Many women aim for a spontaneous vaginal birth without intervention. If that’s not the way it turns out, it’s unlikely they find the experience of meeting their baby for the first time any less joyful, but we’d like to take you through a straightforward birth experience anyway. Even if you are induced or require an assisted or emergency caesarean delivery, some of this article will be true to your experience.

What starts labour?

The exact cause of labour is unknown. Some research suggests that when a baby is ready for life outside of the uterus, it releases a small amount of protein that tells the mother's hormones to start labour. Labour itself is a very hormonal process, so it could be hormones that start things. Physical activity and even maternal illness have also been suggested as reasons a baby gets moving.

What are the four stages of labour?

There are four stages in a vaginal delivery: the early or latent stage, sometimes called early labour, the active stage, the pushing stage (which ends in childbirth), and birthing the placenta. We realise this sounds a lot. They vary in length, and from woman to woman. According to the NHS, labour can take up to 18 hours from the beginning of the active stage (when you are fully dilated) for a first-time mum. The good news is that by the time your baby is out, you’ll usually be so enamoured that you hardly notice the fourth stage. The better news, at least if you’re planning a big family, is that the whole process tends to get faster the more often you do it.

Early labour

This is covered in more detail in the Early Signs of Labour episode of Unii’s Antenatal Journey. This is the stage where your cervix is softening and opening to about 3–4 cm, though you won’t be able to check how much you are dilated at home and shouldn’t try to check your own cervix. Signs you’re in this stage include your waters breaking, your mucus plug going, Braxton-Hicks contractions, nausea, and real contractions. It’s usually the longest stage of labour and can last for days or even a few weeks, so you might consider making a toolkit for it in advance with over-the-counter painkillers, a favourite book, a TENS machine, and other comforting items. You’ll usually be at home—or told by hospital staff to go home—until you are in active labour, though staying in regular contact with your midwife is important.

Active labour

This is when you're dilating from 4 to 10 cm. You’ll usually head to the birth centre or hospital when this starts. If you’re giving birth in your home, your midwife should be there. You’ll usually be given your chosen pain relief at this stage. Your contractions will be stronger, lasting 1-2 minutes with no prolonged rest periods. As we’ve mentioned, this stage can last up to 18 hours for new mothers. For other pregnancies, it’s up to 12. Your midwife will monitor your baby’s heartbeat, as well as your contractions, blood pressure, pulse, and temperature. You’ll be offered vaginal examinations. Your waters may break at this stage if they haven’t already, which is a good sign your labour is progressing. If you haven’t had an epidural, you may be able to have something to eat to keep your energy levels up. It’s important to rest between contractions.

The end of this stage, when contractions are strongest and the cervix is almost open, is usually called ‘transitional.’ It is so tiring and hormonal that some women who haven’t previously opted for an epidural change their minds. It’s worth noting the language you’d like to be addressed with at this stage somewhere in your birth plan. You may not know until it happens, but would you prefer words of encouragement or quiet? Do you like being called ‘hun’ or ‘dear’ or would you prefer to be addressed more formally? Every woman and every labour is different, and your healthcare team will usually want to make the experience as positive as possible for you.

How will I know the best position to give birth?

There is no one best position for all vaginal births. There are many positions that work brilliantly, including squatting, leaning on the back of the bed, lying on your left side with a peanut ball in between your legs. Some may feel better than others, or something that didn’t work well at the beginning of this stage might work well later. If your baby is in the OP or “back to back” position (head down, facing your naval) you both have to do a bit more work to have a vaginal birth. Labour is often longer, while the baby attempts to turn to face your tailbone. Back pain is common when your baby is in this position because of the hard surface of the skull pressing on the mother's lower back. Your midwife is a wealth of knowledge and is usually wonderful with their support and suggestions at this stage. In the natural pain relief episode of this Journey, we mentioned the benefits of staying upright and active, even if it’s just slow dancing with your birth partner. Remember to balance any periods of mobility with rest, especially if your labour is prolonged.

