused by your baby's head pressing on your bowel

Contractions

You may have felt 'false' contractions throughout your pregnancy, when the muscles of your abdomen (tummy) tighten and then relax. These are called Braxton Hicks contractions, and are not the start of labour. Although they can be painful, they are usually not regular and rarely last for long. You may notice them more in the later stages of your pregnancy.

When you are having regular contractions that feel stronger and last more than 30 seconds, labour may have started. Your contractions will 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 will probably advise you to stay at home until your contractions are frequent. If your contractions last 30-60 seconds and come every three to five minutes, call your midwife for advice. Or, if you are planning to have your baby in hospital, phone the hospital.

The 'show'

While you are pregnant, a plug of mucus (the operculum) seals your cervix. Just before labour starts, or in early labour, the plug comes away and out of your vagina. This is called a 'show'. It is a sign that the cervix is getting ready for your baby to be born.

The show may come away in one blob, or in several pieces. It is sticky, jelly-like and pink in colour because it is blood-stained, but you do not lose a lot of blood.

Labour may start quite quickly after the show, or it may take a few days. Some women do not notice the show come away.

If you are concerned about the amount of blood in the show, it may be a sign that something is wrong, so call your midwife or hospital straightaway.

Breaking of the waters

Most women's waters break during labour, but it can also happen before labour starts.

Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it is time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

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 (not a tampon) handy if you are going out, and you can put a plastic sheet on your bed.

Amniotic fluid is clear and a pale straw colour. When it comes out, it may be a little blood-stained to start with. Tell your midwife at once if the waters are smelly or coloured or if you are losing blood, as this could mean your baby needs urgent attention.

If your waters break before labour 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. If you plan to give birth in hospital or a midwife unit, you will probably be advised to go in.

Labour is painful, and it is important to learn about the different ways to relieve pain.

Your midwife will explain the pain-relief options available so that you can decide which you prefer.

You should include your preferred choice of pain relief in your birth plan, although you may need to be flexible. Labour is a natural process and it does not always go to plan. During labour, you may change your mind and decide that you want more pain relief than you thought you would. Or your midwife may advise you to have more pain relief to help deliver your baby safely.

Types of pain relief

Every woman has her own way of dealing with the pain that comes with labour.

Non-medicinal ways of relieving pain include:

• breathing exercises
• relaxation
• hydrotherapy
• TENS (transcutaneous electrical nerve stimulation) 

Medicines used to help reduce the pain include:

• gas and air
• an injection of pain-relieving drugs
• an epidural painkiller

These are discussed in more detail below.

Self-help

The below advice can help you to relax in labour and cope with the pain:

• Learn about labour through reading, talking to your midwife and going to antenatal classes. This can help you to feel more in control and less frightened about what is going to happen.
• Learn how to relax and stay calm. Try breathing deeply.
• Keep moving, as changing your position can help with the pain. Try kneeling, walking and rocking back and forth.
• Have a partner, friend or relative there to help you through your labour.
• Ask your partner to massage you.

Hydrotherapy

Water can help you to relax and make contractions seem less painful. Ask if you can have a bath or use a birth pool during your labour. The water should be kept at a comfortable temperature for you, and it should be monitored closely.

TENS (transcutaneous electrical nerve stimulation)

TENS (transcutaneous electrical nerve stimulation) has not been shown to be effective in the later stages of labour, but it may be useful if you are having a home birth or if you are in the early stages of labour while still at home. If you are interested in using a TENS machine, speak to your midwife.

How it works

Electrodes are taped to your back and connected by wires to a small battery-powered stimulator, or TENS machine.

You hold the machine and give yourself short, safe bursts of electric current. This is thought to stimulate your body’s production of endorphins, chemicals that help to relieve pain. It also reduces the number of pain signals that are sent to the brain by the spinal cord.

Side effects

There are no known side effects for you or your baby from using a TENS machine.

Gas and air

Gas and air is a mixture of oxygen and another gas called nitrous oxide. It does not remove the pain but can help to reduce it and make it easier to deal with. It is easy to use and you control it yourself during labour.

How it works

You breathe gas and air through a mask or mouthpiece, which you hold yourself. The gas takes 15-20 seconds to work, so you need to breathe it in just as a contraction is starting. It works best if you take slow, deep breaths.

Side effects

There are no harmful side effects for you or your baby from using gas and air. However, it can make you feel light headed, and some women find it makes them feel sick or sleepy. If this is the case, you can stop using it.

Injections

Injections of pain-relieving drugs, such as pethidine or diamorphine, can help you to relax and they can lessen the pain of labour.

How it works

You are given an injection in your thigh or bottom. The drugs take about 20 minutes to work and their effects last between two and four hours.

