Labour has started when contractions come regularly, every 3 to 5 minutes, and last at least a minute. In 10 to 15 per cent of cases labour starts with the waters breaking. When to call us is explained under When to call.
Contractions open the cervix; this is called dilation. With a first baby dilation takes 12 to 20 hours on average. With later babies it is usually quicker. Stress can slow dilation down, so try to relax as well as you can between contractions. A shower or a bath can help. If you need more than relaxation, read about the options under Pain relief.
We check regularly how far dilation has progressed.
Full dilation
At 10 cm the cervix is completely open: this is full dilation. Usually you feel the urge to push at that point, and that is the moment you can start pushing actively. Pushing means bearing down with the rhythm of the contractions to move your baby out. With a first baby pushing can take one to one and a half hours. With a later birth it is often quicker.
The birth
With every pushing contraction the head comes a little further down. Between contractions it slips back a little; that is part of the process. Just before the head is born, we will usually ask you to stop pushing and to breathe out slowly instead. That way the head is born gently and your pelvic floor has time to stretch.
Even so, the skin between your vagina and your anus can tear. Sometimes we make a cut, for instance if your baby needs to be born quickly. With the next contraction the rest of the body follows and your baby is here.
Your baby is placed straight onto your tummy, skin to skin, with a warm towel over you both. A little later the cord is cut; your partner is often the one to do it.
The afterbirth
Once your baby is here the birth is not quite over: the placenta has to be born as well. This is called the afterbirth. It usually comes within half an hour, with a few afterpains and one more gentle push. You may be given an injection that helps the womb contract, so that you lose less blood.
We then check that the placenta is complete and how much blood you are losing. If a tear or a cut needs stitching, that is done shortly afterwards. If the afterbirth takes longer than an hour, you will go to hospital after all.
After that there is all the time you need to recover together. You can read what happens next on the first hours after the birth.