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Share your experience of using maternity services in Leeds
We are always looking at ways to improve maternity services in Leeds. Below are just some of the ways you can feedback to us about your experiences or the experiences of someone you know who has used maternity services.
In order to obtain as much feedback at possible we aim to use a multitude of different methods, including questionnaires, surveys, formal consultations and engagement events.
Take a look below for some of our most recent feedback, or to have your say.
We recently carried out a survey on experiences of maternity services in Leeds during the coronavirus pandemic. Over 200 people responded to this survey.
Find out what you told us hereA recent consultation took place in Leedsto find out people’s views about plans to centralise maternity and neonatal services at LGI and the proposals for hospital antenatal appointments.
Find out more about this consultation hereWe are always wanting feedback about maternity services in Leeds and would love to hear about your experiences of using services in the city. Your feedback helps us to make improvements where needed so that all families can have the best start possible.
If you would like to share with us your experiences, please take the time to fill in this short survey. We really appreciate your feedback.
Take the surveyWe are very sorry for your loss, and we appreciate that this is an extremely difficult time for you.
This questionnaire is for parents who have experienced the loss of their baby/babies during pregnancy or shortly after birth. Please complete as much or as little of the form that you are able to. Some questions may not be relevant to your experience. Your feedback will help us to improve bereavement services in maternity across Leeds.
Take the surveyHome births are as safe as hospital births for low risk mothers, particularly if it is your second or subsequent baby and you are more likely to have a vaginal birth without interventions. You can, however, change your mind to a hospital birth at any time during pregnancy or labour.
If you are considering a home birth, or would like more information, discuss this with your midwife.
What is a homebirth?
A homebirth is where you give birth to your baby in your own place of residence (home). It can be planned or unplanned.
Many women like the idea of birthing their baby at home, surrounded by their family and in a familiar environment.
You can still receive various forms of pain relief at home. Your midwife will bring Entonox (gas and air) on arrival and your midwife can also order you dihydrocodeine tablets in advance, for you to collect from your GP. There are also many forms of pain relief that you can provide yourself, which can be found under the section about things to think about when planning a homebirth. These have been highlighted by an asterisk (*).
What happens at a homebirth?
Once you feel like you are in established labour, call your midwife. She/he will talk to you over the phone and ask you a few questions. Your midwife will then decide if she/he needs to come out and see you. Once your midwife arrives, they will monitor you and your baby’s wellbeing and they might want to also examine you (if you consent) and see how dilated your cervix is. This can indicate how advanced your labour is. If you are still in early stages of labour and not yet in active labour, they might go away and come back later.
When you are in the second stage of labour and your baby is nearly ready to be born, a second midwife will arrive. This is so that one midwife can look after you and one midwife can look after your baby.
Once your baby has been born and your placenta is safely delivered, your midwife will check to see if there are any tears that need stitching. Most stitches can be stitched up at home by your midwife. However, if you have some severe tearing, your placenta has not come away properly or if there are any complications with you or your baby, you may need to be transferred to hospital.
Hopefully, all goes well with the birth and you and your baby can remain at home. Your midwife will weigh, check over your baby and observe your baby’s first feed. Once your midwife is happy that you are both comfortable and well, she/he will leave you and your new family to get to know each other.
Within 3 days of birth, a community midwife will visit you at home and carry out a thorough check ups of both you and your baby. She/he will then advise when you will be referred onto the health visiting team.
These are a few items to think about when planning a homebirth
To read about some Leeds homebirth stories, click on the links below:
It is your choice where you have your baby. If you are considered high risk or have any medical conditions, you may be advised to have your baby in hospital. In Leeds there are two hopsitals where you can choose to have your baby – Leeds General Infirmary (LGI) or St James’ University Hospital (SJUH). Leeds are also incredibly lucky to have The Lotus Midwifery Led Unit (LMU) at LGI. Depending on your medical history, you can opt to birth your baby at the maternity unit at either LGI or SJUH, or at the LMU. Ask your doctor or midwife about any of these options.
What is a hospital birth in a maternity unit?
A maternity unit birth in a hospital, means that you will be looked after by midwives, but doctors will also be available, if they are needed. If you experience any complications during labour, obstetricians will be able to care for you too. This includes intervention care such as forceps, ventouse, episiotomy or caesarean section. Once your baby is born, if they are born with any complications, they can be easily transferred to the neonatal team or special care baby unit, to receive any care that they require.
