Childbirth - vaginal delivery

Having a vaginal delivery, or giving birth to your baby through your vagina, is sometimes referred to as ‘natural childbirth’.  Here, we go through everything you need to know about vaginal delivery for childbirth, including the three stages of labour. 

We have a separate topic page for women who choose or need to have a caesarean delivery.

First stage of labour

The first stage of labour is when your cervix (the neck of your womb) gradually stretches and opens (dilates), ready to give birth. By the end of the first stage, your cervix will be fully dilated, which will allow your baby to move down through your pelvis.

You’ll feel the muscles in your womb tensing and relaxing to stretch your cervix as contractions. Contractions feel different to different women. They might feel like period cramps or your bump might feel very tight. Some women feel discomfort or a dull ache in their back.

The first stage of labour is split into two parts – the latent phase and the active phase.

• During the latent first phase, your contractions will be irregular, as your cervix gradually dilates up to 4cm. How long this phase lasts is very different for every woman, but it’s usually several hours.

• The second active phase of labour is sometimes called established labour. In this phase, you’ll have more regular, painful contractions, as your cervix continues to dilate from 4cm to 10cm (fully dilated). This can take an average of eight hours (and unlikely to be more than 18 hours) if it’s your first baby. It usually takes less time (five hours on average) if you’ve had a vaginal delivery before.

As you progress through labour, your contractions will become stronger, longer and more frequent (from as little as every 30 minutes at first, to about every two to three minutes by the end). Your waters (the bag of fluid that surrounds your baby) will usually break at some point during this stage too. This is a normal part of labour. The fluid may rush out in one go or leak out steadily – you might want to wear a sanitary pad if so. The water should be clear – if it isn’t, contact the maternity unit straightaway.

When should I go to hospital? 

You won’t usually need to go to hospital (when you’re in the early stages of labour. You can phone the hospital or your doctor whenever you want to, though. They will check how you are, whether there has been any change in your baby’s movement and go through what to expect next. It’s likely they’ll encourage you to stay at home until you reach the active phase of labour – when your contractions are more regular.

In some circumstances, your doctor may ask you to go to hospital earlier – for instance if your waters have already broken.

Second stage of labour

The second stage of labour is when your cervix is fully dilated, and you give birth to your baby. It usually lasts a couple of hours in women who haven’t given birth before – or less in women who have.

Your contractions will get stronger, longer, and more frequent in this stage. You’ll also feel a strong urge to push when you have your contractions, which will help your baby to be born. You might find it helpful to try different positions, like standing upright, kneeling, sitting or squatting, depending on what’s most comfortable for you.

As you push, your baby will move further down through your pelvis. Usually, your baby’s head comes out first, and then the shoulders and the rest of the body. As you reach the point where your baby ‘crowns’ (their head appears), your midwife may suggest you try to stop pushing by taking shorter breaths (panting). This will slow things down while your baby’s head is coming out, which makes you less likely to tear. For more information about tears, see our FAQ: How can you prevent tearing during childbirth?

Third stage of labour

The third stage of labour is when you deliver the placenta, after the birth of your baby. You can choose to let this happen naturally, which means you’ll push out the placenta yourself (known as a physiological third stage). Or you can have assistance (known as active management) to help speed up this stage.

Active management involves having an injection of oxytocin as your baby’s shoulders are being delivered, to make your womb contract more strongly. After your baby is born, your midwife will clamp and cut the umbilical cord. They’ll then deliver the placenta by pulling gently on the umbilical cord. 

Active management is generally recommended, as it shortens this stage and can reduce your risk of serious bleeding. It’s your choice though if you’d like to aim for a natural third stage. You may need to switch to active management if there’s a risk of you losing a lot of blood, or if the delivery of your placenta takes more than an hour. You’ll need to be transferred to an obstetrician, if this happens, to have your placenta removed manually. An obstetrician is a doctor specialising in pregnancy and childbirth.  

Induced labour

Sometimes your midwife or doctor may recommend that your labour is started artificially. This is called being induced. Reasons for being induced include the following.

• Your pregnancy is going on for longer than 41 or 42 weeks.
• Your waters have broken, but labour hasn't started within 24 hours
• There’s a problem with you or your baby that means it’d be safer for you to give birth earlier.

There are different ways to induce labour.

• Membrane sweeping. Your midwife or doctor will try this first. It involves putting their finger inside your cervix and making a circular movement to separate the membranes around your baby.
• Prostaglandin treatment. These are tablets or a gel, which are placed inside your vagina, and cause your womb to contract.
• Artificially having your waters broken. Your doctor may suggest this if you can’t have prostaglandin treatment, or it hasn’t worked. You might have it on its own, or with an oxytocin drip, which causes your womb to contract.

Having labour induced can be more painful than going into labour naturally, so talk to your midwife or doctor about pain relief options.

Speeding up labour

If your labour is taking longer than usual, your midwife or doctor may suggest breaking your waters for you, if they haven’t broken already. This should strengthen your contractions and speed things up. If this doesn’t help, you may be offered treatment with an oxytocin drip. The oxytocin helps your womb to contract more strongly and more frequently. You’ll be offered an epidural for pain relief beforehand.

Assisted delivery

Sometimes your doctor may need to help you deliver your baby using special instruments. This can happen for the following reasons.

•  Your baby’s health is at risk – for instance, if there’s a problem with the placenta, or their heart rate is abnormal.
• Your baby’s in an awkward position so it’s difficult for them to get out without help.
• You’ve been pushing for a long time and are exhausted, so need a bit of extra help.
• You have a health condition that means a longer labour may be dangerous for you.

The two types of assisted delivery include the following.

·       Forceps. These are like large tongs with curved ends that fit around your baby's head. When you have a contraction, your doctor will pull gently on them while you push.

·       Ventouse (vacuum extraction). This is a metal or plastic cup, that your doctor attaches by suction to your baby's head. Your doctor will then gently pull on the cup as you push, which will help to guide your baby out.

It’s recommended that you have anaesthesia before having an assisted birth, so that you won’t feel any pain. You may be offered a local anaesthetic injection inside your vagina, or an epidural (anaesthetic injection into your back).You may need to have an episiotomy – a cut into your perineum – if you’re having an assisted birth. 

Pain relief for childbirth

All women cope differently with labour, and you may have an idea about the type of pain relief you want. But you may find that this changes once it's actually happening. Try to keep an open mind, and be prepared to do things differently from how you originally planned.

Self-help

Try moving around during labour to find the most comfortable position for you. There are lots of things you can try to relieve your pain that don’t involve taking medicines. These include the following.

• Breathing and relaxation techniques.
• Back massages.
• Being in warm water, such as a bath or birthing pool.
• Using a transcutaneous electrical nerve stimulation (TENS) machine. You apply this to your skin and it sends out mild electrical impulses, which block pain signals going to your brain. There’s no scientific evidence to prove that it works, but many women decide to give it a go.
• Hypnobirthing. This uses visualisation and relaxation techniques, alongside breathing exercises.
• Complementary therapies, including acupuncture, aromatherapy and reflexology. There’s not much evidence to say how well these work. But you can try them if you want to, if they’re available at the setting where you’re giving birth.

Gas and air (Entonox)

This is a mixture of nitrous oxide and oxygen. As you feel a contraction start, you slowly breathe in the mixture through a mouthpiece or a mask over your nose. It's a mild painkiller that takes the edge off your pain. You may find that Entonox makes you feel sick and light-headed though.

Opioids

Opioids are strong painkillers that your doctor will inject into a muscle. They include diamorphine and pethidine. They can cause side-effects, which include feeling sick, dizzy or very sleepy – and these can be passed onto your baby too. Your midwife or doctor will tell you if these are an option, depending on your stage of labour.

Epidural

An epidural is an injection of anaesthesia into your lower back, which blocks all feeling from your waist down. It’s more effective at relieving pain than opioids; however, it can lengthen your second stage of labour and make you more likely to need assistance with forceps or ventouse. It may also make moving around more difficult, and you can only have it if you’re in hospital, where it can be administered by an anaesthetist.

Some hospitals offer mobile epidurals. These use a lower dose of local anaesthetic and allow you to walk about during the first stage of labour, which you may prefer.