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If you've been wondering why pregnancy has sent you into daily crying fits or rages, then we have one word for you: hormones. Yet as well as affecting your mood, these super-powerful hormones can also affect:

growth and development

metabolism

sexual function

reproduction.

(MedlinePlus, 2016)

Yep, when you're pregnant, hormones play a massive role (Kumar and Magon, 2012). They can influence things like the way you now sob at an episode of EastEnders. They also explain why everyone says you are 'glowing' and why your nails have grown properly for the first time since you were eleven.

They also help your growing baby develop and make a difference physically, with certain hormones relaxing your ligaments ready for labour. That might mean you find yourself getting more injuries or niggles in the body when you exercise while you're pregnant too (Healthline, 2017).

Hormones may also have you leaping on your partner at certain points in your pregnancy, and horrified by the idea of sex at others.

Progesterone, oestrogen and other hormones in pregnancy

The most important hormones at play when you're pregnant are as follows.

Oestrogen

Oestrogen is produced in early pregnancy to support your baby until the placenta takes over. Oestrogen helps the development of your baby's organs and the correct function of the placenta. Yet it may also cause nausea and make ligaments softer, putting pressure on your lower back and pelvis (NHS, 2018).

Later in pregnancy, oestrogen helps to prepare your body for breastfeeding (if you choose to do so). It also enables your uterus to respond to oxytocin in labour (Society for Endocrinology, 2018).

Progesterone

Progesterone is produced in early pregnancy to support your baby until the placenta takes over. Progesterone causes an increase in blood flow to the womb. It might also be the one responsible for that pesky heartburn as well as vomiting, reflux, gas and constipation (Society for Endocrinology, 2018).

Later on it can help with your baby's development. It'll prevent you from producing milk until your baby's born and will strengthen your pelvic floor muscles ready for labour (Society for Endocrinology, 2018).

Oxytocin

Oxytocin eases the pain during labour, and encourages the cervix to open as well as helping with your lochia (bleeding after birth) Oxytocin also plays a major role in milk production and bonding (Society for Endocrinology, 2018).

Prolactin

Similar to oxytocin, prolactin helps with bonding (Society for Endocrinology, 2018).

Relaxin

This is the hormone that makes your ligaments softer and means you need to adjust certain types of exercise so you don't get an injury. Relaxin helps in labour, as it softens and lengthens the cervix as well as your pelvic area (Society for Endocrinology, 2018).

Human chorionic gonadotropin (HCG)

HCG is released into your bloodstream when you get pregnant to support you and your baby. It's often an indicator of pregnancy in over-the-counter tests as well (Society for Endocrinology, 2018).

Human placental lactogen (hPL)

The hormone hPL helps your baby to get the nutrients they need while you're pregnant (Society for Endocrinology, 2018).

Prostaglandins

Prostaglandins help to get the cervix ready for labour (Society for Endocrinology, 2018).

Hormones and emotions during pregnancy

While it can be a happy time in many ways, you're likely to feel emotionally vulnerable and down at times during your pregnancy. No matter how excited you are that you're having a baby.

If you think you're feeling down or anxious a lot, speak to your GP, midwife and someone close to you (Northamptonshire Healthcare NHS Foundation Trust 2015). Feeling this way during pregnancy can also increase the chances of postnatal depression later down the line, so it's good to flag it now.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Healthline. (2017) What bodily changes can you expect during pregnancy? Available from: https://www.healthline.com/health/pregnancy/bodily-changes-during [Accessed 11th July 2018]

Kumar P, Magon N. (2012) Hormones in pregnancy. Niger Med J. 53(4):179-183. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23661874 [Accessed 11th July 2018]

MedlinePlus. (2016) Hormones. Available from: https://medlineplus.gov/hormones.html [Accessed 11th July 2018]

NHS Choices. (2018) Back pain in pregnancy. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/backache-pregnant/ [Accessed 11th July 2018]

NHS Inform. (2017) Exercises during pregnancy. Available from: https://www.nhsinform.scot/healthy-living/keeping-active/getting-started/exercise-during-pregnancy [Accessed 11th July 2018]

Northamptonshire Healthcare NHS Foundation Trust. (2015) Emotional changes during pregnancy and following childbirth. Available from: https://www.nhft.nhs.uk/download.cfm?doc=docm93jijm4n1351.pdf&ver=2068 [Accessed 11th July 2018]

Society for Endocrinology. (2018) You and your hormones. Hormones of pregnancy and labour. Available from: http://www.yourhormones.info/topical-issues/hormones-of-pregnancy-and-labour/ [Accessed 11th July 2018]

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Pregnancy hormones: progesterone, oestrogen and the mood swings

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If you've been wondering why pregnancy has sent you into daily crying fits or rages, then we have one word for you: hormones. Yet as well as affecting your mood, these super-powerful hormones can also affect: growth and development metabolism sexual function reproduction.

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What is the best position for my baby to be in?

"The best position for your baby to be in ready for their birth, is head down, facing your back, with their back against your belly."

In this position, your baby's head and neck are flexed and their chin is tucked into their chest. This means the narrowest part of their head (the back) presses on your cervix, helping it to open.

The flexible joints in your baby's skull allow your baby's head to change shape and make its way more easily down the birth canal during labour. This helps them fit through your pelvis more easily (Simpkin, 2010; RCM, 2012).

What is the 'occiput anterior' position?

If your baby is lying head down in your womb and facing your back, like described above, they're in what medics call the occiput anterior (OA) position. This means that the back of their head (occiput) is at the front (anterior). Most babies lay this way and it's the best position for birth (RCM, 2012).

Which other positions might my baby be lying in?

If your baby is lying in your womb to your left, you'll see LOA (left occiput anterior) written in your maternity notes.

If they are lying in your womb to your right, you'll see ROA (right occiput anterior) written in your notes.

If your baby is bottom down in your womb, you'll see B or BR (breech) written in your notes - see our article on breech babies.

Back-to-back - see below.

See our article about maternity notes to find out the other abbreviations for baby positions that your midwife might note.

My baby is 'back-to-back', what does it mean?

Some babies lie with their back against their mother's back. This is known as an occiput posterior (OP) position or back-to-back position in the womb.

Labour tends to take longer, be more painful and you're more likely to have a caesarean or assisted (instrumental) birth if your baby is in a posterior position. This is because they can't tuck their chin in very easily, which makes getting through the pelvis more awkward. This position often causes backache during labour too (Simpkin, 2010; RCM, 2012; Tommy's, 2016).

What can I do to help my baby to turn?

Some people think that women with babies in the back-to-back position can use certain positions during the end of pregnancy to turn their babies. Forward-leaning positions like going on all fours have in the past been said to help babies into the best position for birth. Unfortunately, there is no evidence that this works (Guitier et al, 2016).

On the plus side, forward-leaning positions could ease your backache when you're in the first stage of labour (Hunter, 2007; Guitier et al, 2016).

What position in the womb is my baby in? How to tell whether they're front or back facing

Your midwife should be able to tell you during an ultrasound which way round your baby is lying. Saying that, babies will move position during pregnancy and birth. So it's good to know there are some giveaways to how your baby's lying.

Here are the tell-tale signs you can look out for:

You might be able to visualise how your baby is lying from their movements. Tickles might be their little hands waving around, while harder movements could be their elbows, knees or feet.

Your baby's bum will feel squashier than their head, which will be firm and round.

If your baby is lying back-to-back (OP position), your bump might feel squashy and you may feel (and see) kicks in the middle of your belly. Another sign of the OP position is a dip around your belly button instead of it poking out.

If your baby is head down and facing your back (OA position), you'll probably feel kicks under your ribs. You'll also be able to feel the hard, rounded surface of your baby's back, which will be on one side of your belly.

(Tommy's, 2016)

My baby is not in the ideal position for labour, should I worry?

No, as there isn't much chance it will be a problem. Most babies turn during labour to the anterior position. Here are the stats:

Between 15% to 32% of women have a baby in an OP (back-to-back) or occipito-lateral position when they go into labour. This happens more often among women who haven't given birth before (Simkin, 2010).

Only five to eight babies out of every 100 will stay in the OP position (Tommy's, 2016).

Taking an antenatal course could help to prepare you for labour and birth. It could also help to ease any worries you might have about labour and give you the chance to meet other parents in your local area.
This page was last reviewed in July 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new child.

Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. (2016) Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG. 123(13):2199-2207. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132127/ [Accessed 1st July 2018].

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001063.pub3/full [Accessed 1st July 2018].

RCM (Royal College of Midwives). (2012) Persistent lateral and posterior fetal positions at the onset of labour. Evidence based guidelines for midwifery-led care in labour. Available at: https://www.rcm.org.uk/sites/default/files/Persistent%20Lateral%20and%20Posterior%20Fetal%20Positions%20%20at%20the%20Onset%20of%20Labour.pdf [Accessed 1st July 2018].

Simkin P. (2010) The fetal occiput posterior position: state of the science and a new perspective. Birth. 37(1):61-71. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20402724 [Accessed 1st July 2018].

Tommy's (2016) Getting your baby into the best birth position. Available at: https://www.tommys.org/pregnancy/labour-birth/baby-best-position-birth [Accessed 9th September 2018].

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"The best position for your baby to be in ready for their birth, is head down, facing your back, with their back against your belly." In this position, your baby's head and neck are flexed and their chin is tucked into their chest.

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Hormones, labour and birth: an introduction

You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth. These hormones are:

oxytocin (the love hormone)

beta-endorphins (the hormones of pleasure and transcendence)

epinephrine and norepinephrine (the hormones of excitement)

prolactin (the mothering hormone).

(Buckley, 2002)

Here's what impact all four will have on you...

Oxytocin or the love hormone

Oxytocin is the love hormone, which is why it's released during sex, orgasm, birth and breastfeeding (Odent, 1999; Buckley, 2002).

Oxytocin will make you feel more affectionate and selfless, and its main function in labour is to bring on contractions (Dawood et al, 1978). You'll get a surge of oxytocin in the final stage, so if you're having a vaginal birth it will help you along with pushing.

Oxytocin reduces stress, calms you down and helps with pain during labour (Buckley, 2015). Impressively, your baby will also produce oxytocin before and during labour (Chard et al, 1971).

Oxytocin hangs around after birth too, helping you feel more relaxed, well-nourished and bonded with your baby (Buckley 2002, Buckley 2015). It helps with the let-down reflex during breastfeeding and protects you against postpartum haemorrhage (Buckley, 2002).

Beta-endorphins or the pleasure hormones

Endorphins are naturally occurring opiates, similar to morphine and heroin. Like oxytocin, they mostly appear during sex, pregnancy, birth and breastfeeding. Beta-endorphins reduce pain and suppress the immune system, which is important so that it doesn't act 'against' your baby (Buckley, 2002, 2015).

If you're stressed during labour, that can make you release excessive beta-endorphins, which may inhibit oxytocin and slow things down (Buckley 2015). That's why keeping things as calm as possible is a great thing in labour.

Beta-endorphin also helps with the release of prolactin during labour, preparing your breasts for feeding (Rivier et al, 1976).

And one more thing: it helps in the final phase of your baby's developing lungs too (Buckley 2015).

Epinephrine and norepinephrine or fight or flight hormones

You might have heard these two referred to as fight-or-flight hormones but their proper names are epinephrine and norepinephrine (adrenaline and noradrenaline). They are produced during stresses like fright, anxiety, hunger or cold and also when you're excited (Buckley 2015).

You're likely to get a high level of these hormones if you don't feel private, calm, safe and undisturbed and they can then inhibit oxytocin (Buckley 2015). Yet in the late-labour stage if you perceive danger or stress, they may paradoxically stimulate contractions so you give birth more quickly (Buckley 2015).

A rise in epinephrine when you're in the later stages of labour increases your levels of prostaglandin and cortisol to help with contractions. This will make you feel a sudden rush of energy and will cause several strong contractions and will help you push (Buckley, 2002, 2015).

These hormones help your baby too by protecting them against a lack of oxygen (Buckley, 2002). Your baby will have high levels of these hormones during birth but they'll drop quickly once you sooth them afterwards (Lagercrantz and Bistoletti 1977; Buckley, 2002).

Prolactin or the mothering hormone

Prolactin is the mothering hormone. And it's the major hormone for breastfeeding.

Prolactin starts to increase during pregnancy and peaks at birth (Buckley, 2002). Your baby produces prolactin in the womb too (Daniels and Martin, 1994).

Hormones and your feelings after birth

Lots of women get the baby blues during the first week after birth of her baby days (NHS Choices, 2018). You might feel down or depressed, emotional or irritated and likely to burst into tears at any second.

Don't despair though: these symptoms are totally normal. They're due to the sudden hormonal and chemical changes that happen after you give birth.

If you feel like you are suffering from something more extreme and it isn't going away though, talk to your GP or midwife. You might be suffering from postnatal depression and should get some support or help right away.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor... [Accessed 25th April 2018]

Buckley SJ. (2002) Ecstatic birth: The hormonal blueprint of labor. Available from: http://www.dancingstarbirth.ca/Handouts/Ecstatic_Birth.pdf [Accessed 25th April 2018]

Chard T, Hudson CN, Edwards CR, Boyd NR. (1971)Release of oxytocin and vasopressin by the human fetus during labour. Nature. 234:352-354. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4944487 [Accessed 25th April 2018]

Daniels G, Martin J. (1994) Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus, In Harrison's Principles of Internal Medicine, 13th edition. New York: McGraw- Hill. [Accessed 25th April 2018]

Dawood MY, Raghavan KS, Pociask C, Fuchs F. (1978) Oxytocin in human pregnancy and partrurition. Obstetrics and Gynecology. 1978; (51):138-143. Available from: https://www.ncbi.nlm.nih.gov/pubmed/622223 [Accessed 25th April 2018]
Lagercrantz H and Bistoletti H. (1977) Catecholamine release in the newborn infant at birth. Pediatric Research. 8:889-893. Available from: https://www.ncbi.nlm.nih.gov/pubmed/887309 [Accessed 25th April 2018]

NHS Choices. (2018) Feeling depressed after childbirth. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-afte... [Accessed 25th April 2018]

Odent M. (1999) The Scientification of Love. London. Free Association Press.

Rivier C, Vale W, Ling N, Brown M, Guillemin R.(1976) Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. 100:238-241. Available from: https://www.ncbi.nlm.nih.gov/pubmed/187406 [Accessed 25th April 2018]

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Hormones in labour: oxytocin and the others - how they work | Labour & birth articles & support | NCT

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Hormones play a big role when it comes to pregnancy and birth. Here we explore what they do and why.