A maternity unit can offer you various pain relief options, such as anaesthetics (epidural, general anaesthetics), water birth, gas and air, and pethidine. Midwives will be able to monitor you and your baby if they need to and they will be able to access various kinds of equipment, to assist with complicated births.
After the birth of your baby, midwives and maternity care assistants will be able to help you care for yourself and your baby. Leeds hospitals support and encourage breastfeeding and are available to offer you any help and support that you require.
What is the Lotus Midwifery Led Unit? (LMU)
The LMU is a birthing centre for pregnant women who are “low risk” and want to give birth in a home from home environment. They can also be easily transferred to maternity care if they need to have epidurals, obstetric care, interventions or neonatal care.
The Lotus Midwifery Led Unit at Leeds General Infirmary is situated at the end of the delivery suite on L44. It is a separate area to the delivery suite and inside the Lotus suite you will find 3 birthing room. 1 is a delivery room and 2 are water birth rooms. The LMU has calming colours, low lighting and various types of active birth equipment. There is plenty of space to move around when in active labour and you will be looked after and supported by just your named midwife, instead of various clinicians.
The room will be mainly free of any medical reminders, but you will find a free-standing K2 electronic screen notes system and Entonox (gas and air).
What happens at a hospital birth?
You will most likely be cared for by various midwives on shift, as your labour progresses. These midwives will be different to the community midwife who cared for you during your pregnancy. When you arrive at hospital, you will be seen by a midwife in the maternity assessment centre (MAC) or in the antenatal day unit (ANDU). The midwife will determine how advanced your labour is and you will then be either sent to the labour ward or delivery suite, where you will then be greeted and cared for by another midwife. Once your baby is born, you may then be moved to the postnatal ward, where another team of midwives will care for you and your baby. In certain areas of Leeds, we are privileged to have a great team of midwives who are part of the continuity of carer program. If you live in an area of Leeds, where this continuity pathway is taking place, you will see the same team of midwives who will care for you antenatally, in labour and after birth. Your midwife will be able to advise you on whether you will be able to be cared for under the continuity pathway.
Birthing your baby in a Leeds hospital
Useful information if you decide to deliver your baby in a Leeds hospital:
During labour and birth, there are various pain relief options available. The options available can all vary, depending on where you are planning to give birth. Each comes with their own advantages and disadvantages. The list below will hopefully help you to make your own informed decision about pain relief options during childbirth.
Entonox (Gas and Air)
This is a mixture of oxygen and nitrous oxide gas. You breathe in the gas and air through a mask or mouthpiece, just as a contraction starts.
| Advantages | Disadvantages |
| No harmful side effects for mother or baby | Can make you feel lightheaded |
| It is quick to work and only takes 15-20 seconds to take effect, by taking slow deep breathes as the contractions start. | Can make you feel sick, sleepy or find it hard to concentrate |
| The mother is in control, using it by themselves and can stop and start whenever they want. | It only reduces the pain and does not fully take the pain away. Some women find that they need additional pain relief |
| Once you stop breathing in the gas and air, it leaves the body quickly. If you experience any negative side effects, this can quickly be resolved. | The effects are short lived |
| An increase in oxygen from the mother can benefit the baby | Can cause a dry mouth |
| Best to use Entonox when labour is fully established (when the cervix is 4cm dilated) and is not highly effective if used over a long period of time |
Epidural
An epidural is a local anaesthetic and painkiller that is inserted into the back, using a fine tube. Spinal blocks are similar to epidurals and they are given in the same way, but they offer immediate pain relief. These are often used for emergency caesareans or complicated births.
| Advantages | Disadvantages |
| Particularly good at removing pain, by numbing the nerves. Only 1 in 10 women will need additional pain relief | Takes about 10 minutes to administer and a further 10-15 minutes to work. Does not always perfectly work first time. |
| Only numbed from the waist down, so you are awake during labour | Might not be suitable if you have pre-existing conditions, blood clotting issues, high blood pressure or a high BMI. |
| Does not usually make you feel drowsy or sick | Can cause difficulties when passing urine after the epidural has worn off |
| Little or no effect on the baby | Can cause a bad headache that can last for several days or weeks, if not treated |
| Useful during long, tiring and particularly painful labours | Can cause a high temperature and maybe a sign of infection |
| Mobile epidurals or a lower-dose epidurals (only available in some hospitals), mean that you will still be able to have some sensation during birth and can move around, but this also means that you will still have some discomfort.
