If you are in planning to come into hospital or are concerned or have questions, please ring 4885 6930 to speak with a midwife first. This allows a midwife to assess your progress and prepare for your arrival.
Your arrival
On your arrival a midwife will assess your health and discuss your birthing preferences before taking you into one of the birthing rooms for your labour.
The midwife will:
- check the baby’s position by feeling your abdomen
- check your temperature, pulse and blood pressure
- listen to the baby’s heart rate
- time your contractions
- with consent, may do an internal (vaginal) examination to see how much your cervix has opened and to check the baby’s position
- put an identification band on your wrist.
Labour
There are four stages of labour. Understanding the four stages can help you to know what is happening during labour. Labour can be very different from woman to woman.
- The first stage of labour is the slow opening of your cervix.
- The second stage is the birth of your baby.
- The third stage is separation and birth of the placenta.
- The fourth stage is the first two hours after birth.
The main signs of labour
- contractions
- a ‘show’ (a mucous blood-tinged vaginal discharge)
- waters breaking.
Other information
Other concerns you may have about labour and birthing and want to know more information about are:
- managing pain in labour
- induction of labour (IOL)
- assisted birth techniques
- caesarean birth
- post partum haemorrhage
First stage
The first stage of labour is made up of three different phases and involves the thinning of the cervix and its dilation to around 10 centimetres.
Latent phase
- Generally, this stage is the longest and the least painful part of labour.
- The cervix thins out and dilates from zero up to four – six centimetres.
- This may occur over days or hours and be accompanied by mild contractions.
- The contractions may be regularly or irregularly spaced, or you might not notice them at all.
Active phase
- The next phase is marked by strong, painful contractions that tend to occur three or four minutes apart, and last from 30 to 60 seconds.
- The cervix dilates from four – six to eight centimetres.
Transition
- The cervix dilates from eight to 10 centimetres (that is, fully dilated).
- These contractions can become more intense, painful and frequent. It may feel as though the contractions are no longer separate but running into each other.
- It is not unusual to feel out of control and even a strong urge to go to the toilet as the baby’s head moves down the birth canal and pushes against the rectum.
Throughout the first stage of labour, careful monitoring and recording of your wellbeing, your baby’s wellbeing, and the progress of your labour, is important. This helps us to know whether your labour is progressing normally, to recognise any problems early and for clear communication. Ideally, you will experience the latent phase in the comfort of your home. You may wish to come to hospital as you move through the active phase.
More information: Queensland Clinical Guidelines parent information – Early labour (PDF)
What can I do in the active stage of labour?
Birth partner’s role
- Remind your partner to go to the toilet.
- Help her with changing positions.
- It might help to dim the lights or play some music.
- Support her in any decisions she makes about pain relief.
- Keep yourself relaxed as possible and look after your needs.
- Sometimes humour can lighten the atmosphere, when appropriate.
Helping yourself in first stage
- Make sure you stay well hydrated.
- Eat lightly during labour; your digestive system naturally moves more slowly, and you may find that you become nauseated. Some easily digested foods include fruits, yogurt or toast.
- Choose positions of comfort; you might find your body instinctively moves to certain positions during contractions.
- Slow swaying movements may also help during contractions.
- Standing helps your body and your baby work with gravity and encourages the downward movement of your baby through the pelvis.
- Remember – an empty bladder is more comfortable and gives your baby more space to move down.
Second stage
The second stage of labour is the birth of your baby. This stage starts when your cervix is fully dilated, and you will usually have a strong urge to push because of the pressure your baby’s head is placing on your pelvic area. At this stage your baby is moving from your uterus into your vagina and out into the world. The second stage can last from 10 minutes to two hours.
What can I do in the second stage?
Birth partner’s role
- Help your partner into a comfortable position.
- Your encouragement is important but avoid cheerleading.
- It can be helpful to repeat the midwife’s advice to your partner in a calm steady voice.