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How does early labour start?

For up to a week before labour starts, you might notice that you're feeling a bit different. This is because changes are taking place in your body as it prepares for birth. While they're not reliable signs and they do vary between women (McCormick, 2003), here's what you might notice:

Mucus plug discharge: the plug of clear mucus ('show') released from your cervix, perhaps with a streak of blood, although this doesn't always happen until later in labour (McCormick, 2003; Becher, 2010; NHS, 2017a).

Feeling unusually energetic or 'nesting instinct' behaviours (cleaning and organising things, and being selective about who you want to be around) (McCormick, 2003; Anderson and Rutherford, 2013).

The NHS say that women could also experience:

loose bowels or the urge to go to the toilet more often

backache or mild cramps.

It's good to remember though that these symptoms could be related to the growing weight of your baby or a stomach upset.

You'll probably be at home during this stage (NHS, 2017a; NICE, 2017). It can help to take this opportunity to rest and nourish yourself with food that'll sustain your energy. It's also good to distract yourself with activities that you find fun and relaxing, such as having a bath or meeting a friend for a gentle stroll (NHS, 2017a).

Your birth partner can help you too by offering support and encouragement (NHS, 2017b).

Watch our video to find out what to expect and what you might feel as labour starts.

What starts early labour?

It's not known exactly what starts off labour but natural hormones (mainly oxytocin) in your body control your contractions. And your emotions and the external environment can influence your hormonal activity. So that means experiencing fear or stress makes you more likely have a labour that slows down or stops (Buckley, 2011). This is why some women try using relaxation and breathing exercises.

Your baby's actions, position and stage of maturity might also influence your progress towards labour.

How long should I stay at home in the latent/early stage of labour?

Many women feel anxious about remaining at home (Nolan, 2011; Gutteridge, 2013). But there are benefits of doing so.

Women who spend less time on the labour ward, are less likely to receive syntocinon, they feel more in control and have less need for pain management drugs. A couple of studies say that women who stayed at home during their latent stage described a 'sense of power' that stayed with them throughout labour (Lauzon et al, 2001; Carlsson, 2011).

There is no universal agreement about when the latent stage of labour ends and established labour begins (Hundley et al, 2017). The NHS suggests phoning your midwife for guidance if you experience the following signs:

regular contractions

lasting at least a minute

occurring every 5 minutes or less in active labour.

Most women describe these contractions as very painful while others say they are intense or overwhelming (Baker et al, 2001).

What does active labour vs early labour feel like?

For most women the early cramps and niggles will develop into stronger sensations. Some women say they're like strong menstrual cramps that gradually become stronger, longer and closer together (NHS, 2017a). There is no 'normal' path and you may have a very different experience to friends and family who have given birth.

While some women experience lots of sensations in the run up to active labour, others will have a quick onset. For this reason, early or latent labour is almost impossible to define (Enkin et al, 2000). The definition of active labour is:

regular, painful contractions and

progressive cervical dilatation from 4 cm.

Your midwife will talk to you about how many contractions you are having. But there is no single definition of the point at which active labour begins (Hundley et al, 2017). Your midwife will need to use their professional judgement as well as the local policy of the hospital or birth centre you are attending.

If you are choosing to go to hospital or a birth centre, your midwife may want to check you're in active labour before you come in by talking to you on the phone (NICE, 2017). It's possible your midwife might ask you to come to the hospital if they think active labour has started. In some areas, the midwife might visit at home first (NICE, 2017).

What should I do if I go into active/established labour?

Whatever your experience of contractions, you'll need to focus on them as you go from latent to active labour. You or your birth partner might notice that you start to switch off from the world around you while you use your coping techniques (Buckley, 2011).

At this stage many women find they want to be quiet and appreciate a more peaceful relaxed environment around them (Buckley, 2011). Holding a conversation becomes more difficult, especially during a contraction (Gutteridge, 2013).

Because everyone is so different, it is important to listen to your body and your own unique experience of labour (Dixon et al, 2013). Do ask your midwife if you're unsure about anything or want more information.

When should I call my midwife?

If you're less than 37 weeks pregnant, call your midwife if you're having contractions and have:

a watery discharge or bloody vaginal discharge and/or

regular contractions

lower back pain or cramping.

These are signs that you may be going into premature labour.

After 37 weeks, call your doctor or midwife if:

you think your baby's movements have slowed down

you think your waters have broken and/or (NHS, 2017a)

you have any bleeding.

(RCOG, 2011; NHS, 2017a)

From 36 weeks, it's a good idea to get ready for labour and the next section discusses some things to keep in mind.

"As your due date approaches, your body is getting ready for the baby and so can you by packing your maternity bag from 36 weeks."

What are Braxton Hicks contractions?

Braxton Hicks contractions are caused by the tightening of your uterine (womb) muscles in preparation for labour. That's why they're called practice contractions and are usually painless (NHS, 2016; Tommy's, 2017).

Some women experience Braxton Hicks contractions as early as their second trimester. So they're not an indicator of labour, more your uterus keeping itself fit and active (Tommy's, 2017).

Braxton Hicks contractions often become more noticeable at the end of pregnancy as the size of the uterus increases. You may be worried about confusing Braxton Hicks with labour itself (McCormick, 2003; Tommy's, 2017).

What do Braxton Hicks vs early labour contractions feel like?

When you're entering early labour, your contractions will become more frequent, rhythmic, intense and longer, as the cervix starts to soften and open up (dilate) (McCormick, 2003; NHS, 2017a). You can read more about the first stage of labour here. Braxton Hicks contractions usually stop after a period of time and don't increase in intensity (McCormick, 2003; Tommy's, 2017).

When should I get ready for my due date?

As your due date approaches, you will have lots on your mind so it's a good idea to run through the following and make sure everything is ready:

Have your bag ready for hospital or your home maternity pack at hand. Include some treats for yourself, such as your own pillows and cushions, snacks or music. (NHS, 2018)

Consider having more than one birth partner to support you in labour.

Go through your birth plan with your birthing partner, making sure you have all the information you need to make decisions about your care (Better Births, 2016)

Practise your pelvic floor exercises and take some gentle exercise (Woodley et al, 2017).

Consider protecting your bed with a plastic sheet or wearing a pad in case your waters break.

If you have any doubts about whether your labour is starting, give your midwife a call.

The build up to your due date can be exciting, stressful and tiring. So try to relax as much as you can in the last few weeks of pregnancy. Once your baby arrives things will certainly get busier.

What can your birth partner do?

Your birth partner can help you in the last few weeks to get ready for the arrival of your baby, they could:

keep a list of necessary telephone numbers including the community midwife and the labour ward

check the route to hospital, keep change for car park, or keep the number of a taxi company to hand

check whether mobile phones are allowed in the hospital or birth centre (if not, bring money for a phonecard or change)

make sure camera and phone batteries are charged.

Most importantly, birth partners should try to be patient, calm and supportive. Listen to your partner - she's the one who knows best what she needs and your support will be invaluable to her (Carlsson et al, 2011).
This page was last reviewed in January 2020.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

Anderson M, Rutherford M. (2013) Evidence of nesting psychology during human pregnancy. Evolution and human behaviour. 34(6):390-397. Available at: https://www.sciencedirect.com/science/article/pii/S1090513813000706 (accessed 22nd November 2019)

Baker A, Fergurson S, Roach GD, Dawson D. (2001) Perceptions of labour pain by mothers and their attending midwives. J Adv Nurs. 35(2):171-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11442696 (accessed 22nd November 2019)

Becher N, Waldorf, K, Hein M, Uldbjerg N. (2010) The cervical mucus plug: structured review of the literature. ACOG. 88(5): 502-513. Available at: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1080/00016340902852898 (accessed 22nd November 2019)

Better Births. (2016) National Maternity Review Report. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf (accessed 22nd November 2019)

Buckley S. (2011) Undisturbed birth. AIMS Journal. 23(4). Available at: https://www.aims.org.uk/journal/item/undisturbed-birth (accessed 22nd November 2019)

Carlsson I-M, Ziegert K, Sahlberg-Blom E, Nissen E. (2011). Maintaining power: women's experiences from labour onset before admittance to maternity ward. Midwifery 28(1):86-92. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21237538 (accessed 22nd November 2019)

Dixon L, Skinner J, Foureur M. (2013) Women's perspectives of the stage and phases of labour. Midwifery. 29(1):10-7. Available at: https://www.midwiferyjournal.com/article/S0266-6138(12)00124-6/fulltext (accessed 22nd November 2019)

Enkin M, Keirse M, Neilson J, et al. (2000) A guide to effective care in pregnancy and childbirth 3rd ed. Oxford: Oxford University Press.

Gutteridge K. (2013) Assessing progress through labour using midwifery wisdom. Essentially MIDIRS 4(3):17-22.

Hundley V, Way S, Cheyne H, Janssen P, Gross M, Spiby H. (2017) Defining the latent phase of labour: is it important? Evidence Based Midwifery. 15(3):89-94. Available at: https://dspace.stir.ac.uk/bitstream/1893/26109/1/EBM_138_Hundley.pdf (accessed 22nd November 2019)

Lauzon L, Hodnett E. (2001) Labour assessment programs to delay admission to labour wards Cochrane Database of Systematic Reviews. (3):CD000936. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000936/epdf/full (accessed 22nd November 2019)

McCormick C. (2003) The First Stage of Labour: Physiology and Early Care. In: Myles Text Book For Midwives. 14th edition. Edited by Fraser and Cooper. Churchill Livingstone.

NHS. (2017a) Signs that labour has begun. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/ (accessed 22nd November 2019)

NHS. (2017b) What your birth partner can do. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/what-your-birth-partner-can-do/ (accessed 22nd November 2019)

NHS. (2017c) Premature labour and birth. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/premature-early-labour/ (accessed 22nd November 2019)

NHS. (2018) Pack your bag for birth. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/pack-your-bag-for-birth/ (accessed 22nd November 2019)

NICE. (2017) Intrapartum care for healthy women and babies. Available at: https://www.nice.org.uk/guidance/cg190/chapter/recommendations#latent-first-stage-of-labour (accessed 22nd November 2019)

Nolan M. (2011) What is women's experience of being at home in early labour? New Digest. Available at: https://www.nct.org.uk/sites/default/files/related_documents/3nolan-what-is-womens-early-experience-home-early-labour-18-9-.pdf (accessed 22nd November 2019)

RCOG. (2011) Royal college of gynaecologists green top guidelines. Reduced fetal movements Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_57.pdf (accessed 22nd November 2019)

Tommy's. (2017) Braxton Hicks. Available at: https://www.Tommy's.org/pregnancy-information/labour-birth/braxton-hicks (accessed 22nd November 2019)

Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EC. (2017) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. (12): CD007471. Available at: https://www.cochrane.org/CD007471/INCONT_how-effective-are-pelvic-floor-muscle-exercises-undertaken-during-pregnancy-or-after-birth (accessed 22nd November 2019)

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The early signs of labour | Labour & birth articles & support | NCT

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You might already know about active labour but what happens before that? Here we explain the early signs of labour and when to call your midwife...

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First stage of labour: a definition

As labour can be a long, complex process, it's handily referred to as happening in three stages (NICE, 2017).

"The first stage of labour is made up of contractions that will get longer, stronger and more frequent."

These contractions will help to push your baby down and your cervix to open (dilate) so that your baby can come into the world. When your cervix has dilated to about 4cm, you're in 'established labour' (NICE, 2017).

If this is your first baby, the first stage of established labour usually lasts between eight and 18 hours. If it's not, it's more likely to be around five to 12 hours (NICE, 2017).

What do contractions feel like?

Ah, the big question. Trouble is, contractions can feel completely different from woman to woman and even in different pregnancies. So the way your friend describes hers may be a world away from your own experience.

Some ways you might describe the feeling are:

discomfort or a dull ache in your back or lower stomach

pressure in the pelvis

stomach becoming hard, then soft again

wave-like motion from the top of the uterus to the bottom

similar to period pain.

If you're wondering what early labour feels like, watch our video where new mums talk about what it felt like for them.

The good news is that contractions will come and go so - if you can - try and relax in between them (WebMD, 2018).

Contractions versus Braxton Hicks contractions

The contractions you'll experience during established labour are different from the Braxton Hicks contractions (false contractions) that you probably felt while you were pregnant. Unlike Braxton Hicks, they don't go away when you change your position or relax.

Early labour pain management and calling your midwife

Your midwife will know how far on you are and whether you need to be in hospital or at your birthing centre yet. So before you head off anywhere, give them a call.

Your midwife will then ask questions and assess you based on your:

movements

breathing

ability to hold a conversation

emotional state.

Call your midwife or a doctor straight away if:

you have a heavy 'show'

your waters break

your baby's moving less than usual

you're less than 37 weeks pregnant.

(NHS Choices, 2017)

First stage of labour: managing pain at home

In the early part of labour, you're likely to be at home. Try the following if you can:

walk or move around

drink a lot of fluids and healthy snacks

have a warm bath

do some relaxation or breathing exercises

ask your birth partner to rub your back

manage the pain with paracetamol (if needed)

stay in an upright position.

When your contractions start coming every five minutes and last at least 60 seconds, give your midwife a call (NHS Choices, 2017).

Early labour and your birth partner

Having a supportive birth partner can give you a sense of control, comfort and competence and make complications less likely (Hodnett et al, 2013). So (no pressure), choose carefully...

Things your birth partner can do to help you are:

Speaking to midwives or doctors if you're not able to.

Encouraging you (especially through contractions...) and reassuring you.

Massaging your back (if you can bear it... some women can't).

Getting you those crucial energy-boosting drinks and snacks.

Speaking to you about pain-relief options.

Helping you with relaxation and breathing techniques.

Supporting you while you try different positions.

First stage of labour: how it will progress

When you meet your midwife, they will:

Ask you about the length, strength and how often your contractions are coming.

Possibly conduct a vaginal examination and record your pulse, blood pressure and temperature.

Ask about your baby's movement in the last 24 hours.

Examine your stomach.

Monitor your baby's heart rate.

(NICE, 2017; Which?, 2018)

First stage of labour: what happens at the end

Toward the end of the first stage of labour, your cervix will be about 7cm to 8cm dilated.

A lot of women find this the hardest, most painful part of giving birth and you might feel like you are out of control. If this happens to you, don't worry: it's totally normal.