|
Unable to keep active during labour and will be assigned to the bed and monitored. Will need a catheter to drain the bladder and a drip to keep hydrated. |
| Severe complications (very rare) | |
| Itchiness and depressed breathing | |
| An increased risk of an assisted birth | |
| Can slow labour down and might increase the need for synthetic oxytocin (drip) to make the contractions stronger | |
| Higher chance of needing a caesarean | |
| Can affect breastfeeding straight after birth if interventions or an assisted delivery is required. | |
| Can cause temporary nerve damage (low chance) | |
| Not suitable to be administered in very early labour or very late labour | |
| Only suitable to be used in hospital | |
| Sometimes a clip needs to be inserted into the vagina and attached to the baby’s head for extra monitoring. | |
| Might make your legs feel heavy | |
| Can cause blood pressure to drop, but this is rare | |
| Can cause an area of soreness in the back, at the sight of the injection. This lasts about 1-2 days. Does not usually cause long-term backache. |
General Anaesthetic
A general anaesthetic means that you will need to go to theatre and you will be asleep when your baby is born. General anaesthetic is usually only used for caesarean sections, when an epidural or spinal block is not suitable or it is an emergency.
| Advantages | Disadvantages |
| A quick acting pain relief and can be given in an emergency | Your birth partner will not be able to be with you in theatre |
| An alternative anaesthetic to an epidural or spinal block (regional anaesthetic) | You may feel sore or sick afterwards |
| Be drowsy for a while | |
| Will miss the birth of your baby | |
| You will need strong pain killers as soon as you wake up | |
| Baby can be quite sleepy afterwards |
Pethidine or Diamorphine
This is an injection of medicine, that is inserted into the thigh or buttock to relieve pain.
| Advantages | Disadvantages |
| Helps you to relax | It can take 20 minutes to work |
| The effects only last 2-4 hours | |
| Not recommended when the mother is close to the second stage of labour (ready to push) | |
| Can make you feel sick, dizzy or forgetful | |
| If given too late in labour and near to the time of delivery, it can effect the baby’s breathing. | |
| It can interfere with the baby’s first feed |
Paracetamol
Paracetamol can be useful in early labour.
| Advantages | Disadvantages |
| Can reduce pain in early labour | |
| No negative effects on mother or baby |
Water (Pool or bath)
Water births are a good natural form of pain relief. The water is kept at a comfortable temperature, not ever getting above 37.5 degrees and the mother’s body temperature is also monitored hourly.
| Advantages | Disadvantages |
| Helps the mother to relax, feel secure and make the contractions seem less painful | If the mother develops a high temperature, pulse, blood pressure or vaginal bleeding, you will be advised to get out of the water. This also applies if the baby’s heart rate changes or meconium (baby poo) is found in the water |
| You can move easily, into a comfortable position and takes pressure off your back and pelvis | You can not use epidurals, pethidine or TENS machine in water |
| You are in control and can get in and out of the water whenever you want | |
| Many women describe a water birth as a positive birth experience | |
| Less need for other pain relief options, as the pain threshold increases in water and water is likely to shorten the first stage of labour. If additional pain relief is required, Entonox can be used in water | |
| Your birth partner can give you a relaxing massage | |
| Baby’s are often born more relaxed and less traumatised when born in water, as the water can feel comforting and reminds them of the womb. | |
| Evidence to suggest a reduced risk of tearing |
Hot water Bottle/ Wheat bag
Hot water bottles or wheat bags are a great natural pain relief for women, when in labour. Hot water bottles should not be too hot, so do not fill them with boiling water and make sure that they are wrapped in a soft cloth or towel before using it.
| Advantages | Disadvantages |
| Warmth is a great way to relaxing aching, tense muscles. | Not as effective in later stages of labour, when the contractions become stronger |
| Natural pain relief, with no side effects for mother or baby | Will need to be regularly refilled when the water goes cold |
Hypnobirthing/ Breathing Techniques
Hypnobirthing helps women get to a state of deep relaxation during labour, using positive visualisation, relaxation techniques and self-hypnosis.