Side effects

• Injections can make some women feel sick, ‘woozy’ and forgetful.
• If the effects have not worn off towards the end of labour, it can make it difficult to push. You can ask for a half dose initially to see how you feel.
• If given too close to the time of birth, the drugs may affect your baby’s breathing. If this happens, an antidote (remedy to counteract the effect) to the drugs can be given.
• The drugs can interfere with breastfeeding. Pethidine can pass into breast milk and should be used with caution in mothers planning to breastfeed. Seek medical advice from your midwife or doctor if you are concerned.

Epidural painkiller

An epidural is a special kind of painkiller that numbs the nerves that carry pain from the birth canal to the brain. It gives complete pain relief for most women and is particularly useful if you are having a long or painful labour.

Only an anaesthetist can give an epidural. If you think you may want one, check whether anaesthetists are always available at your hospital.

How it works

A drip will be put into a vein in your arm and an anaesthetist will numb a small area on your back with some anaesthetic. A very small tube will be placed into your back near the nerves that carry pain from your womb. Painkilling drugs are then administered through the tube.

It takes 20 minutes to set up an epidural and another 10-15 minutes for the drugs to work. The epidural dose can be ‘topped up’ by an anaesthetist or midwife, or you may be given a machine so that you can top it up yourself.

After an epidural, your contractions and your baby’s heart rate need to be constantly monitored. An epidural should not make you feel drowsy or sick.

For more information, see the Health A-Z topic on epidurals.

Side effects

• Depending on the type you have, an epidural may make your legs feel heavy.
• The epidural can prolong the second stage of labour. If you cannot feel your contractions, your midwife will need to tell you when to push, and instruments may need to be used to deliver your baby. Sometimes, less epidural is used towards the end of labour so that the effects wear off and you can push your baby out naturally.
• You may find it difficult to pass urine, therefore you may need to have a catheter (tube) fitted.
• About 1 in 100 women get a headache after an epidural.
• About 1 in 2,000 mothers get a tingling feeling like pins and needles down one leg after having a baby. This can also happen if you do not have an epidural, simply as a result of giving birth.
• Your blood pressure can drop. However, this is rare as the drip in your arm should help to maintain good blood pressure.

Alternative methods of pain relief

Some women wish to use alternative methods of pain relief, such as acupuncture, massage and reflexology. There is no evidence that these techniques provide effective pain relief, but if you would like to use one of them during your birth, talk to your midwife or doctor and let your hospital know beforehand.

If you wish to use an alternative pain-relief technique, make sure the practitioner you use is properly trained and experienced.

There are three stages to labour.

• first stage – the cervix (entrance to the womb) gradually opens up (dilates)
• second stage – the baby is pushed down the vagina and is born
• third stage – the placenta comes away from the wall of the womb and is also pushed out of the vagina

The first stage – dilation of the cervix

Contractions at the start of labour help to soften the cervix so it gradually opens up (dilates). Midwives refer to labour as being ‘established’ when your cervix has dilated to 4cm. This can take many hours.

The cervix needs to open up to around 10cm, known as fully dilated, before you pass into the second stage of labour and your baby can pass through.

Once your labour is fully established, your midwife will be checking on you regularly to see how your labour is progressing. In a first labour, the time it takes from the start of established labour to full dilation can take 6-12 hours. It is often quicker in subsequent pregnancies.

Your midwife will tell you to try not to push until your cervix is fully open and you can see the baby’s head.

Foetal heart monitoring

Your baby’s heart will be monitored throughout your labour and your midwife will watch for any marked changes in your baby’s heart rate. There are different ways of monitoring the baby’s heartbeat:

• Your midwife may listen to your baby’s heart using a handheld ultrasound monitor. This will have to be done for 60 seconds every 15 minutes when you are in established labour. This method leaves you free to move around.
• Your baby’s heartbeat may be followed electronically through a monitor linked to a machine called a CTG. The monitor will be strapped to your abdomen (tummy) on a belt.
• A clip can be put on your baby’s head to monitor their heart rate. The clip is attached during a vaginal examination and your waters will break if they have not broken already.

You can speak to your midwife about these different methods and tell them if you are uncomfortable with any of them.

Speeding up labour

Your labour may be slower than expected if your contractions are not frequent or strong enough, or if your baby is in an awkward position. Your midwife or doctor may recommend a vaginal examination to break your waters (if this has not happened) and get things moving.

If this does not work, you may be given a drip containing a hormone to encourage contractions.

The second stage of labour – the birth

The second stage of labour begins when the cervix is fully dilated, and lasts until the birth of your baby.

Find a position

Your midwife will help you to find a position such as:

• lying in bed with your back propped up with pillows
• standing, sitting, kneeling or squatting
• lying on your side rather than being propped up
• kneeling on all fours (this may help if you suffer from backache)

Pushing

Once you are fully dilated, you can start to push when you feel you need to during contractions:

• take two deep breaths as the contractions start and push down
• take another breath when you need to
• give several pushes until the contraction ends
• rest after each contraction, and build up strength for the next one

The pushing stage may last for an hour or more.