- Offer your partner sips of water or ice.
Helping yourself during the second stage
- Push when you have a contraction and relax in between.
- It is more effective to get two or three pushes in with each contraction, breathing in between, rather than one long push.
- Being upright allows gravity to help you.
- Relax your pelvic floor muscles around the vaginal opening.
- Your midwife may apply warm compresses to your perineum for comfort and to reduce tearing.
Third stage
Third stage of labour is the birth of your placenta. After the birth of your baby, your uterus gently contracts to loosen and push out the placenta. This may occur five to 30 minutes after the birth of your baby. The muscles of the uterus continue to contract to stop the bleeding. This process is always associated with a moderate blood loss – up to 500 millilitres. In this stage of labour, one of the potential problems is excessive bleeding (postpartum haemorrhage), which can result in anaemia and fatigue. This is why the third stage is carefully supervised.
There are three approaches to managing the third stage:
- natural (also known as physiological or expectant) management, or
- active management
- modified active management.
Natural third stage
A physiological or natural third stage means that you wait for the placenta to be delivered naturally. After your baby’s birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby. Your uterus (womb) will contract, and the placenta will peel away from the wall of your uterus. The placenta will then drop down into your vagina, ready for you to push it out.
Delayed cord clamping
The benefits of delayed cord clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells which results in higher iron stores in the baby for up to six months.
Active (or managed) third stage
The advantage of an active third stage is the lower risk of very heavy bleeding immediately after the birth. Your midwife or doctor will recommend you have an active third stage if you had complications during pregnancy or labour, such as:
- twin pregnancy
- polyhydramnios
- heavy bleeding during pregnancy or in labour
- a history of retained placenta
- a low-lying placenta
- anaemia
- an induced or very long labour
- an assisted birth or caesarean birth.
Immediately after the birth of your baby, the midwife or doctor gives you (with your consent) an injection of oxytocin, clamps and cuts the umbilical cord, and then carefully pulls on the cord to speed up delivery of the placenta.
Modified active third stage
This is a combination of active and natural. It is similar to active third stage, but it includes delayed cord clamping. This is the safest method for most women to birth their placenta and maximises both benefits to mother and baby.
Fourth stage of labour
After the birth, you and your partner will be given time with your baby so that you can get to know one another.
- It’s important that you and your baby stay together, skin to skin, ideally for the first two hours after birth.
- Your baby will be examined, weighed, measured and given identification bracelet/s.
- If you consent, baby will also be given vitamin K as an injection or orally and the Hepatitis B vaccine
- Your baby may be dressed and wrapped in a warm blanket.
- You may then be transferred to the postnatal wards or you may request an early discharge if you and baby are well.
Checks after your baby is born
While you are holding your baby, your midwife or doctor will do a check called an APGAR score.
The APGAR score will be done twice, at one minute and five minutes after birth. You probably won’t even notice it’s being done, as the midwife can do this while baby and mother are skin to skin.
It helps the midwife or doctor to know whether your baby needs additional care following birth.
The APGAR score is based on the baby’s:
- breathing rate
- heart rate
- skin colour
- muscle tone
- reflexes.
Blood loss after birth
Blood loss after birth is normal. Bleeding in the days or weeks after birth (also called lochia) is completely normal and occurs regardless of whether you have a vaginal or caesarean birth.
What is normal blood loss after birth?
Women’s experiences of bleeding after birth vary considerably. In the first few days after birth, most women experience moderate to heavy bleeding. Over the first few days to weeks this bleeding will gradually decrease and will change colour. It is also common for bleeding to be heavier after breastfeeding. Most women will stop bleeding between four and six weeks after birth.
What is excessive blood loss after birth?
Excessive blood loss after birth is over 500ml after a vaginal birth and over 100ml after a caesarean section.
More information: Queensland clinical guidelines parent information- Bleeding after birth
Queensland clinical guidelines parent information- Severe bleeding after birth