| Advantages | Disadvantages |
| A natural form of pain relief, with no negative side effects to the mother or baby | Works best if the techniques are practiced in advance of labour |
| Helps eliminate the fear of pain during childbirth | Some mothers find it confusing or difficult to use structured breathing techniques |
| Less likely to need other forms of pain relief | |
| Have a shorter labour and less likely to need interventions | |
| Rhythmic breathing helps conserve your energy, feel calmer and ease any pain | |
| Feel more in control, focused and can help mothers manage the pain better | |
| Remain conscious and attentive throughout the birthing process and have a positive birth experience | |
| Increases the release of endorphins and takes away the fear, tension, pain cycle | |
| Increased oxygen for the baby, reducing any foetal distress | |
| Can be used alongside any other forms of pain relief, including during epidurals or caesareans. |
Massage
Massage is a great way to help keep you calm and cope with any labour pains. Your birth partner could massage the base of your lower back between contractions or your shoulders. Some women find a foot massage or hand massage to be relaxing and calming too.
| Advantages | Disadvantages |
| A slow massage, with firm pressure will help stimulate your body to release endorphins and relax | Can make some women uncomfortable and not want to be touched when in labour. It can distract them from being able to focus |
| Touch and massage are soothing, it promotes circulation and relaxation | Birth partner might not apply the right pressure or have the correct technique to ease the pain |
| Can be used in conjunction with pregnancy approved essential oils | Not as easy to do if the mother is in water or using a TENS machine |
| Immediate effect |
TENS Machine (Transcutaneous Electrical Nerve Stimulation)
A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce natural painkillers, called endorphins.
| Advantages | Disadvantages |
| Can be a good distraction from the pain and provides the woman with control, reducing anxiety | Some women might find the machine irritating or dislike the sensation |
| Can be used by anyone, regardless of any other medical conditions | Benefits are mainly seen in early labour and not as useful in later stages of labour (active labour) |
| No side effects for mother or baby | Will need support from birth partner to apply the sticky pads and to have read the instruction manual in advance of labour, to know where to apply the pads and how to use the machine |
| Does not increase the length of labour or increase any risk of intervention | Not possible to receive a back massage whilst the TENS machine is in place on the back
|
| Can be stopped at any time if the woman does not like the sensation or would like to try another form of pain relief | Cannot be used in water |
| Can be used alongside Entonox, pethidine, or diamorphine | Need to be bought (can be expensive) or hired. Some hospitals can provide them, but only if there are some available |
| Allows the woman to remain active and move around | It can take some time before the effects are felt. Around 20 minutes before endorphins kick in |
| Particularly useful for back pain in early labour |
Active Birth Positions
Keeping active and upright during labour can help labour progress. During the first stage of labour, being active can help by using gravity to encourage your baby into the birth canal. Birthing balls, chairs, walls, mats, partners, and pillows are all useful tools to help progress labour. During the second stage of labour, remaining upright can also advance labour, by helping your pelvis to open and use gravity to encourage the baby out. Squatting and kneeling are good positions during the second stage.
| Advantages | Disadvantages |
| Rocking, swaying, walking and leaning forwards helps advance labour, by using gravity to move the baby into the birth canal. The pressure of the baby’s head on the cervix will promote the release of oxytocin and endorphins | Can be tiring. Try not to overdo it. Try save your energy for when you are in active labour. Try taking a break, laying on your side for a while, using pillows to support you |
| A natural pain relief, with no side effects for mother or baby | Might not be enough to reduce the pain |
| Less likely to need an epidural or caesarean | Space might be limited |
| Mother remains in control | |
| By staying off her back, this increases the amount of oxygen the baby receives, reducing the possibility of foetal distress |
Hormones Involved During Childbirth
There are four main hormones that are responsible for the process of childbirth. Oxytocin, adrenaline, endorphins and prolactin. Other hormones involved are oestrogen, progesterone, prostaglandin and relaxin.
Oxytocin
Oxytocin is the hormone of love and it is involved with lovemaking, fertility, contractions, birth and the release of milk in breastfeeding. It helps us feel good and it triggers nurturing feelings and behaviours. Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labour. Oxytocin stimulates powerful contractions that help to thin and dilate the cervix, move the baby down and out of the birth canal, push out the placenta and limit bleeding at the site of the placenta. During labour and birth, the pressure of the baby against your cervix, stimulates oxytocin and contractions. Breastfeeding a newborn also releases oxytocin. During labour and birth, oxytocin levels can drop, causing contractions to stop or slow down, making labour take longer. To help increase oxytocin levels, it is important to have privacy, stay calm, comfortable, confident and free of any emotional or psychological anxieties. Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures. Staying upright and using gravity, so that your baby is pressed against your cervix and then, as the baby is born, against the tissues of your pelvic floor. Avoiding epidurals, stimulating your nipples or sexual activity before birth and letting your baby suckle (breastfeed) shortly after birth, can all help keep oxytocin levels high. Another way of helping oxytocin to flow freely, is by finding a quiet, dark room where you will not be disturbed. You and your baby need to feel safe when you are in labour and it is your body’s natural way of protecting you and your baby. When you feel safe, calm, not being watched and not under threat, oxytocin will increase and labour will progress well.
