Labour can be difficult to describe as it is different for every woman. If unsure, the midwives are experienced in giving advice over the phone and welcome your call any time.
This page will look at the signs of labour, stages of labour, managing the pain and assisted birth options. Please also see our Maternity Ward page to find out more about the maternity ward, when to come to hospital and what to bring.
SWH is a teaching hospital and we aim to provide the best possible experience and environment for nursing, midwifery, allied health, and medical students. Students may be involved in your care by asking to talk to or examine you. We want your experience to be the best one possible for you, so if you have any concerns you have the right to say “No”.
In the early stages of labour your cervix begins to soften and thin, this process can take time and can be different for every woman.
It is normal for this stage to occur over numerous days. Most women are able to stay at home during this time.
In the early stages of labour you may have:
Sometimes women start to have contractions and then they fade away. These can be deceptive and can make you think that you are in labour.
You may go to hospital to find that everything stops. Don’t feel embarrassed or worry, this can be a very normal labour process.
This sort of false alarm happens all the time. Remain calm and relaxed. Practice relaxation techniques and rest when able.
Health Professionals normally describe labour as being in three stages. The first stage is normally the longest and can last anywhere from a couple of hours to twenty-four hours.
To start with you may have:
This stage may take many hours or pass quite quickly into the middle phase.
If you think you are in labour, phone maternity to speak to a midwife for advice about when to come to hospital.
During this phase:
This is an intense stage of the birth. You may feel impatient, tired, irritable and even angry and frustrated with your carer and your support person/people. This is normal and means that your baby is not far off.
Contractions are now about 2-3 minutes apart. They may come one on top of the other without a lot of break in-between. You may feel:
Your midwife is crucial at this stage of the labour. Your midwife will guide you with when and how to push. The midwife can also assist you in trying different positions to find the one that feels best for you.
The pushing stage can vary from woman to woman, it is not uncommon for first time mother to push for up to 2 hours.
During this stage:
This stage of labour is from the birth of the baby until the birth of the placenta and membranes.
This stage is usually completed within 30 minutes but can take up to an hour. During the third stage it is usual to have some bleeding while the placenta separates from the uterus. Mostly this bleeding is minimal, but there is a small risk of excessive bleeding called ‘postpartum haemorrhage’.
You may experience more contractions to expel the placenta and a feeling of fullness in the vagina as the placenta is being birthed.
To help with the delivery of the placenta, the midwife may apply some gentle traction on the cord. You may be hardly aware of the third stage as you will be focused on your baby. You may feel shaky due to the adrenaline surge and the adjustments your body immediately starts to make.
Management of the third stage of labour can occur in two ways: physiological management and active management. A discussion about these options and a plan for third stage will occur during your 36 weeks antenatal appointment.
Active Management: After discussion with you, your midwife will give you an injection in your thigh or into your intravenous cannula if you have one. This will be done within a few minutes after birth. The injection is the same hormone that is produced by the body to make contractions and therefore helps the uterus to contract and prevent a postpartum haemorrhage.
Physiological management: As a result of this management signs of placental separation are awaited and the placenta is delivered without intervention or medication to make your uterus contract. Blood loss may be greater where there is physiological management of the third stage.
While we respect your decision there are some circumstances where you will be strongly advised to choose active management. These are situations in which the risk of bleeding is higher, such as a long or induced labour, assisted vaginal birth or previous postpartum haemorrhage.
Measuring your baby’s heart rate is a way of assessing your baby’s health throughout the labour and birth
Listening: For low risk pregnancies and labour a fetal Doppler (same as what is used in antenatal appointments) is used to listen to your baby’s heartbeat at frequent intervals during the labour.
Continuous external monitoring: If you are being induced or certain events that may occur in labour, it may require that your baby is monitored via a CTG Cardiotocograph. An electronic monitor is attached to a belt around your abdomen. The monitor continuously records the baby’s heartbeat and any contractions on a paper printout. SWH have the option of portable monitoring which enables women to stay active (and even shower!) and not be restricted by the technology.
Internal monitoring: An electronic monitor is attached to a probe which is connected to the baby’s head though your vagina. It is only used if the quality of the external monitoring is poor.
Fetal scalp lactate: A few drops of blood are taken from your baby’s scalp (like a pinprick). It gives an immediate result on the baby’s condition in labour. Doctors use this test when they need to get more information than they can get from continuous heart rate monitoring. The result will show if the baby needs to born immediately.
Labour and how you experience the pain of labour is very individual. Your pain can often be managed with relaxation techniques, letting go and trusting that your body knows what to do. Fear, tension and resistance are a normal response when you feel out of control or you are not sure what to expect next. On the other hand, relaxing and trusting your body will help you manage your pain. Your pain can also vary according to the environment in which you give birth, your support people, whether you’ve had a baby before, the position of your baby as well as your method of pain management. There are a number of natural and medical methods you can use to manage your labour pain.
