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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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Coping with early labour and when to call the midwife

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Coping with early labour and when to call the 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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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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What to expect when your waters go, mothers talk about their experiences, midwife Virginia Howes gives advice

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Midwives Demonstrating Relaxation Techniques For Labor

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Midwife Virginia Howes and mothers talk about the noises made in labour

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Hormones in labour EBook Dr Sarah Buckley 2014