During labour:

Your cervix (neck of the womb) dilates (opens) so that your baby can pass through. When it has dilated to about 4 cm, you are said to be in established or active labour – your contractions will come more often and get stronger. 

If you are having your first baby, the first stage of labour usually lasts about 8 to18 hours. If you have had a baby before, the first stage of established labour usually lasts about 5 -12 hours. 

Your midwife will offer vaginal examinations during labour. These are done to check how far your cervix (neck of the womb) has opened (dilated) and the position of your baby's head. Your midwife will always explain why an examination is being advised and what it will involve. It should only be carried out with your agreement. 

You may be offered a vaginal examination during the early checks, especially if the midwife thinks you are in established labour. But this is not always necessary, and your own wishes should be taken into account. 

Your midwife should explain to you and your birth companion(s) what the examinations show. 

Once your cervix is fully dilated, your baby's head will start moving down through your vagina. This is called the second stage of labour. Even when your cervix is fully dilated, you may not have an urge to push with your contractions straight away – this is called the passive second stage. 

The active second stage:

This is when you have an urge to push with most contractions and ends when your baby is born. The birth is expected to take place within three hours of the start of active pushing in most women having their first baby, and within two hours for most women who have had a baby before. 

Your midwife will help, encourage and talk to you, and monitor both you and your baby closely. You will be guided by your own urge to push. Your midwife will encourage you not to lie on your back but instead to find another position that is comfortable. If pushing doesn't seem to be working well or you are feeling tired, you may be advised to change position, and to empty your bladder if needed. 

When your baby is born:

You may choose to hold them straight away after the birth. We will encourage you to have skin-to-skin contact with your baby, and they will be covered with a towel or blanket for warmth. Your baby's cord will not be clamped or cut straight away. We will support you to feed your baby, you can do so as soon as you wish, and you will be encouraged to start within one hour of the birth. You shouldn't be separated from your baby, unless it is essential for us to provide urgent care. 

When you are pregnant, a midwife will explain to you about the two options for the third stage (the delivery of your placenta after the baby is born), and about the advantages and disadvantages of each. They are called active management and physiological management: 

Active management:

• An injection of a drug called syntometrine or oxytocin is given into your thigh, usually immediately after you give birth.
• The cord is clamped and cut between one and five minutes after the birth.
• The placenta is gently pulled out by the midwife once it has separated from the wall of the uterus (womb) – usually within 30 minutes.
• Lowers the risk of heavy bleeding (haemorrhage.)
• Increases the chance you may feel sick or vomit. 

Physiological management:

• No injection is given. 
• The cord is clamped and cut once it has stopped pulsating. 
• You will push your placenta out with contractions – this can take up to one hour. 

Your midwife will discuss these options with you again in the early stage of labour. You may be advised to have active management of the third stage if you are at a higher risk of bleeding but will be asked about your preferences. If you have a low risk of heavy blood loss, you may choose to have physiological management. 

However you chose to deliver your placenta we will recommend that you have delayed cord clamping. This means that we will not clamp and cut your baby’s cord to separate them from you until there is no more blood flowing and the cord has stopped pulsating. This ensures that your baby receives as much oxygen in the blood as possible and helps to support them with the adaptation to the life outside the womb.