Active birth: or moving around and changing positions, is one of the most important things you can do to manage the pain of labour and birth. Being able to move freely can help you to cope with the contractions. If you stay upright, gravity will also help your baby to move down through your pelvis.
Your midwife may suggest that you try different positions as labour progresses. You can try a variety of positions during labour, such as:
Standing, walking, lying on your side, kneeling, leaning on your partner or support person or on a beanbag, squatting etc.
Heat and water can also help to ease tension and backache in labour. Both hot and cold packs are useful, as is being immersed in water in either a shower or a bath.
Touch and massage can reduce muscle tension as well as providing a distraction between and during contractions. Practice with your partner during your pregnancy and find out how you like to be massaged. Sometimes during labour massage will feel good and then it might be suddenly annoying (which is important for your partner or support person to know).
Music during labour: music is a good distraction and can be very relaxing but it can also be suddenly and unexpectedly annoying. Be prepared for any eventuality.
Helpful tips for labour:
The TENS machine is a small, portable, battery-operated device which is worn on the body. The box is attached by wires to sticky pads that are stuck to the skin. Small electrical pulses are transmitted to the body, like little electric shocks. While there is no harm is using a TENS machine, there is not a lot of evidence to show they are effective but some women find them helpful.
Many women have lower back pain that persists throughout their labour. Midwives can use a technique involving sterile water injections in the lower back. Usually injections are given in four different places in your lower back, just beneath the skin. Some points to consider are:
You and your carers will have discussed your preferences for pain relief long before you go into labour. You can also record your preferences for pain relief in your birth plan. During your labour, the midwife will continue to guide you and work with you according to your wishes.
The gas given to women in labour is a mixture of nitrous oxide mixed with oxygen; sometimes known as laughing gas. It helps take the edge off the pain during a contraction.
It is inhaled during a contraction through a mask or a mouthpiece. You may feel a little nauseous or light-headed and you may have dry mouth for a short time.
There are no after effects for you or your baby.
Morphine is a strong painkiller (opiate) given by injection. It helps reduce the severity of pain, but does not take it away completely.
It can take up to 20 minutes to work and effect lasts three hours or more. Morphine is preferable to pethidine because it lasts longer and has fewer side effects. Unlike an epidural, you do not need to have an IV (intravenous) drip, a catheter or CTG monitoring.
Morphine can make you and your baby sleepy. Morphine may contribute to breathing problems in your baby if given within two hours of birth. This is uncommon and the effects can be reversed by giving your baby an injection. Babies who need this injection will need closer observation for a few hours after birth.
Epidural is a local anaesthetic, which is injected into your back (not the spinal cord). It must be inserted by an anaesthetist.
An effective epidural provides total pain relief from the waist down for as long as necessary. You won’t be able to walk around but you will still be awake.
A very thin tube will be left in your back so the anaesthetic can be topped up. Sometimes the tube is attached to a machine so that you have control over when the epidural is topped up. An epidural can take away the sensation to pass urine so you will also need a urinary catheter (a thin tube) to drain your urine. You will also need an IV (intravenous) drip inserted into your hand to make sure you are getting enough fluids.
A cardiotocography or CTG machine will continuously monitor the baby’s heart and your contractions. Your blood pressure will also be monitored more closely. You may still feel the urge to push, but the sensation is reduced.
The benefits of an epidural:
The disadvantages include the possibility of:
Sometimes labour doesn’t go as planned and your baby will need help to be born. Sometimes it is necessary to help a woman to start her labour using artificial methods. This is called induction of labour. Sometimes it may be necessary to assist the birth of a baby with the use of forceps or vacuum extraction. These are used only after the cervix has fully dilated.
The most common reasons are:
Before an assisted birth you have a catheter inserted into your bladder to drain urine. You may also need a local anaesthetic to numb the vagina and perineum. A paediatrician is always called to attend an assisted birth.
Sometimes is it necessary to help a woman to start her labour using artificial methods. This is called induction of labour. You will only be offered an induction of labour if your health or your baby’s health is at risk.
It might involve having your waters broken or taking medicines to encourage the birth process to start.
Most common reasons for induction:
When your doctor or midwife recommends an induction you can expect that they will explain:
If they don’t explain, use this list to ask them. Some women will choose to ‘wait and see’ if labour will start on its own. It’s important that you consider all the risks and benefits in your particular situation so that you are able to make a well-informed decision.
While not having an induction can put the health and even the life of your baby at risk, there are also risks with having an induction. Having an induction for reasons other than prolonged pregnancy may increase the chance that you will need an emergency caesarean section.