Are there any positions to avoid?

Try not to cross your legs, as this will reduce space at the front of the pelvis and open it up at the back. For good positioning, the baby needs to have lots of space at the front.
Don't do any deep squatting until you know he or she is facing the right way, as this position opens up the pelvis and encourages the baby to move down.
A birthing ball can encourage good positioning, both before and during labour.
Avoid slouching back in armchairs, sitting in car seats where you are leaning back or anything where your knees are higher than your pelvis. All of these positions encourage the baby to face your tummy.

The pushing stage and giving birth vaginally

This stage starts when you are fully dilated. If you haven’t had an epidural, you will feel an overwhelming urge to push. If you’re anaesthetised, you may still feel pressure, but your midwife will have to tell you when and how to push. Contrary to what you’ve seen in films, gravity is your friend at this stage, and you should try to be mobile and upright if you can. Even if you’ve had an epidural, squatting, kneeling, or positioning yourself on all fours can help with pushing your baby out. Remember, you and your baby are working together; effectively, you’re pushing with the contractions to get birth to happen. Some midwives describe birth as a ballet between you and your baby, which is beautiful, even though it may not feel that graceful at times!

Try to focus exactly on what your midwife is telling you. The urge to make a lot of noise is common, and when the baby begins to crown, you may want to just push and get it over with instead of ‘panting’ the way you’re being told, but doing exactly as instructed can prevent or reduce any vaginal and perineal tearing, which is many mothers' major fear about this kind of birth. In most cases, the delivery of the head is the hardest part. There are a few minutes between contractions even at this stage, so it may feel like a wait before the body arrives, but when you push strongly with the contraction that follows, your baby is out! All going well, your midwife will deliver him or her straight onto your chest for some skin-to-skin contact, cord still intact.

Don’t worry if you don’t hear crying immediately after birth, it’s normal for a baby to take a little time to start breathing, and the midwife will rub his or her body vigorously to get this to start before wrapping it loosely in a towel to give to you. Some mothers ask for their baby to be wiped before being given to them, and you can specify this in your birth plan.

Birthing the placenta.

The placenta was your baby’s lifeline as it grew and now needs to be delivered. You can have an oxytocin injection to help this happen (this is called active management), or you can push it out yourself. Believe it or not, you’re still having contractions in this fourth stage. If you have the injection, the placenta separates from the lining of the uterus and comes out within about fifteen minutes of your baby being born.

If you’ve chosen to birth the placenta physiologically, this stage can take about an hour while you wait for the placenta to peel away from the uterine wall and drop into your vagina to be pushed out. It is easier for the placenta to do this when you’re upright, and if you’ve given birth in a pool, you’ll usually be encouraged to get out. Rarely, a placenta is not fully delivered naturally or with the help of an injection, and you’ll need to be treated right away to avoid health complications.

You can put your placenta preferences in your birth plan. It is worth knowing that there are no significant risks associated with having the oxytocin injection, and it reduces your risk of heavy bleeding after childbirth. You will also be less likely to become anaemic in the days following the birth. Side effects of the injection can include headaches, nausea, and a greater need for pain relief.

What if I want to eat my placenta?

We respect your choice. As an evidence-based resource, we need to point out that there is no medical evidence supporting the belief that eating your placenta prevents postpartum depression. We encourage you to follow your healthcare team’s recommendations for maintaining your mental well-being. However, your placenta is your property. If you want to keep it for any reason, let your midwife know, and it should be packed and stored for you to take home from the hospital or birthing centre.

If the whole experience goes by in a blur, can I have it explained to me afterwards?

Yes, every case is different, and a doctor or midwife should be able to brief you and your partner afterwards. This is an opportunity you should definitely take up, especially if you’re concerned about having deviated from your birth plan. You may learn some things that are useful for future pregnancies.

What will a straightforward vaginal birth be like?

Many of us want one but how would it go? Unii knows.