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https://youtu.be/2-BA5tQCJP8

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Straightforward labour - a step-by-step guide to what’s happening and what mum and birth partner can do at each stage

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Straightforward labour - a step-by-step guide to what’s happening and what mum and birth partner can do at each stage

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Current guidelines on what to expect from your care during birth

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Current guidelines on what to expect from your care during birth

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Recognising you are in labour and what happens next

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Recognising you are in labour and what happens next

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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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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.

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Acupressure for birth

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Debra Betts - Acupuncture and Acupressure for Pregnancy and Childbirth

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Wecome to this webpage about the use of acupuncutre and acupressure in pregnancy and for postnatal recovery Acupressure is a safe evidenced based therapy you can use to prepare for Labour. Acupressure Resources The Acupressure resources on this webpage have been updated. You will now find videos to assist you locate each point and illustrated handouts.

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How to keep birth and the first weeks straightforward -hormones that help and hinder

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How to keep birth and the first weeks straightforward -hormones that help and hinder

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The parasympathetic

calm and connection  system

Associated with states of trust,

curiosity, growth , healing.

Increases pain threshold and

makes us more courageous

OXYTOCIN (the love hormone)

is released when the

parasympathetic system is

dominant

Oxytocin is released when

privacy, trust, warmth, low light

and a feeling of safety prevail

Effects of Oxytocin on labour

 Starts and maintains

strong contractions

 Helps women cope with

labour

 Helps with endorphin

release= pain relief,

bonding and feel good

hormone

Effects of oxytocin post birth

 Enhances bonding

 Enhances milk production

 Enhances healing

The sympathetic

Survival  system

Associated with states of

alertness, reactivity, stress.

Increases ability to act fast in

the face of danger and is very

helpful in short bursts

ADRENALINE (fight or flight

hormone) is released when the

sympathetic system is

dominant

Adrenaline is released when we

feel unsafe, exposed, cold,

judged, and unsure of our

surroundings

Effects of adrenaline on labour

 Can slow contractions by

inhibiting oxytocin

receptors

 Increases pain through

tension and constriction

of blood vessels

 Can make women fight

their labour rather than

going with

Effects of Adrenaline post birth

 Inhibits bonding and

receptivity

 Inhibits milk production
Parents can’t switch off and relax