Adrenaline
Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labour (for example, by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labour or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety. Too much adrenaline can cause distress to the baby before birth, cause contractions to stop, slow or have an erratic pattern and lengthen labour. Adrenaline can increase when the mother panics or experiences increased pain. Adrenaline often increases in women, when they receive interventions from health care professionals or if they need to go into theatre for a caesarean. If adrenaline increases, oxytocin can not flow freely and the body thinks that it is under attack and therefore provides the body with extra blood flow to the legs, arms and heart, getting it ready to fight or flight and run away from danger. Adrenaline reduces the blood flow to the uterus and the digestive system, sending more blood to the life-saving parts of the body when under threat. Once adrenaline is released, in the body, the reduced blood flow to the uterus leads to less oxygen being pumped into the uterus, making the labour process more difficult, more painful and last longer. Therefore, it is important to stay calm, comfortable and relaxed when in labour. Be informed and prepared. Have trust and confidence in your body and your capabilities as a woman. Have trust and confidence in your care providers and birth setting. Be in a calm, peaceful and private environment and avoid conflict. Be with people who can provide comfort measures, good information, positive words and other support. Avoiding intrusive, painful, disruptive procedures is also important.
Endorphins
When you face stress or pain, your body produces calming and pain-relieving hormones called endorphins. You may have higher levels of endorphins near the end of pregnancy. For women who do not use pain medication during labour, the level of endorphins continues to rise steadily and steeply through the birth of the baby. (Most studies have found a sharp drop in endorphin levels with use of epidurals.) High endorphin levels during labour and birth can produce an altered state of consciousness that can help you deal with the process of giving birth, even if it is long and challenging. High endorphin levels can make you feel alert, attentive and even euphoric (very happy) after birth, as you begin to get to know and care for your baby. In the early postpartum period, endorphins are believed to play a role in strengthening the mother-infant relationship. A drop in endorphin levels at this time may contribute to the “blues,” or postpartum depression, that many women experience for a brief time after birth. Low levels of endorphins can cause problems in labour and birth by causing labour to be excessively painful and difficult to tolerate. This leads health care providers to often respond to this problem with interventions, creating even lower levels of endorphins and oxytocin and increasing adrenaline levels. You can enhance your body’s production of endorphins during labour and birth by staying calm, comfortable and confident, avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures and by delaying or avoiding the use of epidurals.
Prolactin
Prolactin is known as the mothering hormone. It increases during pregnancy and peaks when labour starts on its own. Prolactin production during and after labour appears to be readying a woman’s body for breastfeeding. It may also play a role in moving labour along and helping the newborn adjust to life outside the womb. Prolactin is central to breast milk production. High levels of prolactin with early breastfeeding may foster women’s caretaking behaviours and adjustment to being a mother. This hormone may also support the infant’s healthy development. You can promote your body’s production of prolactin by waiting for labour to start on its own, minimising stress during labour and after birth, staying with your baby after birth and start breastfeeding early and thereafter on cue from the baby.
What triggers labour?
During pregnancy progesterone hormones are high and prevents the uterus from contracting. Towards the end of pregnancy however, oestrogen levels start to rise until they are relative to the level of progesterone. At the same time, the baby is producing increased levels of oxytocin and it is thought that the increased level of oestrogen from the maternal brain, is the cause of this oxytocin increase. By the end of pregnancy, prostaglandin also increases. Prostaglandin is the hormone that softens the cervix and it also softens the pelvic ligaments, along with relaxin, enabling the pelvis to open more effectively during labour.
As the baby descends into the pelvis towards the end of pregnancy (lightening), the presenting part of the baby starts to apply pressure to the internal part of the cervix. This pressure when applied evenly, results in a reflex reaction that triggers the maternal brain to release increased levels of oxytocin. This in term stimulates contractions. As the contractions move down over the uterus, the pressure from them causes the baby’s head to become more flexed. As this happens, it allows the baby’s head to move even lower and apply greater pressure on the cervix, increasing the amount of oxytocin released.
