This is when the cervix starts to soften, thin out and open. It is complete when the cervix is fully dilated, around 10cm. This can go on for hours, even days.

In early labour you may have:

• Blood stained mucus called a show.
• Lower back pain.
• Period like pain that comes and goes.
• Loose bowel motions.
• An urge to vomit.
• Sudden gush or slow leak of fluid from vagina which is clear or slightly pink: if it is green or bloody you should contact the hospital immediately.

Things your can do:

• Listen to and tryst your body, it knows what to do.
• Stay at home as long as you are happy there.
• Have regular snacks so you are building your energy stores.
• Rest as much as possible.
• Try relaxing in a bath or shower.
• Go to the toilet regularly and empty your bowels if you can.

Eventually you will start feeling more restless and tired, your pain will be more intense and the time between each wave of pain will be smaller, this signals your are moving closer to second stage.

When to go to hospital:

• It is not always clear if labour has started. If you are not sure call the hospital and talk though your symptoms to gain some guidance.
• Your waters break.
• If your have greenish discharge vaginally.
• You have vaginal bleeding that is not a show.
• Small vaginal bleeding mixed with lots of mucus is called a show and is sign that labour is progressing normally. You may also get a show if you have had a vaginal examination.
• Your contractions are regular, last more than 30 seconds and are closer than 5 minutes apart.
• You need pain relief.
• You do not feel baby moving.
• If at any stage you are worried or unsure about what is happening.

This is the period of time from when the cervix is fully dilated to when the baby is born.

During the second stage you may have:

• Longer and stronger contractions.
• Increased pressure in your bottom.
• The desire or urge to push.
• Nausea and vomiting.
• Stretching and burning feelings in your vagina.

Things you can do:

• Stay calm, let go, allow your body to do what is needs and be guided by me.
• Concentrate on your contractions and rest in between.
• Try different positions.
• Keep up your fluids.

The pushing phase varies for each woman and when the urge arrives it can be overwhelming.

• You may feel pressure, a strong urge to go to the toilet, stretching and burning in your vagina or the baby’s head moving down.
• The best thing you can do is breath, relax, follow you body’s urge to push.
• Trust and listen to me and I will guide you.

• This begins after your baby is born and finished when the placenta and membranes have been delivered.
• During this stage you may feel more contractions to expel the placenta and a feeling of fullness in your vagina.

How you experience the pain of labour is very individual. It will vary depending on your environment, support people, if you have had a baby before, the position of your baby as well as your method of pain relief.

Options include:

Natural options

• Being active, moving around, changing position.
• Touch and massage can reduce muscle tension and act as a distraction during contractions.
• Music may also help you relax and be a good distraction.

TENS or Trans-Electrical Nerve Stimulation

• A small portable battery operated device worn on the body that transmits electrical pulses to the body.
• Despite not a lot of evidence some women find them useful.

Gas: mixture of nitrous oxide and oxygen

• Inhaled during a contraction can help take the edge off the pain. You may feel lightheaded, nauseous with a very dry mouth.

Pethidine

• A strong painkiller given by injection that helps reduce your pain but doesn’t take it away all together.
• It can take up to 30 minutes to work and can make your baby sleepy and contribute to breathing problems in your baby if given within two hours of birth.

Epidural

• This is a local anaesthetic, injected into your back altering your sensation from the waist down. A thin tube is left in your back allowing it to be topped up.
• It takes the pain of contractions away and can be effective for hours so in a long labour can allow you to sleep and recover your strength. It can be increased in strength if you need an emergency operation and can be helpful if your blood pressure is high to reduce it. An epidural does not directly affect your baby or increase your chance of needing a caesarean section but it can make the pushing phase of your labour longer.
• Your anaesthetist will talk to you about the risks in your individual situation.

• Where possible I will aim to facilitate skin-to-skin contact. This is allowing your naked baby to be placed on your bare skin and you both covered with a warm blanket.
• You must remember there are situations where this will not be possible due to either maternal or neonatal complications and this is in the best interest of both mother or baby or both.

Induction of labour is the process by which labour is encouraged to start artificially.

This can be done in a number of ways including:

• Sweeping the foetal membranes: with the aim of initiating natural labour.
• Artificially breaking the waters.
• Cervical ripening with medication – prostaglandin E2.
• Cervical ripening with a balloon catheter.
• Intravenous oxytocin.

Before deciding how labour is to be induced you will have a vaginal examination and based on this one or a combination of the above techniques will be recommended.

Sometimes your baby will need help to be born. This help may vary from relatively simple procedures such as breaking your waters or performing an episiotomy (a cut in the tissue between the vagina and anus to make the opening bigger), or more assistance with a forceps or a ventouse (vacuum cup) to more medically demanding procedures such as caesarean section.