If you want to give birth without pain relief, this might also be the part when you find it the trickiest to stick to your plan. It's absolutely fine, of course, if you do change your mind but if you do want to still avoid pain relief, it is possible to use self-help methods like hypnobirthing instead.

Then you'll be on to the second stage of labour, which will last until you have your baby, normally for two to three hours at the most. (NICE, 2017)

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth and life with a new baby.

You will also find useful information on NHS Choices in a guide to labour.

More information on stages of labour can be found in NICE guidelines.

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013) Continuous support for women during childbirth. Cochrane Database Syst Rev.(7):CD003766. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003766.pub5/pdf [Accessed 3rd August 2018].

NHS Choices. (2017) Signs that labour has begun. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/labour-signs-what-happens/ [Accessed 3rd August 2018].

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/what-happens-during-labour [Accessed 3rd August 2018].

RCM. (2012) Evidence based guidelines for midwifery-led care in labour: assessing progress in labour. Available from: https://www.rcm.org.uk/sites/default/files/Assessing%20Progress%20in%20Labour.pdf [Accessed 3rd August 2018].

WebMD. (2018) Pregnancy and signs of labor. Available from: https://www.webmd.com/baby/labor-signs#1 [Accessed 3rd August 2018].

Which? (2018) Stages of labour. Available from: https://www.which.co.uk/birth-choice/getting-ready-to-give-birth/stages-of-labour [Accessed 3rd August 2018].

WHO. (2013) Counselling for maternal and newborn health care: a handbook for building skills. Available from : https://www.ncbi.nlm.nih.gov/books/NBK304186/ends [Accessed 3rd August 2018].

Further reading

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. (2013) Maternal position and mobility during first stage labour. Cochrance Database Syst Rev.(8):CD003934. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164173/ [Accessed 3rd August 2018].

Which? (2018b) Choosing your birth partner. Available from: https://www.which.co.uk/birth-choice/getting-ready-to-give-birth/choosing-your-birth-partner [Accessed 3rd August 2018].

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First stage of labour: signs, coping and when to go to hospital | Labour & birth articles & support | NCT

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The first stage of labour - when things start happening - can be daunting. Here's you're guide to everything from contractions to when to call the midwife.

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Second stage of labour: what is it?

The second stage of labour starts when your cervix is open (dilated) fully and ends when your baby is born (NICE, 2017; Hofmeyr and Singata-Madliki, 2020; Häggsgård et al, 2021).

There may be some time between when the cervix is open and when the pushing contractions begin, and this is known as the passive second stage of labour. Once the baby is visible and the pushing contractions begin, that is known as the active second stage of labour (NICE, 2017).

While most people feel the urge to push in the second stage of labour, not everyone experiences this. For some the first and second stages of labour may be a continuous, rather than a two-stage, process (Häggsgård et al, 2021).

For those who do notice a difference in the second stage of labour, it can feel intense and powerful, as you experience a strong pressure pushing the baby downwards. Some people find these contractions easier to cope with as they follow their body's impulses. Others can feel overwhelmed and out of control as their body takes over (Häggsgård et al, 2021).

How long does the second stage of labour last?

Usually, your baby will be born within three hours of active pushing if it's your first baby, and within two hours for second and subsequent births (NICE, 2017; Hofmeyr and Singata-Madliki, 2020). But it can be much quicker.

What can I do to make the second stage of labour easier?

Finding the right position in the second stage of labour may be beneficial and your midwife and birth partner can support you to move into the most comfortable position.

Getting into an upright or side-lying position could help to make the second stage of labour shorter and more comfortable (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020). These positions aid gravity, and mean your pelvis can be more flexible so movement will help your baby out.

Examples of upright positions include:

kneeling

squatting (either independently or using a hammock, rope or bar to dangle from)

standing

using a birthing stool

leaning over a birthing ball.

If you are experiencing back pain then a position that gets you on all fours, like using the birthing ball, can help with that (Hunter et al, 2007). Being in water can help, too.

In the end, follow your instincts and get in whatever position feels right for you, asking your midwife or birth partner to support you to move (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020).

It may help if the midwife and your birth partner offer physical support or positive updates about your baby's progress during the pushing stage of labour. Feeling cared for is particularly important at this time (Häggsgård et al, 2021). Some women may like to be told what is happening, (Häggsgård et al, 2021) while some may not.

It could be a good idea to discuss beforehand how you think you'd like your birth partner to care for you and how much you'd like them to tell you about what they can see happening. Remember, however, that this might change in the moment, so acknowledge that possibility too.

When the time comes, you might want to reach down so you can feel your baby's head. Some people find this boosts their energy levels and can make the birth seem more real (Häggsgård et al, 2021). If things are going slowly, you could ask to be supported to change positions or go to the toilet to create more space for the baby to be born (NICE, 2017).

You might have seen on TV or heard of midwives telling women when or how to push. But this is no longer done as it makes the pushing stage longer, more tiring and can make the experience feel more negative rather than listening to your own body (Prins et al, 2011; Ibrahim et al, 2017; Häggsgård et al, 2021). Instead, your midwife will encourage you to work with your body (Häggsgård et al, 2021).

What if I have an epidural?

If you're experiencing the second stage of labour with an epidural, it may be harder to recognise the changing sensations. So this is when it might help to be guided by your midwife. Once the cervix is open, you could be encouraged to wait for an hour or until the baby's head is visible before beginning to push (NICE, 2017).

You should be supported to find a position that is comfortable for you, such as lying on your side, or leaning over the end of the bed (NICE, 2017; Walker et al, 2018). For more about epidurals and their effect on labour, read our article.

The last push

As your baby's head comes down ready to be born, you may experience a burning or stinging pain in the soft tissue between vagina and anus. You might have concerns about perineal tearing (Häggsgård et al, 2021).

At this point you can slow down your pushing efforts so that your baby's head is born slowly. Your midwife may suggest gently blowing out (like cooling a hot drink) as this can protect the perineum and reduce the chance of tearing (Ibrahim et al, 2017).

Some midwives might use a warm compress on the perineum or support the baby's head as they are born, but others will be more hands-off (NICE, 2017). Neither approach has been shown to be better, and you can say what your preference is. You may find it helpful to have a mirror to see what's happening, as this can help you to feel more in control.

After your baby's head comes out, there could be a pause between contractions before the shoulders are born. When they are fully born, you can then bring your baby to your chest or tummy for skin-to-skin contact, or ask the midwife to do that for you.

What can my birth partner do

Your birth partner might help with physical support or massage, encouragement, or just to sit quietly by if you prefer. They can also make sure your views are heard and acted upon (Bohren et al, 2017). Not to mention providing constant drinks and food when you need them to keep your strength up.

How can I prepare for the second stage of labour?

Some research has found that using breathing techniques involving deep breaths in and out can shorten the second stage of labour and reduce pain (Yuksel et al, 2017). You may wish to practise these techniques in advance.

Perineal massage in the last month of pregnancy can reduce the likelihood of tearing or needing an episiotomy (a cut made in the tissue between the vaginal opening and the anus during childbirth) (Beckman and Stock, 2013).

What if I still feel anxious about the second stage of labour?

Some people may feel particularly apprehensive about the second stage of labour, for example if you have had a previous difficult birth or have experienced sexual violence. Talk to your midwife about your concerns and they will give you information, options and support you in your decisions (NICE, 2017).
This page was last reviewed in September 2022.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

You will also find useful information on NHS Choices here.

Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available at: https://doi.org/10.1002/14651858.CD005123.pub3

Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. (2019) Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth. 19(1):466. Available at: https://doi.org/10.1186/s12884-019-2620-0

Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. (2017) Continuous support for women during childbirth. Cochrane Database Syst Rev. (7):CD003766. Available at: https://doi.org/10.1002/14651858.CD003766.pub6

Ibrahim H, Ghattas V, Abd H, Kandeel E. (2017) Effect of breathing technique (blowing) on the integrity of perineum and duration of the second stage of labor among primiparous women. World Journal of Nursing Sciences. 3(3). https://www.researchgate.net/publication/348610324_Effect_of_Breathing_Technique_Blowing_on_the_Integrity_of_Perineum_and_Duration_of_the_Second_Stage_of_Labor_among_Primiparous_Women

Häggsgård C, Nilsson C, Teleman P, Rubertsson C, Edqvist M. (2021) Women's experiences of the second stage of labour. Women Birth. 35(5):e464-e470. Available at: https://doi.org/10.1016/j.wombi.2021.11.005

Hofmeyr G, Singata-Madliki M. (2020) The Second Stage of Labour. Best Practice Research Clinical Obstetrics Gynaecology. 67:53-64. Available at: https://doi.org/10.1016/j.bpobgyn.2020.03.012

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available at: https://doi.org/10.1002/14651858.CD001063.pub3

NICE. (2017) Intrapartum care: care of healthy women and their babies. Available from: https://www.nice.org.uk/guidance/cg190 [Accessed 6th August 2022]

Prins M, Boxem J, Lucas C, Hutton E. (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG. 118(6):662-670. Available at: https://doi.org/10.1111/j.1471-0528.2011.02910.x

Walker K, Kibuka M, Thornton J, Jones N. (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 11(11):CD008070. Available at: https://doi.org/10.1002/14651858.CD008070.pub4

Yuksel H, Cayir Y, Kosan Z, Tastan K. (2017) Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 15(6):456-461. Available at: https://doi.org/10.1016/S2095-4964(17)60368-6&nbsp;

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Second stage of labour: how and when to push | Labour & birth articles & support | NCT

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How will you know when to push and how long does the second stage of labour last? Here's what you need to know about the stage when your baby will be born.

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What is the third stage of labour?

The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out (Begley et al, 2011; NICE, 2017).

Once your baby's born, the release of the hormone oxytocin will make the uterus contract and become smaller. This'll make the placenta start to separate.

You will have some bleeding during the third stage of labour as you pass the placenta (Begley et al, 2011).

Active management versus physiological management

Generally, you have two options for how you do the third stage of labour: active management and physiological management. But there's also a third option - mixed management - combining active and physiological approaches (Begley et al, 2011; NICE, 2017).

Physiological management:

It's generally practised in midwife-led units and in home births.

It allows the placenta to be ready to come out mainly by pushing, gravity, contractions and sometimes by nipple stimulation.

It doesn't use oxytocin injections.

The umbilical cord is clamped and cut once it has stopped pulsing or when the placenta has come out.

It can take up to one hour (and shouldn't take more).

Skin-to-skin contact and breastfeeding can help it along, by making your body produce more oxytocin.

It involves sitting in an upright position to encourage the placenta to come out.

Your midwife will monitor your blood loss and keep you and your baby warm.

You'll push the placenta out once it has separated and moved down to your vagina.

It's mostly used if you're at low risk of heavy blood loss.

You can change to active management at any time if needed. (Begley et al, 2011; NICE, 2017)

When the placenta is out, your midwife will clamp and cut the cord. But if you want, you can ask them to wait until it has finished pulsating (RCM, 2013a). Delaying cord clamping for at least a minute has been shown to be beneficial for babies(Science Direct, 2021).

Active management:

Involves an injection of a drug called syntocinon or ergometrine in your thigh soon after your baby's born.

It speeds up the delivery of the placenta - it usually happens within 30 minutes of having your baby. Your midwife will apply some pressure to your belly and pull gently on the umbilical cord to ease the placenta out.

You'll have the umbilical cord cut between one and five minutes after you give birth.

It lowers the risk of heavy blood loss.

It might make you feel sick or vomit, and can increase your risk of high blood pressure.

(Begley et al, 2011; RCM 2013b; NICE, 2017)

Should I have active management or physiological management?

Generally, active management is recommended for all women, to avoid severe haemorrhage. Though this is more of an issue in low-income countries where women are more likely to be poorly nourished, anaemic or have infectious diseases (Begley et al 2015).

If you do go through a haemorrhage though, you'll need to be transferred to a hospital if you're not already there. You'll then be offered treatment that involves:

oxytocin or another drug called ergometrine, which helps the womb to contract and stop the bleeding

your placenta being removed if it hasn't been delivered already

fluids through a drip

oxygen through a facemask.

If the bleeding continues, you'll be given more oxytocin, ergometrine or other drugs. In some cases, an examination under anaesthesia and surgery and/or a blood transfusion might be needed (NICE, 2017).

Retained placenta and problems after birth

If all or some of your placenta has not come out within one hour of you having your baby, this is called a retained placenta.

If that happens to you, you'll need to be put on an intravenous drip. You might also be offered a vaginal examination to see whether you need an operation to remove the placenta. You'll also be offered pain relief (NICE, 2017).

If you do have the placenta removed under anaesthesia, you'll need to have it done within a few hours of the birth to avoid haemorrhage (Weeks, 2001). You'll then need to be transferred to an obstetric unit if you are not already there and might be advised to have an epidural or spinal anaesthetic when the placenta is actually removed (NICE, 2017).
This page was last reviewed in July 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Important information on the third stage of labour can be found in NICE guidelines.

Begley CM, Gyte GML, Murphy DJ, et al. (2011) Active versus expectant management of women in the third stage of labour. Cochrane Database Syst Rev.(11):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/delivering-the-placenta [Accessed: 13th August 2018]

Rabe H, Gyte GML, Díaz‐Rossello JL, Duley L. (2019) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. Available from: (9):CD003248. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003248.pub4... [Accessed: 4th October 2019]

RCM. (2013) How to conduct active management of the third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-conduct-active-management-of-the-third-stage-of-labour [Accessed: 13th August 2018]

Weeks AD. (2001) The retained placenta. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704447/] African Health Sciences. 1(1):36-41. [Accessed: 13th August 2018]

Science Direct (2021) A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns [Accessed: 27 August 2021] https://www.sciencedirect.com/science/article/abs/pii/S0301211521002098...
Further reading
Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. (2015) Delivering the placenta with active, expectant or mixed management in the third stage of labour. Cochrane Database Syst Rev. 2015.(3):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

Jangsten E, Mattsson LA, Lyckestam I, Hellstrom AL, Berg M. (2011) A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. British J Obst Gynaecol. 118(3):362-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21134105 [Accessed: 13th August 2018]

RCM. (2013) How to promote a physiological third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-promote-a-physiological-third-stage-of-labour [Accessed: 13th August 2018]

Midwife thinking An actively managed placental birth might be the best option for most women https://midwifethinking.com/2015/03/11/an-actively-managed-placental-bi...

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Third stage of labour: delivering placenta and cord clamping | Labour & birth articles & support | NCT

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The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out.