Waters Breaking (Rupture of Membranes)
Sometimes at the beginning of labour, the bag of water surrounding the baby breaks (rupture of membranes). However, the most common time for this to happen is when the cervix is 7-10 cm dilated. If the membranes break in early labour, this is a hind water leak (waters coming from the top of the uterus, where the baby’s bottom is. Provided that baby is in a head down position). Sometimes it is hard to tell if a woman is leaking amniotic fluid or if they have passed a small amount of urine. The best way to tell is by the smell. Amniotic fluid does not smell, like urine does. Apply a pad and see if the trickle continues. If it does, then it is possible that the waters could be leaking. The waters should be clear or straw coloured. If they are red, brown, green or foul smelling, you should contact your doctor or midwife. If the waters have broken early, the biggest risk is infection. It is best to avoid any internal vaginal examinations and keeping out of environments that the maternal immune system is unfamiliar with to avoid any risks of infection if the waters have broken early.
If the waters break before labour begins it is called premature rupture of membranes. If waters break before 37 weeks of pregnancy, it is called preterm premature rupture of membranes. The membranes may break prematurely on their own for no obvious reason, or certain conditions can increase the risk of this happening. For example, vaginal examinations during pregnancy, excessive amniotic fluid, amniocentesis, smoking in pregnancy and uterine infection.
Mucus Plug
The cervix contains a small plug of mucus, which protects the baby and womb from infection. Sometimes when labour begins and the cervix softens and starts to dilate, the mucous plug comes away. The loss of the plug, called a show, does not indicate that labour has started, but it does indicate that the body is starting to get ready for labour. The plug could be clear, cloudy, yellow, brown, pink or red and looks like a thick lump of discharge or looks like snotty mucus. If you experience any heavy bleeding, you should contact your doctor or midwife.
Contractions or surges
For some women, the first sign of labour is the start of contractions. You may have been experiences Braxton Hicks or practice contractions for several days or weeks. These might feel uncomfortable, but they will not have any pattern and will be irregular. They will not change if you move around but may stop or slow down if you rest.
Labour contractions however have a regular pattern and will mostly start off gently, rise to a peak at the height of the contractions and then ease off again. When labour first starts, the contractions last for around 30-45 seconds. By the end of the first stage of labour, the contractions will last for around 90 seconds. The baby will not be born until contractions are lasting for around 90 seconds. You may not notice the first contractions or you may notice that they are very strong and frequent from early on. There is no set space in between contractions. Sometimes contractions can start off every 20-30 minutes and then build up so that they are coming every 2 minutes. For some women though, they are every 3-4 minutes from the beginning to the end of labour. Initially you will be able to talk through contractions, but as they progress you may need to concentrate on each one and take deep breaths to help you get through it.
When you experience a contraction, the muscle fibres at the top of the uterus shorten and draw up the cervix. Labour is divided into 3 stages.
Stage 1: From the first onset of labour until the cervix has fully opened to 10cm.
Stage 2: The expulsion of the baby through to complete delivery (the pushing stage).
Stage 3: The expulsion of the placenta.
The first stage of labour is often broken down into several separate phases. Early first stage (or latent stage), active first stage and transition.
Early First Stage
| Dilation | Length of Contractions | Time between contractions | Other signs | What the body is doing |
| 0-6 cm | 30-45 seconds | 3-20 minutes | Talking during or between contractions. Still very together, possible backache, maybe a show, maybe some leaking fluid | The cervix begins to soften and prepare for labour. It will begin to thin and dilate. This can occur over several hours, days or weeks. |
Active First Stage
| Dilation | Length of Contractions | Time between contractions | Other signs | What the body is doing |
| 6-9 cm | 60-80 seconds | 2-10 minutes | Begin to make some noise, rocking, focused, begin to look glazed. Finding it hard to talk | Contractions will be much stronger and more regular. The cervix will be fully effaced and dilating more. The baby will be moving deep down into the pelvis and getting into a position to be born. First labours in the active phase can last from 8-16 hours. Subsequent labours can be much shorter. |
Transition Stage
| Dilation | Length of Contractions | Time between contractions | Other signs | What the body is doing |
| 8-10 cm | 90 seconds | 2-5minutes | Waters break, bloody show, legs shake, feeling hot or cold, nauseous, pressure in the bottom, losing confidence. Feeling like you want to give up, feeling like you need to pass a bowel motion, not caring about your appearance | This is part of the active stage. The cervix is almost fully dilated and contractions are at their strongest. This stage can last from a few minutes, to an hour or more. |
Second Stage
| Dilation | Length of Contractions | