The stages and progressions of labour

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Starting & progressing through labour

The stages and progressions of labour

Stage 1: The cervix opening

Stage 1 is made of three parts. During this stage of labour, you will go from experiencing some contractions to having regular contractions. In your first birth this is expected to last on average 8 hours and not usually more than 18 hours. If you have already had a baby, this part is expected to last on average 5 hours and unlikely to last over 12 hours. We will say there is a delay in the first stage of labour if your cervix opens less than 2cm in a 4-hour period.

The early stages where you may experience some contractions and your cervix will start to change. This part continues until your cervix is 4cm dilated.

The ‘active’ stage- this is where your cervix is actively dilates from 4cm to 10cm and you are contracting regularly. Some women experience an intensity at the end of this stage. This is known as a ‘transition’. This is where the cervix is fully dilated (10cm) but you are not regularly pushing. Labour and birth are very individual and not everyone will experience these stages in the same way.

There are two interventions to speed up first stage of labour:

Breaking your waters: If your waters have not broken or we see that your ‘membranes’ are intact still (fluid from baby), we may offer to break them manually.

Oxytocin: This medication goes into a vein which we can access by putting a cannula in your arm or hand. This medication is given to try and help increase the number and strength of your contractions. If you would like this, we have to keep an eye on your baby a bit more closely and will use continuous monitoring which involves having some straps on your abdomen which are attached to a machine. Oxytocin doesn’t have an impact on the mode of birth you will end up with but it can cause hyperstimulation. This is where your uterus contracts too much and it can increase the risk of transient fetal hypoxia which is where your baby has less oxygen for a short period. If there are issues with this, we can stop the oxytocin. If you decide that you would like to have the oxytocin.

Stage 2: Pushing and having your baby

Stage 2 is made up of two parts. In first births, we expect this stage to take up to 3 hours and in subsequent births we expect this to take up to 2 hours. We would not expect you to need to push for more than 2 hours.

The passive stage is when you will have a fully dilated cervix but you will not have started to push yet.

The active stage is where you will be pushing and baby will be born.

There are two interventions for the second stage of labour: oxytocin to increase the strength and frequency of contractions or an instrumental vaginal birth, or if this is not possible a caesarean section.

Stage 3: Birthing the placenta

Stage 3 is the stage where your placenta is born. You can have an ‘active’ or a ‘physiological’ third stage.

Active management is where we give you an injection to help the placenta come out of your uterus, we clamp and cut the cord after approximately two minutes and we pull gently on the cord to encourage the placenta to be born quickly. We recommend this to reduce excessive bleeding after birth.

Physiological management is where we don’t use drugs, we only clamp the cord after it has stopped pulsating or if the placenta has been delivered. The placenta is delivered by your effort rather than us guiding it out.

You are less likely to have a post-partum haemorrhage (big bleed after birth) when we do active management compared to physiological management. You are also less likely to need a blood transfusion, become anaemic, or need more uterotonic drugs to help. However, you are more likely to feel sick, be sick, have a headache, have high blood pressure, and come back to hospital with bleeding.

If your placenta doesn’t come out or it is taking too long, we can give you drugs to help it be born, empty your bladder and perform a vaginal examination. It this does not work; we will need to transfer you to a surgical theatre for a procedure to take your placenta out of your uterus. If you are not in a doctor-led unit, this will mean transferring you to one.

The third stage of labour is prolonged if it is not complete within 30 minutes after birthing your baby if we use active management, and 60 minutes if we use physiological management.

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