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You know having a baby will be life-changing, so you might be preparing yourself by attending classes and Googling just about everything to do with childbirth. You might also be thinking about alternative pain relief methods and labour techniques, like hypnobirthing.

Hypnobirthing is gaining popularity as some say it's a way of birthing gently and calmly. Some people describe it as allowing them to give birth without medication (The Guardian, 2015). So if you're wondering what hypnobirthing is all about, here we introduce you to this mysterious-sounding technique...

What is hypnobirthing?

"Hypnobirthing teaches relaxation, visualisation and self-hypnosis skills (Varner, 2015)."

This preparation tries to give pregnant women a positive view of birth and the belief that childbirth does not have to be painful. The aim is a shorter, more comfortable, easier labour, with less need for intervention or pain relief (Madden et al, 2016).

How does hypnobirthing work?

Hypnosis focuses on preparing a woman for birth by reframing the representation of labour from a painful and difficult experience to a positive one (Catsaros, 2020).

Women's experience of labour pain can vary in intensity; but fear, tension and anxiety can worsen it (Catsaros, 2020; RCM 2014) and the mental and physical activities practised through hypnobirthing can lessen this.

So can it really work - what's the evidence?

A systematic review of hypnosis-based interventions during pregnancy found that it improved childbirth experience by reducing fear and pain and enhancing a sense of control (Catsaros, 2020).

It improved women's emotional experience and outlook towards birth with less anxiety, increased satisfaction, fewer birth interventions, more postnatal wellbeing and a better childbirth experience overall (Catsaros, 2020). Other research has found that self-hypnosis promoted 'feelings of calmness, confidence and empowerment (Finlayson et al, 2015).'

How can I practice hypnobirthing?

Practitioners say hypnobirthing can create an altered state of conscious awareness (Madden et al, 2016). Hypnobirthing involves learning techniques that you can use in preparation for and during labour like:

visualisation

pregnancy and birth affirmations

relaxation

deep breathing

self-hypnosis

mindfulness.

(Semple et al, 2011; Madden et al, 2016)

How do I learn hypnobirthing techniques?

You can learn about hypnobirthing by reading about it, or through listening to hypnosis tracks or podcasts. Some of the online resources that you'll find are free (Madden et al, 2016).

If you'd prefer to attend a class, some NCT courses include elements of teaching about hypnobirthing as well as breathing techniques and ways to stay relaxed during labour. But you can find specialist hypnobirthing courses that add more specific techniques (Madden et al, 2016). Hypnobirthing classes teach the techniques mentioned above, such as self-hypnosis, deep relaxation and deep breathing, in addition to birth positions and the basic physiology of birth.

Once you've learnt the techniques, you'd use them to help you focus and concentrate completely on your body and your baby. Hypnobirthing can be used in all birth settings, during vaginal or caesarean birth, with or without all types of pain relief and can be added to your birth plan.

If I try hypnobirthing will I be aware of what is happening?

A common misconception about hypnobirthing is that women lose control of their thoughts and actions in a hypnotic state. In fact, women who learn hypnobirthing use it to be less aware of external stimuli. They also learn to have a more focused attention and responsiveness to verbal or non-verbal suggestions. The idea is that these suggestions might make her feel safer, more relaxed and comfortable, and give her some relief from her pain (Madden et al, 2016).

So women who use self-hypnosis during labour are fully in control and aware of what is happening to them and to those around them. What hypnobirthing actually aims to do is help a woman focus and enhance her birthing experience.

What are the advantages of hypnobirthing?

It can help women feel more confident with themselves and their capacity to go through labour feeling in control, leading to a more positive birth experience (Catsaros, 2020).

Hypnobirthing reduces anxiety and reduces fears related to pregnancy and childbirth (Which?, 2018; Downe, 2015). This can lead to lower perceptions of pain during labour and a shorter labour (Catsaros, 2020).

It can promote positive mental health and self-confidence after birth (Catsaros, 2020).

NICE states that women who choose to use hypnosis during childbirth should be supported in doing so (NICE, 2014).

A review of the evidence suggested hypnosis might help to reduce the pain of labour and does not seem to have any adverse effects on outcomes (Smith et al, 2006).

What are the disadvantages?

There can be a difference between what you expect to or hope will happen during labour and the reality of your birth experience.

Styles and language may vary between different hypnobirthing schools or practitioners, so you may wish to look into what suits you best (Varner, 2015).

It takes time to learn about hypnobirthing, practice it and master the breathing, visualisation and self-hypnosis techniques. It is more effective when it has been practised regularly during pregnancy so will take time and commitment (Varner, 2015; Catsaros, 2020).

Hypnobirthing courses are an additional cost. Although in some parts of the UK, NHS hospitals have introduced free hypnobirthing classes (Which?, 2018).

Women who use self-hypnosis techniques may seem so relaxed that health care professionals could underestimate their progression of labour (Catsaros, 2020).

There is very little research on the feelings and experiences of birth partners when hypnobirthing is used (Catsaros, 2020).

How do I find out more about hypnobirthing?

Ask your midwife whether there are any local antenatal courses that might include hypnobirthing.

Ask friends and family members about their birth experiences and talk to those who have tried hypnobirthing.

Read hypnobirthing birth stories online and listen to podcasts on the topic.

This page was last reviewed in March 2021.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Learn how to use breathing exercises in this labour video from Tommy's.

Catsaros S, Wendland J. (2020) Hypnosis-based interventions during pregnancy and childbirth and their impact on women's childbirth experience: A systematic review. Midwifery. Available at: https://doi.org/10.1016/j.midw.2020.102666 [Accessed 23rd March 2021].

Downe S, Finlayson K, Melvin C, Spiby H, Ali S, Diggle P, et al. (2015) Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG. 122(9):1226-1234. Available at: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.13433 [Accessed 23rd March 2021].

Finlayson, K., Downe, S., Hinder, S. et al. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour. BMC Pregnancy Childbirth 15, 229 (2015). https://doi.org/10.1186/s12884-015-0659-0&nbsp;

Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. (2016) Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev. (5):CD009356. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009356.pub3/full [Accessed 23rd March 2021].

NICE. (2014) Intrapartum care for healthy women and babies. Available at: https://www.nice.org.uk/guidance/cg190 [Accessed 23rd March 2021].

RCM. (2014) How to support hypnobirthing. Midwives. 5:34-35. Available at: https://www.rcm.org.uk/sites/default/files/34-35_0.pdf [Accessed 19th April 2021].

Semple A, Newburn M; NCT. (2011) Research overview: self-hypnosis for labour and birth. Perspective. December: 16-20. https://www.nct.org.uk/sites/default/files/related_documents/Research%20overview-%20Self%20hypnosis%20for%20labour%20and%20birth%20%282011%29_2.pdf

Tommy's (2018) What is hypnobirthing? Available at: https://www.tommys.org/pregnancy-information/labour-birth/pain-relief-labour/hypnobirthing [Accessed 21st March 2021].

Varner CA. (2015) Comparison of the Bradley method and HypnoBirthing childbirth education classes. J Perinata Educ. 24(2): 128-136. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744344/ [Accessed 23rd March 2021].

Which? (2018) What is hypnobirthing? Available at: https://www.which.co.uk/birth-choice/coping-with-pain-in-labour/what-is-hypnobirthing [Accessed 23rd March 2021].

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Hypnobirthing: where to start | Labour & birth articles & support | NCT

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We discuss what you need to know about hypnobirthing and the potential advantages and disadvantages of using this technique in labour and birth.

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Second stage of labour: what is it?

The second stage of labour starts when your cervix is open (dilated) fully and ends when your baby is born (NICE, 2017; Hofmeyr and Singata-Madliki, 2020; Häggsgård et al, 2021).

There may be some time between when the cervix is open and when the pushing contractions begin, and this is known as the passive second stage of labour. Once the baby is visible and the pushing contractions begin, that is known as the active second stage of labour (NICE, 2017).

While most people feel the urge to push in the second stage of labour, not everyone experiences this. For some the first and second stages of labour may be a continuous, rather than a two-stage, process (Häggsgård et al, 2021).

For those who do notice a difference in the second stage of labour, it can feel intense and powerful, as you experience a strong pressure pushing the baby downwards. Some people find these contractions easier to cope with as they follow their body's impulses. Others can feel overwhelmed and out of control as their body takes over (Häggsgård et al, 2021).

How long does the second stage of labour last?

Usually, your baby will be born within three hours of active pushing if it's your first baby, and within two hours for second and subsequent births (NICE, 2017; Hofmeyr and Singata-Madliki, 2020). But it can be much quicker.

What can I do to make the second stage of labour easier?

Finding the right position in the second stage of labour may be beneficial and your midwife and birth partner can support you to move into the most comfortable position.

Getting into an upright or side-lying position could help to make the second stage of labour shorter and more comfortable (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020). These positions aid gravity, and mean your pelvis can be more flexible so movement will help your baby out.

Examples of upright positions include:

kneeling

squatting (either independently or using a hammock, rope or bar to dangle from)

standing

using a birthing stool

leaning over a birthing ball.

If you are experiencing back pain then a position that gets you on all fours, like using the birthing ball, can help with that (Hunter et al, 2007). Being in water can help, too.

In the end, follow your instincts and get in whatever position feels right for you, asking your midwife or birth partner to support you to move (NICE, 2017; Berta et al, 2019; Hofmeyr and Singata-Madliki, 2020).

It may help if the midwife and your birth partner offer physical support or positive updates about your baby's progress during the pushing stage of labour. Feeling cared for is particularly important at this time (Häggsgård et al, 2021). Some women may like to be told what is happening, (Häggsgård et al, 2021) while some may not.

It could be a good idea to discuss beforehand how you think you'd like your birth partner to care for you and how much you'd like them to tell you about what they can see happening. Remember, however, that this might change in the moment, so acknowledge that possibility too.

When the time comes, you might want to reach down so you can feel your baby's head. Some people find this boosts their energy levels and can make the birth seem more real (Häggsgård et al, 2021). If things are going slowly, you could ask to be supported to change positions or go to the toilet to create more space for the baby to be born (NICE, 2017).

You might have seen on TV or heard of midwives telling women when or how to push. But this is no longer done as it makes the pushing stage longer, more tiring and can make the experience feel more negative rather than listening to your own body (Prins et al, 2011; Ibrahim et al, 2017; Häggsgård et al, 2021). Instead, your midwife will encourage you to work with your body (Häggsgård et al, 2021).

What if I have an epidural?

If you're experiencing the second stage of labour with an epidural, it may be harder to recognise the changing sensations. So this is when it might help to be guided by your midwife. Once the cervix is open, you could be encouraged to wait for an hour or until the baby's head is visible before beginning to push (NICE, 2017).

You should be supported to find a position that is comfortable for you, such as lying on your side, or leaning over the end of the bed (NICE, 2017; Walker et al, 2018). For more about epidurals and their effect on labour, read our article.

The last push

As your baby's head comes down ready to be born, you may experience a burning or stinging pain in the soft tissue between vagina and anus. You might have concerns about perineal tearing (Häggsgård et al, 2021).

At this point you can slow down your pushing efforts so that your baby's head is born slowly. Your midwife may suggest gently blowing out (like cooling a hot drink) as this can protect the perineum and reduce the chance of tearing (Ibrahim et al, 2017).

Some midwives might use a warm compress on the perineum or support the baby's head as they are born, but others will be more hands-off (NICE, 2017). Neither approach has been shown to be better, and you can say what your preference is. You may find it helpful to have a mirror to see what's happening, as this can help you to feel more in control.

After your baby's head comes out, there could be a pause between contractions before the shoulders are born. When they are fully born, you can then bring your baby to your chest or tummy for skin-to-skin contact, or ask the midwife to do that for you.

What can my birth partner do

Your birth partner might help with physical support or massage, encouragement, or just to sit quietly by if you prefer. They can also make sure your views are heard and acted upon (Bohren et al, 2017). Not to mention providing constant drinks and food when you need them to keep your strength up.

How can I prepare for the second stage of labour?

Some research has found that using breathing techniques involving deep breaths in and out can shorten the second stage of labour and reduce pain (Yuksel et al, 2017). You may wish to practise these techniques in advance.

Perineal massage in the last month of pregnancy can reduce the likelihood of tearing or needing an episiotomy (a cut made in the tissue between the vaginal opening and the anus during childbirth) (Beckman and Stock, 2013).

What if I still feel anxious about the second stage of labour?

Some people may feel particularly apprehensive about the second stage of labour, for example if you have had a previous difficult birth or have experienced sexual violence. Talk to your midwife about your concerns and they will give you information, options and support you in your decisions (NICE, 2017).
This page was last reviewed in September 2022.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

You will also find useful information on NHS Choices here.

Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available at: https://doi.org/10.1002/14651858.CD005123.pub3

Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. (2019) Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth. 19(1):466. Available at: https://doi.org/10.1186/s12884-019-2620-0

Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. (2017) Continuous support for women during childbirth. Cochrane Database Syst Rev. (7):CD003766. Available at: https://doi.org/10.1002/14651858.CD003766.pub6

Ibrahim H, Ghattas V, Abd H, Kandeel E. (2017) Effect of breathing technique (blowing) on the integrity of perineum and duration of the second stage of labor among primiparous women. World Journal of Nursing Sciences. 3(3). https://www.researchgate.net/publication/348610324_Effect_of_Breathing_Technique_Blowing_on_the_Integrity_of_Perineum_and_Duration_of_the_Second_Stage_of_Labor_among_Primiparous_Women

Häggsgård C, Nilsson C, Teleman P, Rubertsson C, Edqvist M. (2021) Women's experiences of the second stage of labour. Women Birth. 35(5):e464-e470. Available at: https://doi.org/10.1016/j.wombi.2021.11.005

Hofmeyr G, Singata-Madliki M. (2020) The Second Stage of Labour. Best Practice Research Clinical Obstetrics Gynaecology. 67:53-64. Available at: https://doi.org/10.1016/j.bpobgyn.2020.03.012

Hunter S, Hofmeyr GJ, Kulier R. (2007) Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. (4):CD001063. Available at: https://doi.org/10.1002/14651858.CD001063.pub3

NICE. (2017) Intrapartum care: care of healthy women and their babies. Available from: https://www.nice.org.uk/guidance/cg190 [Accessed 6th August 2022]

Prins M, Boxem J, Lucas C, Hutton E. (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG. 118(6):662-670. Available at: https://doi.org/10.1111/j.1471-0528.2011.02910.x

Walker K, Kibuka M, Thornton J, Jones N. (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 11(11):CD008070. Available at: https://doi.org/10.1002/14651858.CD008070.pub4

Yuksel H, Cayir Y, Kosan Z, Tastan K. (2017) Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 15(6):456-461. Available at: https://doi.org/10.1016/S2095-4964(17)60368-6&nbsp;

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Second stage of labour: how and when to push | Labour & birth articles & support | NCT

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How will you know when to push and how long does the second stage of labour last? Here's what you need to know about the stage when your baby will be born.