Women who are induced are more likely to experience above average blood loss after the birth.
First the doctor or midwife will do an examination of your cervix. The examination takes only a few minutes but it can be a little uncomfortable.
Based on this examination your doctor or midwife will recommend one of the following methods of induction:
An induction might involve one or several of these methods.
If your waters have not broken, the midwife or doctor can do this for you. The procedure is called Artificial Rupture of Membranes or ARM.
The midwife or doctor makes a hole in your membrane sac to release the fluid inside. This procedure is done through your vagina using a small instrument. Sometimes releasing the waters is enough to get things going and labour will start. However, most women will also need oxytocin.
Things to know:
Oxytocin is the hormone that causes contractions. A synthetic version can be given if your waters have broken but contractions don’t start.
Oxytocin is given through a drip in your arm. Once contractions begin, the rate of the drip is adjusted so that contractions occur regularly until your baby is born.
This process can take several hours. Your baby’s heart rate will be monitored throughout labour using a CTG machine.
Things to know:
Prostaglandin is a hormone that prepares your body for labour. A synthetic version can be inserted into your vagina, in the form of a pessary.
When the prostaglandin is in place, it’s a good idea to lie down and rest for at least 30 minutes. Once the prostaglandin has been inserted you will need to remain in hospital.
The pessary slowly releases the prostaglandin over 12 to 24 hours. When the cervix is soft and open, your body is prepared for labour.
The next steps will vary from woman to woman – some might need an ARM to break their waters, and some women might need oxytocin to stimulate the contractions.
Things to know:
Your doctor may recommend using a cervical ripening balloon catheter over prostaglandin.
This is a thin tube or catheter with balloons on the end. The catheter is inserted into your cervix and the balloons are inflated with saline.
Once inflated the balloons apply pressure to the cervix. The pressure should soften and open your cervix.
When the catheter is in place, you do not need to stay in hospital and you can move around normally.
What happens next will vary from woman to woman – but most are booked in the next morning for an ARM to break their waters. Some women might need oxytocin to stimulate the contractions.
More information about induction of labour is available here.
Forceps are used to help the baby out of the vagina.
They may be used if you are too exhausted to push, the baby is in an awkward position or there are concerns for your baby’s wellbeing.
Sometimes the forceps leave a mark on the baby’s cheeks, but these soon fade.
You will usually need an episiotomy.
This is more commonly used in labour than forceps.
The vacuum cup is made of plastic and is attached to a suction device. The cup is inserted into the vagina and creates a vacuum against the baby’s head. This helps the doctor to gently pull the baby out.
It may cause a raised bruise on the baby’s head, but this soon fades, usually within a day.
You may need an episiotomy.
An episiotomy is a cut made in the perineum (the tissue between the vagina and the anus).
Sometimes it is necessary to make the opening to the vagina bigger, especially if you need a forceps birth or if the baby is distressed.
A local anaesthetic is used to numb the area and you will need stitches afterwards.
The stitches will dissolve by themselves and you will be offered ice packs to reduce swelling and pain.
A caesarean section is a major surgical operation in which your baby is born through a cut in your abdomen and uterus. It is usually performed under a spinal or epidural anaesthesia. In some cases it is necessary to use a general anaesthetic so that you are asleep throughout.
Some caesarean births are planned in advance (elective caesarean) because of existing problems with your pregnancy. In other cases, the decision to perform a caesarean is made during the course of labour. This is called an emergency caesarean.
An emergency caesarean is recommended for the following reasons:
You may be in the operating theatre for an hour or more.
Unless you are having a general anaesthetic, in most cases, your partner can be with you in the operating theatre.
You will have a midwife stay and look after you and your baby in the theatre and the recovery area.
Unless you have had a general anaesthetic, skin-to-skin contact with your baby will be encouraged immediately after the birth, otherwise you are likely to have skin-to-skin as soon as you are able. Your support partner can request to do skin-to-skin contact if you are unable to.
The midwife will help you with breastfeeding. You will be encouraged to express breast milk if your baby is unable to feed from the breast. This will start as soon as possible after the birth and you will need to express about 8 to 10 times every 24 hours.
If your baby is unwell or needs to be monitored they may need to go to special care. In some cases they may need to go to a different hospital, which has a higher level of care for babies who are very sick.
After surgery you will be offered a number of different pain-relieving medications as you need them.
Midwives will ensure that they have assistance to shower and care for the baby. Midwives will also ensure that they have enough pain relief medication.
Caesarean section– RANZCOG
If you have had a caesarean section it may affect your future pregnancies and births. For future births, you will need to make a choice about whether to have another caesarean section or attempt a vaginal birth.
This is called a Vaginal Birth After Caesarean Section (VBAC). Both options carry a level of risk. Having another caesarean carries all of the risks of a normal caesarean section.
The main risk for VBAC is that the scar on the uterus will rupture, which can be very painful and, in some cases, life threatening. Between one and two in 200 women who attempt a VBAC will suffer a ruptured scar.
Most women who attempt a vaginal birth after a caesarean will succeed (70 per cent). Thirty per cent of women who attempt a vaginal birth will, for any number of reasons, end up having an emergency caesarean.
Many women who have had a previous caesarean section find the prospect of a vaginal birth healing, particularly if the first caesarean was unplanned or traumatic. Unless there are particular health reasons why you would be advised to have another caesarean, the decision is ultimately yours. Midwives or doctors will discuss this with you throughout your pregnancy. It’s a good idea to ask about the specific risks and benefits for you.
Vaginal Birth After Caesarean Section – RANZCOG
A preterm or premature birth is one that happens before 37 weeks of pregnancy. In about half of all preterm births, the cause is unknown.
Factors that increase the likelihood of a premature birth can be:
If babies are premature, they are likely to require extra care at and after birth.
Some of the signs that you may be starting labour prematurely can be that your waters break, you feel contractions or you have a ‘show’. If you think you could be in labour or if you have any vaginal bleeding, call the hospital straight away.
It may possible slow or even stop premature labour using drugs that stop contractions. This will provide more time in the uterus for your baby so that steroids can be given to you which will help to protect your baby’s lungs from breathing problems. Steroids generally take up to 24-48 hours in your system to be effective for your baby.
South West Healthcare does not have facilities needed to care for premature babies less than 34 weeks, so it is necessary to transfer these babies to a higher care facility (Melbourne or Geelong), ideally before delivery (if time permits) or immediately following the birth.
It is normal to bleed from your vagina after you have a baby. This blood mainly comes from the area in your womb (uterus) where the placenta was attached, but it may also come from any cuts and tears caused during the birth.
Bleeding is usually heaviest just after birth and gradually becomes less over the next few hours. The bleeding will reduce further over the next few days. The colour of the blood should change from bright red to brown over a few weeks. This vaginal bleeding is called the lochia and it will usually have stopped by the time your baby is 6 weeks old.
Sometimes bleeding after birth is heavier than normal.
Postpartum haemorrhage (PPH) is heavy bleeding after birth. PPH can be primary or secondary:
Between 5 and 15 per cent of women giving birth will experience a postpartum haemorrhage. It is a little more common after assisted vaginal birth and caesarean section.
After your baby is born, your midwife will keep a very close eye on your blood loss as well as regularly rubbing your abdomen to make sure your uterus is firm and contracted.
If heavy bleeding does occur, it is important that it is treated very quickly. If your blood loss is adding up to 500mls or more, you may require some different types of medication to stop any further bleeding. To assist with this, the midwife may call for some extra assistance in the birth suite from other midwives and Doctors.
If you have experienced a PPH, you will receive a blood test the next day. If the tests show you are anaemic or if you are feeling faint, dizzy, or light-headed, an iron or blood transfusion may be considered.
The Doctors will come around and have a conversation with you and you partner. You will have the opportunity to discuss what has happened and ask any questions before you leave the hospital.
The following emergencies are all rare events. However we want all families to feel educated throughout their pregnancy.
If you have any further questions please ask your midwife or obstetrician at your next appointment.
Our staff our trained to detect and manage these emergencies and will work together to achieve the best possible outcome for you and your baby.
In these emergencies, members of the midwifery, obstetric and paediatric teams may be present.
Incidence: 1-6 per 1000 births
Cord prolapse is a rare event that occurs when your baby’s umbilical cord presents before your baby’s head. This is a very rare emergency that will require your baby to be delivered in the quickest and safest way. Caesarean section is often the safest method of delivery in this emergency.
Incidence: 6-7 per 1000 births
A shoulder dystocia may occur during delivery when your baby’s shoulders get caught behind your pelvic bone. This an emergency that requires your baby to be delivered in the quickest and safest way. There are many different movements and positions staff will use to try to help your baby’s position.
Your perineum is the area between your vaginal opening and back passage (anus). It is common for the perineum to tear to some extent during childbirth. Tears can also occur inside the vagina or other parts of the vulva, including the labia.
Up to 9 in every 10 first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly.
First-degree:
Second-degree:
Third- and fourth-degree tears:
What is the difference between a tear and an episiotomy?
Perineal tears: What you need to know during pregnancy – Australian Commission on Safety and Quality in Health Care
Third and fourth degree perineal tears – Australian Commission on Safety and Quality in Health Care
Perineal tears: How to reduce the risk – Australian Commission on Safety and Quality in Health Care
Your baby:
You: