Name: Childbirth Explained: Stages of Labour and Pain Relief Options
Creator: Dr. Najeeb Layyous

In short: Labour has three stages: the first is the opening of the cervix to 10 cm, which takes 8–12 hours in a first birth and less in later ones; the second is the birth of the baby; the third is the delivery of the placenta. Pain can be eased by support and breathing exercises, by painkillers or by an epidural. Go to hospital if there is bleeding or leaking of water, or when contractions become regular about every 5 minutes.

Here is some information you need to know about labour, its stages, and the pain relief options that can be used to help you feel more prepared and comfortable:
What is labour?

When the time comes, uterine contractions will gently guide your baby out into the world.

There are signs of labour, but it can be difficult to know exactly when it will start.

Video of normal vaginal delivery | Video Stages Of Labour

Video Explanation of the Labour Process

Stages of labour:

There are three stages of labour:

1st stage:

Once labour is established, this stage lasts on average about 8 hours for first-time mothers (primigravida), and is unlikely to last more than 18 hours; for mothers who have given birth before (multipara) it lasts on average about 5 hours, and is unlikely to last more than 12 hours. The duration varies from woman to woman. Once labour starts, this stage continues until the cervix is fully dilated to 10 cm, allowing the baby’s head to pass through.

2nd stage:

This stage usually lasts up to 2 hours for first-time mothers (up to 3 hours with an epidural), and up to 1 hour for mothers who have given birth before (up to 2 hours with an epidural). It is the stage where the baby’s head passes through the birth canal.

3rd stage:

This is when the placenta is delivered. It usually takes up to 30 minutes when you are given an injection to help the uterus contract (the usual practice), and up to 60 minutes if the placenta is delivered naturally without medication.

You may feel irregular, separate contractions in the last weeks of pregnancy, and once they become regular, occurring about every 5 minutes, it is usually time to go for delivery.
During the second stage, you will start to feel an urge to push.
Every patient experiences pain differently, even when contractions are similar in strength.

The cause of labour pain is the pressure placed on the nerves near the uterus.

Causes of labour pain:

Cervical dilatation in response to uterine contractions.
Contraction and retraction of the lower uterine segment as it prepares to dilate the cervix.
Contractions and retractions affect the blood vessels supplying the uterine muscles, leading to a build-up of metabolites that causes pain.

As contractions occur, they create tension on the ligaments supporting the uterus, which also contributes to pain.
Where you may feel pain?
Most often, pain is felt low in the abdomen.
At the sides of the pelvic bone.
From the belly button down to the genital area.
Lower back.
Signs of labour:
True labour pain involves regular uterine contractions that become stronger and closer together and do not go away with rest or a change of position.
Bloody show.
If you are a first-time mother, you may feel irregular contractions ½-1 hour apart, which can often be eased with pain relief.
When should you go to the hospital?
If your contractions are regular and painful, about every 5 minutes (earlier if this is not your first baby or you live far from the hospital), or if you notice your baby moving less than usual.
Heavy, sudden bleeding.
Passage of watery vaginal discharge that wets your clothes.
Passage of greenish, watery vaginal discharge.

What should you do during labour?

1st stage of labour:

Try not to push downward.
Take slow, deep breaths.
Move around and change position as you like — walking, standing, sitting on a birthing ball or lying on your side can all help; avoid lying flat on your back.

2nd stage of labour:

Follow your doctor’s guidance closely: when you feel the urge, push downward with your contractions (as if having a bowel movement), in the way that feels right for you, and rest and relax between contractions; if you have an epidural, you may be advised to wait a little before pushing. Try to avoid screaming, pulling your hair, or moving suddenly on the bed during this stage.

A small cut in the perineum (episiotomy) is not done routinely; your doctor will only suggest it if it is needed, for example to help deliver the baby quickly or during a vacuum or forceps delivery. It is done under local anesthesia.

3rd stage of labour:

Empty your bladder.

Straight after your baby is born, you will be given an injection of oxytocin in your thigh to help the uterus contract and reduce bleeding; your doctor will then gently deliver the placenta and check that your uterus is firm and your bleeding is normal.
Once labour is complete, your doctor will check for any tear and, if stitches are needed, repair it under local anesthesia.
In cases of difficult labour, your doctor may need to use a vacuum device or forceps to help deliver the baby, so it’s helpful to understand what type of delivery may become necessary.
Caesarean section:

Caesarean section Video

It can be performed under general or spinal anesthesia.

It is performed to protect the health of the mother or baby, such as in cases of:

Cephalo-pelvic disproportion, fetal distress, placenta previa, severe bleeding, or severe pre-eclampsia.

How can pain be managed during labour?
Psychoprophylaxis or natural birth:
In this approach, no medication is used; instead, it focuses on encouraging and supporting the mother, helping her relax, and guiding her to breathe deeply and slowly throughout labour.
When your doctor explains what to expect during labour, especially for first-time mothers, it can help you feel more prepared and better able to cope with the pain.

Pain-relieving medications
These may be given either intramuscularly or intravenously.
The type of pain relief, method of administration, and dosage depend on your condition during labour.
Epidural analgesia
With this method, medication is delivered into the epidural space after a local anesthetic is applied.
The anesthesiologist checks how well the medication is working by gently testing sensation, starting from the thigh up to the abdomen. Does this type of anesthesia affect labour?
An epidural does not increase the chance of needing a caesarean section. It may make the pushing stage longer and slightly increase the chance of needing a vacuum or forceps delivery.

Video of normal vaginal delivery | Video Stages Of Labour

Video Explanation of the Labour Process | Caesarean section Video

Few notes to add :

Choosing pain relief during labour is a personal decision, made together with your doctor based on what is appropriate for your situation.
If you notice any of these signs, call your doctor immediately:
Bleeding.
Passage of watery vaginal discharge.
Regular, painful contractions about every 5 minutes, each lasting around a minute, for about an hour (go earlier if this is not your first baby, if you live far from the hospital, or if your waters break or you have bleeding).. At this stage, focus on taking slow, deep breaths.

Preparation for Birth

When you arrive at the hospital, the nurse and resident doctor will assess your condition. If it is still early labour, you may be sent home to wait a little longer. If you are in true labour, you will be admitted.
You may also be admitted if you have high blood pressure, pre-eclampsia, diabetes, or if there are signs of fetal distress.
After delivery, your baby will be dried and placed skin-to-skin on your chest and covered warmly; the mouth and nose are only cleared if needed.

If your baby is well, the umbilical cord will be clamped and cut after at least one minute, which allows extra blood to pass to your baby and improves their iron stores.

Then, another sequence of contractions will help deliver the placenta.

You will hold your baby skin-to-skin for at least the first hour and can start breastfeeding; your baby’s weight and length can be measured afterwards.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist

If you have questions about labour, delivery, or pain relief options, the team at Dr. Najeeb Layyous clinic is here to guide and support you every step of the way.