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If you're feeling totally clueless about what you need to pack in your bag for labour, try not to worry.

Your midwife can steer you in the right direction. The Which? Birth Choice guide can let you know what will already be available at the hospital you'll be giving birth in.

You might also be able to book a tour of the hospital where you'll be having your baby. That way you can ask more about what you need to bring from home and what's available at the hospital.

Here are your other questions answered on all things hospital kit related.

When should I pack my hospital bag for birth?

You can start packing whenever you want to. But it's a good idea to have your bag ready at least two weeks ahead of your due date (NHS, 2018).

What type of hospital bag do I need?

You can use whichever of your bags that'll do the job. You definitely don't have to spend money on a special bag to take into hospital. Why not save the cash for an extra cute babygrow or three instead.

Packing two bags might also work for you - one for during labour and one for afterwards. Or you could go for a small suitcase; it might sound crazy but the stuff you will need adds up. And, after all, you are packing for a possible overnight stay (for at least two people).

When your bag is packed, leave it by the front door so you don't forget it. Then let your birth partner or whoever is driving you to the hospital know where it is and what's in it. That way they can be ready to help as soon as you need them to.

What essentials shall I pack in my hospital bag for labour?

Here's a starting point for what you'll need in labour:

Maternity notes.

Birth plan, if you've made one.

A comfy, loose outfit for labour that you can move around in and that won't make you too hot. A cosy nighty or a big t-shirt is perfect.

Chill-out kit including books, magazines, music or podcasts (more for the early stages).

A fan or water spray to cool you down.

A phone and charger - with good storage.

Healthy snacks and drinks.

Your own pillow, possibly a giant pregnancy one.

A TENS machine and batteries if you want to use one and if your hospital doesn't provide one.

Any medication you're taking.

Your wash bag with your toothbrush, toothpaste, hairbrush, soap, hair ties and other toiletries (NHS, 2018).

Aromatherapy oils, especially if you have been using them during pregnancy, e.g. for hypnobirthing.

You might also want to bring your birth ball but check on your tour or with your midwife whether the hospital has its own.

What essentials shall I pack in my hospital bag for after the birth?

When you're chilling out with your new arrival, you'll need a whole host of other things.

Bring these in your bag:

large sanitary or maternity pads

large comfy knickers (or disposable ones)

towels

dressing gown

slippers or flip-flops

comfy, maternity-sized outfit to wear home

cash - you might need it for parking or to grab a magazine or emergency chocolate bar

iPad or tablet.

And if you're planning to breastfeed, add:

nursing bras

breast pads

front-opening nighties or pyjama tops.

What should I pack in my hospital bag for my new baby?

Yep, it's not just you you're packing for. For the baby, add in:

bodysuits or vests

sleep suits (including one you want them to go home in)

a hat

scratch mittens

socks or booties

nappies

cotton wool balls or pads

blankets

muslin squares

a snowsuit if it's cold.

You'll also need to make sure you have a car seat that's correctly fitted. If you're getting a taxi home, check you know how to fit the car seat yourself (NHS, 2018).

What should my birth partner pack in their hospital bag?

Your birth partner may be at hospital with you for a long time, and even overnight, so they will definitely need to have a bag packed too.

They should think about packing:

snacks

cash

a change of clothes

a wash bag

a camping mattress if there is room for them to stay over

a book or something to distract the mum to be if you're relaxing in the early stages.

Important numbers

Wherever you're planning to give birth, keep a list of important numbers in your purse or in your phone. You'll need to include:

the hospital, midwife or doula's phone number

your partner or birth partner's phone number

your hospital reference number (on your card or notes).

This page was last reviewed in September 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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Hospital bag checklist: what do I need to take? | Labour & birth, Deciding where to give birth articles & support | NCT

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Snuggly PJs, babygrows and a whole buffet of snacks. Here's what you should think about adding to your bag when you go into labour.

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The basics

If you're planning to give birth in a birth centre (midwife-led unit), you'll still need a hospital bag. Pack it with stuff you and the baby will need at the midwife-led unit or birth centre, but also if you are transferred to hospital. Your midwife will probably give you an idea of what you need to pack. But here's the lowdown and the checklist.

The bag

Do remember - in what is probably quite a pricey time for you - you don't need to buy a new bag for labour. You can use any kind of bag you want.

Some women prefer to pack two smaller bags. That means one for labour and one with the stuff you and your baby will need after their birth (Tommy's, 2018).

It's a good idea to have your bag packed by 37 weeks at the latest. Yet you might find it reassuring to get it done by 32 weeks, just in case (Tommy's, 2018).

Packing checklist: labour

Remember to pack the following in your hospital bag for labour:

maternity notes

a couple of changes of clothes - something comfortable and cool for moving around in labour, like big T-shirts

books, iPads, games, music, or magazines - to help you pass the time and relax during labour

water spray bottle or handheld fan

lip balm - lips often get super dry during labour

money for car parking and/or taxis

phone and charger (check you have enough storage on your phone)

healthy snacks and drinks

extra pillows

TENS machine if you want one

birth ball and pump if not provided

any medications you're on

toiletries bag with toothbrush, toothpaste, hairbrush, hair bobbles, soap and shampoo. (NHS, 2018; Tommy's, 2018)

Packing checklist: after the birth

Remember to pack the following in your hospital bag for after the birth:

comfortable and supportive bras, including front-opening nursing bras if you're planning to breastfeed

breast pads

maternity pads (two packets)

an extra five pairs of knickers

towels

one or two front-opening or loose-fitting nighties or tops if you're planning to breastfeed

dressing gown and slippers

loose, comfortable shoes and clothing to go home in

mobile phone and charger

some cash - for parking or hospital shop. (Tommy's, 2018; NHS, 2018).

Packing checklist: baby

Remember to pack the following in your hospital bag for your baby:

bodysuits, vests, sleep suits and a hat

a going home outfit

scratch mittens

socks and booties

lots of nappies for your newborn

cotton wool or baby wipes suitable for a newborn

baby blanket

muslin squares

snowsuit if it's cold - choose one you can easily remove before placing your baby in their car seat

car seat if you're driving home - make sure it's correctly fitted or if you're getting a taxi home, that you know how to fit it. (Tommy's, 2018; NHS, 2018)

Packing checklist: your partner

Don't forget your birth partner. They should either whip up a bag for themselves, or you should pack a joint one with their stuff in it too (Which?, 2018). Either way, make sure they're familiar with what's in yours as you'll probably ask them to pass you various things when the time comes.

In their bag, they should pack:

drinks

snacks

cash

books/games/magazines

a change of clothes and toiletries in case they stay overnight.

Important numbers for labour

Wherever you're planning to give birth, make sure all the important numbers are in your phone and written down as back-up too. Include:

your hospital, midwife or doula's phone number

your partner or birth partner's phone number

your hospital reference number, which is on your card or notes.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

The Which? Birth Choice regional guide to labour wards and birth centres provides information about services in your area, including what equipment is already provided.

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Hospital bag checklist: what to pack for a birth centre

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If you're planning to give birth in a birth centre (midwife-led unit), you'll still need a hospital bag. Pack it with stuff you and the baby will need at the midwife-led unit or birth centre, but also if you are transferred to hospital. Your midwife will probably give you an idea of what you need to pack.

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Home birth: what kit do I need? | Labour & birth, Deciding where to give birth articles & support | NCT

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If you’re thinking of having your baby in your own home, you’ll want to get prepped in advance. Here’s a checklist of the essential equipment you’ll need…

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Many women are interested in the idea, but anxious that a pool will not be available, and so miss out on planning a water birth. But there is a way - you can use one on the NHS, hire one or buy one. Here's how to get a birthing pool and how to prepare yourself for using it.

1. How to find out about NHS birthing pools, or hire one or even buy one

Pools have become more popular so that means midwife-led units and obstetric units have more of them, hooray. Some NHS trusts have pools and your midwife will tell you how many are available locally. You could also look at your local hospital trust's website to find out which local NHS units have pools. The website Which? Birth Choice can show your options too.

The only snag is that you cannot book hospital and midwife-led centre birthing pools in advance with your midwife. In any case, it's a good idea to say to them you're hoping to use one when you contact the midwife when you go into labour.

An organisation that might have pools they can lend or hire to you includes your local Positive Birth Movement group.

If it comes to buying one, several companies hire or sell birth pools and you can find them easily on the internet.

2. You can use a birthing pool at home

It's a little more than a paddling pool and you'd be right in thinking it involves more than sploshing some water in there and hoping for the best. You'll need to read the information that the pool provider gives you about how to use their particular pool.

Something to remember is that pools should not be left filled and heated before labour starts as it'd be a possible infection risk (Public Health England, 2014). See our article about how to labour in water or have a water birth for more about what to do when things get started. NICE guidelines say that midwives monitor the temperature of pool hourly to make sure the water temperature does not go above 37.5°C (NICE, 2014).

3. Preparing to use a pool in hospital or a birth centre

All staff are trained to use the pool, so try not to worry. If you are nervous about using the pool, you could ask about how your midwife's training would support you if you need it. You could also ask about equipment like hoists (to remove an unwell woman from the pool) and telemetry (wireless monitoring).

Pools are cleaned between each woman so they'll be spick and span by the time you get in there.

If a pool is not available your labour room, you are likely to have either a shower or bath that you can use for labour.

4. What you could wear for labouring in water

Some women prefer to be naked during labour.

Some women choose to wear a T-shirt, crop top, or bikini top. Some will keep knickers on during labour until near the end, and others take them off when they get into the water. When the baby is born, women will be encouraged to put their baby on them skin-to-skin, so this might mean taking off a T-shirt at that point.

Dry clothes for when you get out of the water.

Towels for when you get out.

5. What you might want for a water birth

A jug to pour water over the bump or back.

Something to pad the floor of the pool, or to lean on in the water or over the side of the pool.

Birth supports like straws, massage aids, music and a helpful birth partner.

6. How your NCT antenatal course can help you to prepare

Going to an NCT antenatal course will help to prepare you for the different ways of working with pain in labour. The teacher will talk about water births in more or less depth depending on the course length, what the women attending need and pool availability in your area. They are likely to direct you to sources of information about what birth pools are available at local NHS trusts, and gain an understanding of water as a form of pain relief.

Some areas offer NCT Waterbirth Workshops. These workshops can give you a more in-depth exploration of water births, sometimes with an inflatable birth pool to try out.
This page was last reviewed in March 2019.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

You could take a look at AIMS for support finding your way through the maternity services system.

If you want support with or to make your voice heard about the maternity service you are receiving, you can contact Maternity Voices Partnerships (MVP).

To view and compare your maternity options locally, you can look at the Which? Birth Choice website.

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Many women are interested in the idea, but anxious that a pool will not be available, and so miss out on planning a water birth. But there is a way - you can use one on the NHS, hire one or buy one.

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Whether or not you're much of a water baby yourself, labouring or giving birth in water has a whole load of advantages. The great thing is that you should be offered the chance to labour in water, if possible, whether you've had children before or are a first-time mother (NICE, 2014).

About 10% of women in the UK give birth in pools but nearly 20% use water for pain relief (CQC, 2018). Water births started gaining in popularity when the Department of Health recommended them for pain relief in 1993 (Winterton, 1992; Cumberledge et al, 1993; Garland, 2000). But it's not just about the pain...

Why use water in labour or for giving birth?

Women say they feel more relaxed, involved in decision-making and more in control when using water for labour and birth.

It is an effective pain reliever - women use less epidural or spinal pain relief when they have access to water.

It's safe for you and your baby - there is no increased chance of the baby being admitted to neonatal care after a water birth.

It might make the first stage of labour shorter and one study said it shortened labour by almost two hours.

Less or equal blood loss.

(Cluett et al, 2018; Dekker, 2018; RCM, 2018; Ulfsdottir et al, 2018)

Can water births prevent tearing, episiotomy or interventions?

It won't prevent tearing or episiotomy but it's possible water births might make them less likely. Yet the evidence is mixed and there has been no research in midwifery-led settings, where there are fewer interventions in any case than in hospitals (Brocklehurst et al, 2011; Cluett et al, 2018).

One study suggests there is less chance of interventions or second-degree tears with water births (Ulfsdottir et al, 2018). While a large review of various studies suggests water has little effect on tearing or interventions in the first stage of labour. That review couldn't make any conclusions on the rates of tearing for the second stage of labour as the studies did not record them (Cluett et al, 2018).

Another review suggested there is a higher chance of straightforward birth in an upright position with midwife's 'hands off' the perineum with a water birth. They also said that labouring or giving birth in water might make bad tears and episiotomies less likely but may mean minor tears are more likely (Dekker, 2018).

Are water births safe for the baby?

Yes, water births are safe. It makes no difference in how healthy babies are, and they're no more likely to have difficulty breathing or to die. In fact, some research suggests your baby is less likely to need a transfer to hospital or stay in hospital or to be admitted to neonatal intensive care. Your baby won't get cold either - there's no increase in newborn hypothermia with water births (Dekker, 2018).

As for infections, they're not more likely to get group B Strep infections. Water births also make no difference to babies' microbiomes (Dekker, 2018).

What are the potential risks of a water birth?

Training has become standardised so that situations like babies inhaling water have not been seen for many years. Even when that has happened in the past, the babies recovered. Midwives are trained to be gentle with the cord too when guiding the baby out of the water, to prevent a (rare) cord snap (Dekker, 2018).

There is no increase in the risk of infection in newborns but some isolated cases have been reported. Effective cleaning and pool management protocols have reduced the chance of this happening.

As for the mums, water births carry no increased risk of maternal infections (Dekker, 2018).

Can you have water births with gas and air, TENS, epidurals or pethidine?

It's not possible to have an epidural in water. TENS is electrical stimulation so it's also incompatible with water births.

As for what you can use in water, you can breathe a bit sigh of relief that entonox (gas and air) is fine for water births. And you can use self-help techniques like breathing, movement, massage, visualisation, distraction, or other complementary therapies to your heart's content in water.