The birth

During the second stage of labour, your baby’s head will move down until it can be seen. When the head is visible, 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 gives the skin and muscles between your vagina and back passage (your perineum) time to stretch slowly without tearing. It also makes sure your baby’s head is born slowly and gently.

Once the head is born, most of the hard work is over. With one more gentle push, the body is born quite quickly and easily.

Skin-to-skin contact

Skin-to-skin contact with your baby really helps with bonding. It is good to have your baby lifted onto you before the umbilical cord is cut, so you can feel close to each other straight away.

The cord is clamped and cut and your baby will be dried to prevent them getting cold. You can cuddle your baby straight away, or your midwife can clean your baby and wrap him or her in a blanket before you cuddle.

If mucus has to be cleared out of your baby’s nose or mouth, they may need help to start breathing properly. If this is the case, they may be taken away briefly to be given oxygen, but will not be kept away for longer than is necessary.

The third stage – the placenta

After your baby is born, your womb will contract to push out the placenta. Your midwife can offer you an injection in the thigh after you have given birth to encourage a contraction and speed up the delivery of the placenta. The injection also helps to prevent the heavy bleeding some women experience when delivering the placenta. It also reduces your risk of postpartum haemorrhage (see Labour - complications).

Going into labour early

Sometimes, labour can start a long time before your baby is due, even as early as 24 weeks. About 1 in every 13 babies is born before the 37th week of pregnancy.

In most cases, labour starts by itself, but about 1 in every 6 early babies is induced. About 1 in every 5 early babies is delivered by caesarean section.

Depending on the cause of your premature labour, your midwife or doctor may be able to temporarily stop your contractions by using medicines. You may also be advised to have injections of steroids, to help your baby's lungs mature so that they can breathe more easily after birth.

If you have any signs of early labour (see Labour – signs), call your midwife or hospital straight away.

Late babies

Pregnancy normally lasts for 40 weeks. Most women will go into labour within a week before or after their due date.

If you do not go into labour, your midwife will keep a careful check on you and your baby. If your labour does not start by 41 weeks, your midwife will offer you a membrane sweep. This involves having a vaginal examination to stimulate your womb and start labour.

If there are signs that your baby is not doing well, or you have not responded to a membrane sweep, your midwife or doctor will suggest that your labour is started artificially (induced).

Induction

Labour can be induced if your baby is overdue or if there is any risk to your baby’s health. It will always be planned in advance, so you will be able to talk to your midwife or doctor about the benefits and disadvantages.

Contractions are usually started by inserting a pessary or gel into your vagina. The induction of labour may take a while (sometimes 24-48 hours), but once labour has started, it should proceed normally.

Assisted birth

About 1 in 8 women have an assisted birth, where forceps or a ventuose are used to help the baby out of your vagina.

• Forceps are a smooth metal instrument that look like large spoons or tongs. They are curved to fit around your baby’s head. When you have a contraction and push, an obstetrician will gently use the forceps to pull your baby and help with the delivery.
• A ventuose (vacuum extractor) uses a plastic or metal cup that is attached to your baby’s head by a tube fitted to a suction device. When you have a contraction and push, an obstetrician or midwife will gently use the device to pull your baby and help with the delivery. A ventuose is not used if your baby is less than 34 weeks old as the head is still too soft.

These instruments may be used if:

• your baby is distressed
• your baby is in an awkward position
• you are too exhausted

Both forceps and a ventuose are safe for your baby, but will only be used if necessary.

Caesarean section

There are some situations where the safest option for you and your baby is to have a caesarean section. This is when your baby is delivered by cutting through your abdomen (tummy) and your womb, rather than passing through the vagina.

If you are expecting a multiple birth, you may be advised to have a caesarean section. Whenever a caesarean is suggested, your doctor will explain why, and what the possible side effects are.

For more information see the Health A-Z topic on Caesarean section.

Postpartum haemorrhage

Postpartum haemorrhage (PPH) is a complication that can occur during the third stage of labour, after a baby is born. PPH is extremely rare in developed countries such as the UK.

Losing some blood during childbirth is considered normal. PPH is excessive bleeding from the vagina at any time after the baby's birth, until six weeks afterwards.

There are two types of PPH, depending on when the bleeding takes place:

• primary or immediate – bleeding that occurs within 24 hours of the baby's birth
• secondary or delayed – bleeding that occurs after the first 24 hours, up to six weeks after the birth

Depending on the type of PPH, the causes can include:

• contractions stopping after the baby is born (uterine atony)
• part of the placenta being left in the womb (known as ‘retained placenta’ or ‘retained products of conception’)
• infection of the membrane lining the womb (endometritis)

To help prevent PPH, you can choose to be given an oxytocic medicine as your baby is being born, which stimulates contractions and helps to push the placenta out.

If untreated, PPH is a potentially life-threatening condition. If you have continuous slow bleeding or sudden bleeding and you are not already in the care of healthcare professionals, you should seek emergency medical attention.