When it comes to epidurals, a few women labour in water for a while but get out to have an epidural or further assistance. In any case, labouring in water seems to reduce the chance of having an epidural (Cluett et al, 2018). Water also reduces the need for other forms of pain relief, and women are more satisfied with the pain relief water provides (Dekker, 2018).

A woman can use both water and opioids (e.g. pethidine) during labour, but not at the same time. If she has used pethidine she will need to wait for guidance from her midwife that it has passed out of her system before getting in the water, usually a few hours.

When can't I labour or birth in water?

The NICE guidelines say that all 'healthy women and babies...between 37 and 42 weeks of gestation' should be offered the opportunity to labour in water (NICE, 2014). But here's where it gets complicated - women outside of those criteria are not actually excluded from using water in labour. What it actually means is that this is an opportunity for you and your health professionals to explore each other's concerns, before you decide.

There might be local guidance too and you can ask for this. You can also ask to talk with a consultant midwife to explore your options. All NHS midwives are trained to support women birthing in water.

The local Maternity Voices Partnership (MVP), or AIMS may also be interested in supporting you if you want, and these contacts can be found on the internet.

When an NHS Trust is not comfortable with supporting a woman in hospital, some women will decide to use a pool at home, with either an NHS or an independent midwife.

Can I have a water birth if I have a high BMI?

Your BMI (body mass index) will be taken into consideration along with your preferences, mobility, and any other conditions (NICE, 2019). You can talk to your health professional about how your BMI might affect things (NICE, 2019). Local guidance may affect whether women with high BMIs have water births (Marshall, 2019).

Can I have a water birth if I have herpes?

If you're in the third trimester of your pregnancy and it's the first time you've had genital herpes, you'll be offered a planned caesarean. This is because a caesarean decreases the risk of passing the infection to the baby (NICE, 2011).

If you have a recurrence of herpes, you won't be routinely offered a caesarean because of the lack of evidence that a caesarean will reduce the risk of passing on the infection to the (NICE, 2011). It's best to talk with the health professionals caring for you about how a recurrence of herpes may affect your choice for a water birth.

Can I have a water birth if I'm expecting twins?

Selective (caesarean) birth may be offered early to reduce risk for the babies, while expectant management (watchful waiting) is also possible (NICE, 2011a). Women can discuss options with their carers, and some women will decide to birth in a pool.

Can I have a water birth if I have Group B Strep?

Guidelines say there is no reason you can't use water during labour and birth as long as you're offered intrapartum antibiotic prophylaxis (IAP) (RCOG, 2017). Although one report suggested there was insufficient evidence around transmission of Group B Strep, with no increased chance found in the available evidence (Dekker, 2018).

Can I have a water birth if I have gestational diabetes?

The concern here is likely to be the estimated size of the baby and its effect on the progress of labour, i.e. you may be offered an induction. You can discuss this with the health professionals who are caring for you. Some women choose to have a water birth with well-controlled gestational diabetes.

Can I have a water birth if I am due to be induced?

This tends to fall under local practice. Where appropriate facilities exist (i.e. a pool on the obstetric unit) and staff are confident, then women do have water births even when the labour is being induced.
This page was last reviewed in March 2019
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about labour and life with a new baby. There might also be an NCT Waterbirth workshop in your area.

A Guide to Water Birth, 12-minute video.

Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M. (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ.343:d7400. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22117057 [Accessed: 13th November 2018]

Cluett ER, Burns E, Cuthbert A. (2018) Immersion in water in labour and birth. Cochrane Database Syst Rev. (5):CD000111. Available from: https://www.cochrane.org/CD000111/PREG_immersion-water-labour-and-birth [Accessed 13th November 2018]

CQC. (2018) 2017 Maternity survey: national tables for England. Available from: https://www.cqc.org.uk/publications/surveys/maternity-services-survey-2017 [Accessed 13th November 2018]

Cumberledge J; Expert Maternity Group; Department of Health. (1993) Changing childbirth. Part 1, report of the expert maternity group, London, HMSO. [Accessed 13th November 2018]

Dekker R. (2018) The evidence on: waterbirth. Available from: http://evidencebasedbirth.com/waterbirth/ [Accessed 4th March 2019]

Garland D. (2000) Waterbirth: an Attitude to Care. 2nd edition. Oxford: Books for Midwives Press

Marshall A. (2019) High BMI waterbirth - time for trusts to take the plunge? AIMS Journal. 31(2). Available from: https://www.aims.org.uk/journal/item/waterbirth-high-bmi [Accessed 13th November 2018]

NICE. (2014) CG190 Intrapartum care. Available from: https://www.nice.org.uk/guidance/cg190/chapter/recommendations#timing-of-regional-analgesia [Accessed 13th November 2018]

Public Health England. (2014) Patient safety alert: Legionella and heated birthing pools filled in advance of labour in home settings. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/06/psa-legionella-birth-pool.pdf [Accessed 4th March 2019]

RCM. (2018) RCM Midwifery blue top guidance No. 1, London, Royal College of Midwives. Available from: https://www.rcm.org.uk/media/2539/professionals-blue-top-guidance.pdf [Accessed 4th March 2019]

Ulfsdottir H, Saltvedt S, Georgsson S (2018) Waterbirth in Sweden - a comparative study. Acta Obstet Gynecol Scand. 97(3):341-348. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29288489 [Accessed 13th November 2018]

Winterton N. (1992) Maternity Services: Second report of the House of Commons Health Committee (The Winterton Report), London, HMSO.
Further reading
Lewis L, Hauck YL, Crichton C, Barnes C, Poletti C, Overing H, Keyes L, Thomson B. (2018) The perceptions and experiences of women who achieved and did not achieve a waterbirth. BMC Pregnancy and Childbirth. 18(1):23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763519/&nbsp; [Accessed 13th November 2018]

Redshaw M, Henderson J. (2015) Safely delivered: a national survey of women's experience of maternity care 2014, Oxford, NPEU. Available from: https://www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf [Accessed 13th November 2018]

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Water births and labouring in water: questions answered | Labour & birth articles & support | NCT

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Giving birth or at least labouring in water is becoming ever more popular and for good reason. It's a great pain reliever and more. Here we explain all.

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When it comes to giving birth, most women want to know: how much is it going to hurt and will I be able to cope with the pain? Unfortunately, you can't answer either of these questions with certainty. But what you can do is improve your ability to cope with pain during labour, as well as understand your options for pain relief and their impact on you, your labour and baby.

Your birth partner(s) will make a huge difference to how you feel during labour. Emotional support, such as encouragement and reassurance from somebody you trust, can really boost your confidence and ability to cope with pain when you need it most.

Here we look at the different pain relief options that are available during labour.

Overcoming fear during labour

Labour is complex but, unfortunately, fear can affect this amazing process.

Fear makes you release adrenaline, which slows down the production of oxytocin and prepares your body to fight or run away (not helpful when you're trying to give birth). This makes your contractions less efficient and you focus on the pain and feel worse. So staying calm is the key to coping with pain.

To help you feel relaxed, it's good to read up on what happens during labour and choose a place to give birth where you feel safe.

It'll help to choose the right person to be your birth partner to help you cope with the pain and discomfort of labour more easily. It should be a person you trust, and who can give you encouragement, reassurance, listen to you and just be there. Research has shown that emotional support is important for women in labour.

Attending antenatal classes is also a really useful way of preparing for labour and gaining an understanding of what will happen on the day.

If it feels really tough, ask your midwife how you are getting on. Positive encouragement - knowing you are coping really well and making good progress - can make all the difference.

Position and movement in labour

Labour can last a long time so, at the beginning, try movement, upright positions, massage and water to help you cope. If you head straight for maximum pain relief, you'll never know how other things can help - plus your labour may end up being even longer.

Lying on your back can make your contractions slower and more painful. Different positions and movement, such as rocking, swaying and leaning forwards, maximises your body's ability to give birth as it helps ease your baby along the birth canal.

Pros

Maximises your body's ability to give birth.

No lasting side-effects for you or your baby

Cons

Try not to overdo it; saving energy is also important. Lying on your side for a while or sitting up supported by lots of pillows can help your body to work really well while you conserve energy.

Water and birthing pools in labour

Water soothes pain and, in a large birthing pool, supports you, enabling you to glide into any position. For more about water births and using water during labour, see here.

TENS (Transcutaneous Electrical Nerve Stimulation) machine in labour

A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins. For more about the pros and cons of TENS, see here.

Complementary therapies

Various complementary therapies are available, such as acupuncture, aromatherapy, reflexology, yoga, self-hypnosis and massage.

Pros

Some studies show acupuncture is helpful.

Massage or pressure on the lower part of your back can help reduce levels of stress and ease discomfort, too.

You can learn self-hypnosis techniques for labour by attending a course or using CDs; you don't have to have a hypnotherapist with you in labour.

Cons

There is little research proving the effectiveness of these treatments though lots of women say that they found these techniques useful.

Apart from massage and self-hypnosis, you will need a registered practitioner to perform the therapies.

Sterile water injections

Sterile water injections involve injecting a tiny bit of water into the skin of your lower back to help with back pain during labour. For more about sterile water injections, see here.

Gas and air (Entonox) in labour

Entonox is a colourless, odourless gas made up of half nitrous oxide and half oxygen. You'll probably be given gas and air through a mouthpiece and told how to breathe it in. Read more about Entonox here.

Painkilling drugs in labour (opioids such as pethidine, diamorphine, meptid and remifentanil)

Pethidine, diamorphine and meptid are pain relieving drugs given by injection into the thigh. Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine. For more details, see our articles about intramuscular opioids and remifentanil.

Epidural

Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back. It usually removes all pain and most feeling from the waist down.

The combined spinal epidural (CSE) injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. Read more about their pros and cons in our articles about epidurals and CSEs.

Top tips for labour

The following tips have been found to be useful by women in labour:

1. Before labour, spend some time imagining having your new baby in your arms after the birth and that all is well. Imagining that you did it, and that you did it as you wanted, creates a positive picture to focus on.

2. Moving about helps labour to progress and women have said they were better able to work with the pain while rocking and leaning forwards (the pressure of the baby's head on the cervix will promote the release of oxytocin as well as endorphins - the body's natural pain relievers). Focus on letting go and relaxing any muscles that aren't needed to hold you in a position.

3. Focus on the out breath during a contraction. Keep the breathing calm and rhythmic.

4. Make a noise if you want to - be somewhere with people that are happy for you to moan, grunt, sigh or even swear if that helps.

5. Belly-dancing, hip-wriggling and stepping movements all help your baby settle into a good position to be born.

6. Massage or pressure on the lower part of your back just above the top of your bottom can help.

7. Water helps women relax and move more easily; being in a pool can give women a feeling of safety and security.

8. Positive, affirmative thoughts and supportive comments from birth partners help to promote confidence in the process. 'You are doing well - your body is made for this - feel the power of your body - your body knows how to do this - each pain is progress' are all positive and encouraging statements.

9. During labour, think about welcoming each contraction. As your contractions become stronger, longer and closer together your body is getting ready to give birth.

10. Rest, relax and conserve energy between contractions as labour progresses.

11. Have confidence in your own self-help resources.

12. Acknowledge that labour is unpredictable and that uncertainty is difficult to go along with. Try to go with the flow.

Recognising the point at which labour feels worst - when you have had enough - is often the point just before you are ready to start pushing your baby out. Having people with you who help you feel strong and capable can make all the difference.

Do what feels best for you

Every labour is different and each woman should choose whatever she needs to help her work with the pain of labour. Most importantly, have confidence that you can do it.
This page was last reviewed in August 2019.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy and life with a new baby.

NHS Choices guide to pain relief.

Research from the Royal College of Obstetricians and Gynaecologists (RCOG) about the use of water as pain relief in labour.

Information from NHS Choices about complementary therapies during pregnancy and before birth.

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Pain relief in labour | Labour & birth articles & support | NCT

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Find out about the different options available for pain relief in labour and childbirth, including epidural, pethidine, TENS and other ways to reduce pain.

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Obstetric Anaesthetist Guide to Pharmacological Pain Relief & Self Help

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Obstetric Anaesthetist Guide to Pharmacological Pain Relief & Self Help

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The Positive Birth Book Visual Birth Plan

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We now have a fantastic free website where you can choose from all the visual birth plan icons from The Positive Birth Book by Milli Hill, or create your own bespoke icons, to create a personalised visual birth plan (VBP) that you can then download and share with your care providers as you make decisions about your bir

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Royal College of Midwives - advice for pregnancy

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Royal College of Midwives - advice for pregnancy

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Support in the workplace for those who are pregnant

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Support in the workplace for those who are pregnant

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Two days after she informed her employer that she was pregnant with her first child, Joeli Brearley was sacked from her job by voicemail. She was four months pregnant and unemployed with bills to pay. Joeli considered taking legal action but then found out she was having a high-risk pregnancy and could go into labour at any moment. Her career and confidence were at rock-bottom and the health of her baby was in jeopardy.

Realising that her experience was not unique, Joeli launched Pregnant Then Screwed on International Women's Day in 2015, as a space for mothers to share their stories of discrimination. The project quickly grew and today Pregnant Then Screwed is a charity dedicated to ending the motherhood penalty, supporting tens of thousands of women each year, and successfully campaigning for change.

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Two days after she informed her employer that she was pregnant with her first child, Joeli Brearley was sacked from her job by voicemail. She was four months pregnant and unemployed with bills to pay. Joeli considered taking legal action but then found out she was having a high-risk pregnancy and could go into labour at any moment.

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Equality, health and wellbeing for families

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Equality, health and wellbeing for families

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challenging inequality : promoting wellbeing

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Guided Relaxation Hannah Appelgren by Hannah Appelgren

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A short guided relaxation to help you feel calm, suitable for anyone feeling a little anxious, tense or worried right now

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Share your videos with friends, family, and the world

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I am sure you have heard it mentioned by many, from your midwife, doula and every other mum on the planet 'You must strengthen your pelvic floor!' but what is a pelvic floor? The pelvic floor is the set of muscles resembling a hammock located at...

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I am sure you have heard it mentioned by many, from your midwife, doula and every other mum on the planet 'You must strengthen your pelvic floor!' but what is a pelvic floor? The pelvic floor is the set of muscles resembling a hammock located at...

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We love this! Fabulous demo of how to use a birth room to maximise upright birth Clemmie! Just perfect...take note #midwives #studentmidwives! ✅ 

LOVE... | By The Practising Midwife Journal | Facebook

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41K views, 274 likes, 78 loves, 42 comments, 442 shares, Facebook Watch Videos from The Practising Midwife Journal: We love this! Fabulous demo of how to use a birth room to maximise upright birth...

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Shared Decision Making

If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

Ask 3 Questions

To begin with, try to make sure you get the answers to 3 key questions, if you are asked to make a choice about your healthcare:

1. What are my options?

2. What are the pros and cons of each option for me?

3. How do I get support to help me make a decision that is right for me?

*Ask 3 Questions is based on Shepherd et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial. Patient Education and Counselling, 2011;84:379-85

https://www.aquanw.nhs.uk/sdm

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Group B Streptococcus (GBS) in pregnancy and newborn babies

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Shared Decision Making If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.

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Perineal massage in pregnancy | Pregnancy, Worries and discomforts articles & support | NCT

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Find out what perineal massage is and how it might work to help you avoid a tear or episiotomy when you give birth.

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An induced labour is one that's started artificially.

It's common for labour to be induced if your baby is overdue or there's any risk to you or your baby's health.

This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.

Induction will usually be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.

It's your choice whether to have your labour induced or not.

If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

Why you might be induced

if you're overdue

if your waters have broken

if you or your baby have a health problem

If you're overdue

Induction will be offered if you do not go into labour naturally by 41 weeks, as there will be a higher risk of stillbirth or problems for the baby.

If your waters break early

If your waters break more than 24 hours before labour starts, there's an increased risk of infection to you and your baby.

If your waters break after 34 weeks, you'll have the choice of induction or expectant management.

Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you.

Your midwife or doctor should discuss your options with you before you make a decision.

They should also let you know about the newborn (neonatal) special care hospital facilities in your area.

If your baby is born earlier than 37 weeks, they may be vulnerable to problems related to being premature.

If your waters break before 34 weeks, you'll only be offered induction if there are other factors that suggest it's the best thing for you and your baby.

If you have a health condition or your baby is not thriving

You may be offered an induction if you have a condition that means it'll be safer to have your baby sooner, such as diabetes, high blood pressure or intrahepatic cholestasis of pregnancy.

If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced.

Membrane sweep

Before inducing labour, you'll be offered a membrane sweep, also known as a cervical sweep, to bring on labour.

A membrane sweep would usually be offered to you after 39 weeks.

To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination.

This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour.

Some women find the procedure uncomfortable or painful. You may get some cramping and vaginal bleeding afterwards.

If labour does not start after a membrane sweep you may be offered an additional sweep or induction of labour.

Induction is always carried out in a hospital maternity unit. You'll be looked after by midwives and doctors will be available if you need their help.

How labour is induced

If you're being induced, you'll go into the hospital maternity unit.

There are 2 main ways labour can be induced:

Hormones can be put inside your vagina using a vaginal tablet (pessary) or a gel, or given as tablets that you swallow.

Devices such as balloon catheter (a small balloon, full of water) or an osmotic dilator (a type of sponge) can be used to widen your cervix.

You'll usually be offered hormones first to see if they work, unless there's a medical reason you cannot take hormones.

It usually takes many hours for these treatments to start working. You will usually stay in the hospital maternity unit, though you may be able to go home in some cases.

Sometimes a hormone drip is needed to speed up the labour. You may also need to have your waters broken artificially.

What induced labour feels like

If you need to be induced it may affect where you can give birth. You may need to stay in hospital for longer and have more examinations.

Induced labour is usually more painful than labour that starts on its own.

Your pain relief options during labour are not restricted by being induced.

You should have access to all the pain relief options usually available, such as an epidural or water birth.

If you are induced you'll be more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.

If induction of labour does not work

Induction is not always successful, and labour may not start.

Your obstetrician and midwife will assess your condition and your baby's wellbeing. You may be offered another method of induction or a caesarean section, or you may be able to wait a few hours and then be assessed again.

Your midwife and doctor will discuss all your options with you.

Natural ways to start labour

There are no proven ways of starting your labour yourself at home.

You may have heard that certain things can trigger labour, such hot baths, certain food or drinks, having sex or herbal supplements. But there's no evidence that these work. Also there's no information about the safety of herbal supplements and they could be harmful to you or your baby.

Having sex will not cause harm, but you should avoid having sex if your waters have broken as there's an increased risk of infection.

For more information on induction, you can read the NICE information for the public on induction of labour.

Community content from HealthUnlocked

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Find out about induction of labour, where the midwife or doctor starts labour artificially using a membrane sweep, pessary or hormone drip.

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https://www.nct.org.uk/pregnancy/your-pregnancy-week-week/third-trimester/overdue-baby-induced-labour-pros-and-cons

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https://www.nct.org.uk/labour-birth/getting-ready-for-birth/overdue-baby-what-happens-if-my-baby-late

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https://www.nct.org.uk/labour-birth/different-types-birth/caesarean-birth/having-caesarean-what-expect

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https://www.nct.org.uk/labour-birth/different-types-birth/caesarean-birth/what-caesarean-birt

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Info on pain relief

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Togel hongkong memberikan setiap nomor keluaran hk hari ini dan angka pengeluaran hk malam ini akan selalu dirangkum ke dalam bentuk tabel data hk hari ini terlengkap. Hal seperti ini akan mempermudah togel hari ini hongkong dalam menyaksikan hasil angka keluaran hk hari ini hingga nomor pengeluaran hk malam ini. Saat ini, anda hanya perlu mencari kata kunci togel, maka anda sudah akan mendapatkan situs togel hari ini hongkong resmi yang menyediakan semua keluaran hk ataupun pengeluaran hk yang disusun kedalam tabel data hk. Hongkong pools merupakan satu-satunya situs resmi dari togel hongkong malam ini, dimana semua hasil nomor data keluaran hk hari ini diumumkan. Hanya untuk mendapatkan no pengeluaran hk dari situs hongkong pools, sudah begitu sulit di Indonesia. Alasan itulah, disini kami membuat sebuah website dengan menyediakan semua hasil togel hongkong pools terakurat yang kami rangkum dalam data hk terakurat.

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Togel hari ini menyediakan hasil data keluaran togel singapore hongkong sidney di Indonesia. Bagi pemain togel yang menggunakan no togel hongkong, togel singapore dan togel sidney sebagai menentukan nomor jackpot togel hari ini. Maka dari itu, para pemain togel akan setiap harinya mencari hasil data hk dengan pengeluaran sgp hingga keluaran sdy hari ini tercepat. Hanya dengan menyaksikan nomor result togel hari ini, para bettor bisa dengan mudah mendapatkan no togel hari ini. Lantaran bermain togel di Indonesia, saat ini sedang menjadi salah satu permainan terpopuler. Akan tetapi, hanya terdapat sebanyak tiga pasaran togel online resmi yang banyak diminati oleh para pecinta judi togel online seperti togel hongkong, togel sidney dan togel singapore.

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Keluaran sdy menjadi nomor main togel sidney terakurat. Dimana setiap pemain bisa menyaksikan semua data pengeluaran sdy untuk referensi nomor main togel sidney hari ini. Jadi sudah tidak mengherankan lagi, kalau setiap jadwal keluaran sdy pemain selalu mencari situs togel online yang menyediakan hasil keluaran sdy. Oleh karena itu, secara tidak langsung anda bisa mengandalkan situs kami ini sebagai tempat untuk menyaksikan keluaran sdy dan pengeluaran sdy yang ada di data sdy sebagai nomor togel sidney resmi di Indonesia.

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Info togel yang tersedia disini menjadi informasi togel hari ini terpercaya untuk melihat no togel terlengkap di Indonesia. karena pada halaman ini menyediakan semua no pengeluaran sgp, data hk hingga keluaran sdy hari ini. Khusus pemain togel online yang selalu bermain ketiga pasaran togel hari ini. Kini anda sudah bisa menyaksikannya melalui tempat kami ini agar lebih mudah mendapatkan semua data pengeluaran sgp dan data hk hingga keluaran sdy hari ini. Hal ini dikarenakan live draw hk, live draw sgp dan live draw sdy masing-masing melakukan hasil result togel hari ini dengan waktu yang berbeda. Untuk member yang selalu mencari keluaran sdy, pengeluaran sgp dan data hk melalui masing-masing situs yang berbeda, hal seperti ini hanya akan membuang waktu anda saja. Jadi dengan hadirnya halaman kami ini, anda sudah bisa melihat semua no result togel hongkong dan togel singapore maupun togel sidney secara langsung hanya dengan satu situs yang menyediakan keluaran togel hari ini terlengkap.

Angka Keluaran Togel Hk, Togel Sgp Dan Togel Sdy Di Indonesia

Tahun ini semua member togel online sudah dapat menggunakan satu website untuk melihat angka keluaran togel hk, togel sgp dan togel sdy di Indonesia. Ketiga pasaran togel resmi tersebut menjadi tujuan utama dalam bermain judi togel online di Indonesia. Pada masa kini, kami sudah membuat sebuah situs yang hanya memberikan angka keluaran sdy dan pengeluaran sgp hingga data hk hari ini. Tentunya situs kami ini merupakan situs resmi yang memberikan hasil togel hongkong, togel singapore maupun togel sidney sebagai hasil info togel hari ini.

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Togel sgp banyak dikenal dengan sebutan togel singapore maupun toto sgp. Dimana togel sgp ini dimainkan oleh semua petaruh togel online di Indonesia. Buat bettor pastinya akan membutuhkan no pengeluaran sgp dan keluaran sgp hari ini. Jadi halaman kami ini pas banget untuk anda gunakan dalam mendapatkan data pengeluaran sgp dan data keluaran sgp hari ini di Indonesia. Secara pribadi disini kami sudah berhubungan langsung dengan pihak togel sgp pools. Jadi sudah jelas untuk semua angka keluaran sgp maupun pengeluaran sgp hari ini resmi berasal dari togel singapore pools.

Dapatkan Semua Keluaran SDY, Pengeluaran SGP Dan Data HK Hari Ini

Para pemain togel hari ini tentunya sangat membutuhkan situs yang bisa dipercaya yang memberikan data hk, pengeluaran sgp dan keluaran sdy hari ini di Indonesia. Karena kebanyakan orang Indonesia cuman ingin bermain togel online dari ketiga jenis pasaran togel resmi. Untuk itu, para pemain harus bisa menemukan secepat mungkin data hk dari togel hari ini, pengeluaran sgp dari togel singapore hari ini hingga keluaran sdy dari togel sidney hari ini. Oleh itu kami disini membuat situs dengan menyediakan langsung ketiga pasaran togel hari ini di Indonesia hanya untuk anda semua. Disini anda bisa langsung menemukan situs halaman kami ini di mesin pencarian google dengan cara mencari kata kunci togel pada smartphone anda masing-masing. Dengan begitu para pecinta judi togel online sejati bisa menggunakan pencarian google untuk menyaksikan hasil keluaran togel hari ini yang ada di Internet.

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Togel hongkong togel singapore togel sidney merupakan pasaran togel hari ini terpopuler yang memberikan hasil keluaran sdy pengeluaran sgp dan data hk hari ini.

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Many women find having a bath or shower very comfortable in pregnancy, and this feeling of relaxation in water can continue in labour. What's not to love about it - it's warm and you're buoyant so you can move more easily into any position that suits you. Being in the water also increases the chance of respectful midwifery care, and women say it improves their experience (Lewis et al, 2018).

But what about the potential for mess? When might you need to get out? And what will the midwife be doing? Here we answer your questions...

When should I get in the pool?

The great thing is that there's no should about it - you can feel free to get in and out as you wish. There's no evidence that the timing of when you get into the pool makes much difference. You might be a little wobbly on your feet so a birth partner should help you as you get into and out of the pool.

How can my birth partner help?

Here's your chance to get waited on. While in the pool, it's a good idea to have your partner offer you drinks frequently, to make sure you stay hydrated. Your partner can even join you in the pool if you like.

What will my midwife do?

The midwife's role in a water birth is the same as with a land birth. That is, they will monitor you and your baby during labour and birth.

You can decide if you are willing to get out of the pool at any point for internal checks. Try not to worry though, the midwife will have equipment to check all is well while you're in the water too. They'll have waterproof equipment to monitor the baby's heartbeat and a mirror to check the baby as they emerge. They'll also check both your temperature and the pool's hourly, to make sure you're comfortable (NICE, 2014).

Midwives are trained in how to use water for labour and birth, and each NHS trust will have its own guidance for use of their pools (RCM, 2012). This guidance will include measures to check the quality of the water reaching the pool, protocols for cleaning the pool and infection control procedures (RCM, 2012; NICE, 2014).

What temperature will the birthing pool be?

The midwife will keep an eye on the temperature, and will let you know if it's getting too hot (NICE, 2014). The water temperature should not be above 37.5°C (NICE, 2014).

What if I want to get out?

Sometimes women feel their labour has slowed and want to get out of the pool to walk around until it starts again. You can do that and return to the pool if you want. Whatever the case, you'll want warm dry clothes to make sure you don't get too cold.

You might want to get out to use the toilet, or get extra pain relief, or because you simply don't find it comfortable. Some women prefer to get out of the pool and birth the baby on dry land.

What's the longest time I can spend in the water?

Your time in the pool during labour should not be restricted. There is no evidence to say it's an advantage to limit how long you stay in the pool when you're labouring (RCM, 2012).

Will my midwife suggest I get out of the water?

Your midwife might ask you to get out of the water for a vaginal examination to assess progress. You can accept or decline.

If the midwife becomes concerned about you or your baby's wellbeing, she might suggest getting out of the water. This might include if you develop a high temperature, pulse, or blood pressure or are bleeding from the vagina. Concerns about the baby would include changes in the baby's heart rate or meconium (baby's poo) in the water.

What happens if my baby is born in water?

Don't worry, your baby won't drown. If your baby is born in the water, they are brought gently to the surface by the mother or midwife. The baby will not breathe until they meet the air, and they continue to get oxygen through the umbilical cord.

Initially, the baby's body is kept in the water, and against the mother's body, to stay warm. The baby might be very calm, and not cry loudly. You can offer your breast at this point if you like. For more on how your baby will start breastfeeding, see here.

Do I need to get out of the pool to birth my placenta?

You don't have to get out of the pool to birth the placenta (RCM, 2018). Sometimes women decide to get out, and sometimes they stay in. You can tell your midwife what you'd prefer in advance, and you can always change your mind.

Try to remember, this is a common way to birth (CQC, 2018). Midwives are well trained to help you give birth in water. So you're in good hands, and you can relax and let the water help you along.
This page was last reviewed in March 2019.
Further information

Our helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.

For further support and information, see the AIMs, MVP and Which? Birth-choice websites.

Make friends with other parents-to-be and new parents in your local area and see what NCT activities are happening nearby.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M. (2011) 'Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study'. BMJ.343:d7400. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22117057 [Accessed: 13th November 2018]

Cluett ER, Burns E, Cuthbert A. (2018) Immersion in water in labour and birth. (5):CD000111. Available from: https://www.cochrane.org/CD000111/PREG_immersion-water-labour-and-birth [Accessed: 13th November 2018]

CQC. (2018) 2017 Maternity survey: national tables for England. Available from: https://www.cqc.org.uk/publications/surveys/maternity-services-survey-2017 [Accessed: 13th November 2018]

Cumberledge J, Expert Maternity Group; Department of Health. (1993) Changing childbirth. Part 1, report of the expert maternity group, London, HMSO. [Accessed: 13th November 2018]

Dekker R. (2018) The evidence on: waterbirth. Available from: http://evidencebasedbirth.com/waterbirth/ [Accessed: 4th March 2019]

Garland D. (2000) Waterbirth: an Attitude to Care. 2nd edition. Oxford: Books for Midwives Press

Lewis L, Hauck YL, Crichton C, Barnes C, Poletti C, Overing H, Keyes L, Thomson B. (2018) 'The perceptions and experiences of women who achieved and did not achieve a waterbirth', BMC Pregnancy and Childbirth. 18(1):23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763519/ [Accessed: 13th November 2018]

NICE. (2014) CG190 Intrapartum care. Available from: https://www.nice.org.uk/guidance/cg190/chapter/recommendations#timing-of-regional-analgesia [Accessed: 13th November 2018]

Public Health England. (2014) Patient Safety Alert: Legionella and heated birthing pools filled in advance of labour in home settings. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/06/psa-legionella-birth-pool.pdf [Accessed: 4th March 2019]

Redshaw M, Henderson J. (2015) Safely delivered: a national survey of women's experience of maternity care 2014, Oxford, NPEU. Available from: https://www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf [Accessed: 13th November 2018]

RCM. (2012) Evidence based guidelines : Immersion in water for labour and birth. Available from: https://www.rcm.org.uk/sites/default/files/Immersion%20in%20Water%20%20for%20Labour%20and%20Birth_0.pdf [Accessed: 13th November 2018]

RCM. (2018) RCM Midwifery Blue top guidance No. 1, London, Royal College of Midwives.

Ulfsdottir H, Saltvedt S, Georgsson S (2018) 'Waterbirth in Sweden - a comparative study', Acta Obstet Gynecol Scand. 97(3):341-348. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29288489 [Accessed: 13th November 2018]

Winterton N. (1992) Maternity Services: Second report of the House of Commons Health Committee (The Winterton Report), London, HMSO.

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How to labour in water or have a water birth

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Many women find having a bath or shower very comfortable in pregnancy, and this feeling of relaxation in water can continue in labour. What's not to love about it - it's warm and you're buoyant so you can move more easily into any position that suits you.

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Togel hongkong memberikan setiap nomor keluaran hk hari ini dan angka pengeluaran hk malam ini akan selalu dirangkum ke dalam bentuk tabel data hk hari ini terlengkap. Hal seperti ini akan mempermudah togel hari ini hongkong dalam menyaksikan hasil angka keluaran hk hari ini hingga nomor pengeluaran hk malam ini. Saat ini, anda hanya perlu mencari kata kunci togel, maka anda sudah akan mendapatkan situs togel hari ini hongkong resmi yang menyediakan semua keluaran hk ataupun pengeluaran hk yang disusun kedalam tabel data hk. Hongkong pools merupakan satu-satunya situs resmi dari togel hongkong malam ini, dimana semua hasil nomor data keluaran hk hari ini diumumkan. Hanya untuk mendapatkan no pengeluaran hk dari situs hongkong pools, sudah begitu sulit di Indonesia. Alasan itulah, disini kami membuat sebuah website dengan menyediakan semua hasil togel hongkong pools terakurat yang kami rangkum dalam data hk terakurat.

Togel singapore merangkum semua nomor keluaran sgp hari ini dan pengeluaran sgp hari ini yang berasal dari situs resminya singapore pools sudah kami rangkum di data sgp terlengkap. Kini pemain togel singapore hari ini dapat melihat data keluaran sgp dan data pengeluaran sgp melalui halaman ini. Karena semua keluaran sgp hari ini maupun pengeluaran sgp hari ini melalui data sgp. Dengan sudah bekerja sama dengan situs togel singapore pools, maka data keluaran sgp maupun data pengeluaran sgp hari ini adalah no result sgp. Untuk itulah, para bettor dapat mempercayai halaman kami ini sebagai tempat untuk menyaksikan hasil keluaran sgp dan nomor pengeluaran sgp di Indonesia.

Togel sidney hari ini memiliki data keluaran sdy hari ini dan pengeluaran sdy hari ini secara resmi. Dengan menjadi satu-satunya tempat yang menyediakan nomor keluaran sdy hingga pengeluaran sdy hari ini langsung dari live draw sdy. Disini kami selalu tepat waktu dalam menyediakan keluaran sdy dan pengeluaran sdy pada jam result togel sidney. Dengan begitu anda sebagai pemain togel sidney dapat menggunakan situs kami ini sebagai tempat untuk menyaksikan hasil keluaran sdy ataupun pengeluaran sdy hari ini tercepat di Indonesia. Tidak sampai disini, bettor togel sdy di Indonesia dapat menggunakan tempat kami ini sebagai tempat acuan untuk menyaksikan keluaran sdy maupun pengeluaran sdy terakurat. Semua keluaran sdy dan no pengeluaran sdy sudah kami rangkum secara rapi dalam data sdy. Buat pemain togel sidney yang ingin menyaksikan keluaran sdy maupun pengeluaran sdy bisa secara langsung untuk mengunjungi situs kami ini ya, karena semua informasi togel hari ini sidney yang anda butuhkan semuanya sudah terkumpul di data sdy.

Togel hari ini menyediakan hasil data keluaran togel singapore hongkong sidney di Indonesia. Bagi pemain togel yang menggunakan no togel hongkong, togel singapore dan togel sidney sebagai menentukan nomor jackpot togel hari ini. Maka dari itu, para pemain togel akan setiap harinya mencari hasil data hk dengan pengeluaran sgp hingga keluaran sdy hari ini tercepat. Hanya dengan menyaksikan nomor result togel hari ini, para bettor bisa dengan mudah mendapatkan no togel hari ini. Lantaran bermain togel di Indonesia, saat ini sedang menjadi salah satu permainan terpopuler. Akan tetapi, hanya terdapat sebanyak tiga pasaran togel online resmi yang banyak diminati oleh para pecinta judi togel online seperti togel hongkong, togel sidney dan togel singapore.

Bermain togel hari ini pada pasaran togel singapore, togel hongkong hingga togel sidney memang menjadi pasaran terpopuler di tanah air. Sebab itu, kami membuat halaman ini untuk memberikan semua hasil keluaran togel hari ini paling akurat. Dengan nomor keluaran sdy hk sgp dan pengeluaran sgp hk sdy hingga data hk sgp sdy tepat waktu dari pasaran togel hongkong, togel sidney dan togel singapore hari ini.

Info Togel Pengeluaran SGP Melalui Data Hk Hingga Keluaran Sdy Hari Ini

Keluaran sdy menjadi nomor main togel sidney terakurat. Dimana setiap pemain bisa menyaksikan semua data pengeluaran sdy untuk referensi nomor main togel sidney hari ini. Jadi sudah tidak mengherankan lagi, kalau setiap jadwal keluaran sdy pemain selalu mencari situs togel online yang menyediakan hasil keluaran sdy. Oleh karena itu, secara tidak langsung anda bisa mengandalkan situs kami ini sebagai tempat untuk menyaksikan keluaran sdy dan pengeluaran sdy yang ada di data sdy sebagai nomor togel sidney resmi di Indonesia.

Pengeluaran sgp hari ini diumumkan oleh pihak togel singapore pools setiap jam 17.45 wib. Dengan tepat waktu anda bisa melihat data keluaran sgp hari ini. Karena disini kami memberikan layanan togel hari ini singapore pools terpercaya. Untuk itu semua data pengeluaran sgp dan keluaran sgp tentunya terpercaya sebagai no result togel singapore hari ini. Informasi togel kami adakan melalui data sgp dengan semua history angka keluaran sgp hari ini.

Data hk hari ini terlengkap sudah kami sediakan melalui tabel keluaran hk pools. Dengan cara seperti ini pemain togel hongkong bisa sesegera mungkin menggunakan hasil pengeluaran hk dan keluaran hk kami sebagai acuan untuk menyaksikan nomor keluaran hk hari malam ini. Disini kami langsung menyediakan togel hongkong pools melalui situs resminya. Dengan tersedianya data hk hari ini melalui keluaran hk malam ini, para pemain dapat memanfaatkan data hk menjadi angka hk jitu terakurat. Cuman melakukan pengumpulan semua data keluaran hk terlengkap untuk dipergunakan sebagai referensi terbaru. Jadi para bettor togel hongkong lebih dipermudahkan untuk mendapatkan hasil jackpot hongkong menggunakan data hk dari hasil pengeluaran hk malam ini.

Info togel yang tersedia disini menjadi informasi togel hari ini terpercaya untuk melihat no togel terlengkap di Indonesia. karena pada halaman ini menyediakan semua no pengeluaran sgp, data hk hingga keluaran sdy hari ini. Khusus pemain togel online yang selalu bermain ketiga pasaran togel hari ini. Kini anda sudah bisa menyaksikannya melalui tempat kami ini agar lebih mudah mendapatkan semua data pengeluaran sgp dan data hk hingga keluaran sdy hari ini. Hal ini dikarenakan live draw hk, live draw sgp dan live draw sdy masing-masing melakukan hasil result togel hari ini dengan waktu yang berbeda. Untuk member yang selalu mencari keluaran sdy, pengeluaran sgp dan data hk melalui masing-masing situs yang berbeda, hal seperti ini hanya akan membuang waktu anda saja. Jadi dengan hadirnya halaman kami ini, anda sudah bisa melihat semua no result togel hongkong dan togel singapore maupun togel sidney secara langsung hanya dengan satu situs yang menyediakan keluaran togel hari ini terlengkap.

Angka Keluaran Togel Hk, Togel Sgp Dan Togel Sdy Di Indonesia

Tahun ini semua member togel online sudah dapat menggunakan satu website untuk melihat angka keluaran togel hk, togel sgp dan togel sdy di Indonesia. Ketiga pasaran togel resmi tersebut menjadi tujuan utama dalam bermain judi togel online di Indonesia. Pada masa kini, kami sudah membuat sebuah situs yang hanya memberikan angka keluaran sdy dan pengeluaran sgp hingga data hk hari ini. Tentunya situs kami ini merupakan situs resmi yang memberikan hasil togel hongkong, togel singapore maupun togel sidney sebagai hasil info togel hari ini.

Togel hk banyak disebut sebagai togel hongkong, togel hkg ataupun toto hk. Togel hk menyediakan keluaran hk maupun pengeluaran hk sebagai nomor result togel hongkong asli. Para pemain bisa dapat melihat semua keluaran hk hari ini melalui tabel data hk yang sudah kami sediakan diatas. Semua barisan keluaran hk hingga pengeluaran hk kami tayangkan secara langsung pada setiap hari ini. Jadi bagi anda yang merupakan pemain sejati dari togel hongkong dapat mempergunakan tabel keluaran hk hari ini sebagai referensi untuk menyaksikan pengeluaran hk terbaru.

Togel sdy dikenal sebagai togel sidney hingga toto sdy. Togel sdy hari ini menyediakan siaran live draw sdy pada situs resmi sydney pools dan disini kami mengupdate semua hasil keluaran sdy hingga pengeluaran sdy pada tabel data sdy. Jadi buat hasil keluaran sdy dan pengeluaran sdy hari ini semuanya melalui result togel sdy terakurat. Hanya melalui nomor togel hari ini sidney para pemain bisa mendapatkan data keluaran sdy hari ini dari togel sdy pools. Sebab itu, kepada anda semua yang ada diluar sana, yang masih belum menyaksikan nomor result pengeluaran sdy bisa mengunjungi situs kami ini.

Togel sgp banyak dikenal dengan sebutan togel singapore maupun toto sgp. Dimana togel sgp ini dimainkan oleh semua petaruh togel online di Indonesia. Buat bettor pastinya akan membutuhkan no pengeluaran sgp dan keluaran sgp hari ini. Jadi halaman kami ini pas banget untuk anda gunakan dalam mendapatkan data pengeluaran sgp dan data keluaran sgp hari ini di Indonesia. Secara pribadi disini kami sudah berhubungan langsung dengan pihak togel sgp pools. Jadi sudah jelas untuk semua angka keluaran sgp maupun pengeluaran sgp hari ini resmi berasal dari togel singapore pools.

Dapatkan Semua Keluaran SDY, Pengeluaran SGP Dan Data HK Hari Ini

Para pemain togel hari ini tentunya sangat membutuhkan situs yang bisa dipercaya yang memberikan data hk, pengeluaran sgp dan keluaran sdy hari ini di Indonesia. Karena kebanyakan orang Indonesia cuman ingin bermain togel online dari ketiga jenis pasaran togel resmi. Untuk itu, para pemain harus bisa menemukan secepat mungkin data hk dari togel hari ini, pengeluaran sgp dari togel singapore hari ini hingga keluaran sdy dari togel sidney hari ini. Oleh itu kami disini membuat situs dengan menyediakan langsung ketiga pasaran togel hari ini di Indonesia hanya untuk anda semua. Disini anda bisa langsung menemukan situs halaman kami ini di mesin pencarian google dengan cara mencari kata kunci togel pada smartphone anda masing-masing. Dengan begitu para pecinta judi togel online sejati bisa menggunakan pencarian google untuk menyaksikan hasil keluaran togel hari ini yang ada di Internet.

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Togel Hongkong - Togel Singapore - Togel Sidney - Keluaran SDY - Pengeluaran SGP - Data HK Hari Ini

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Togel hongkong togel singapore togel sidney merupakan pasaran togel hari ini terpopuler yang memberikan hasil keluaran sdy pengeluaran sgp dan data hk hari ini.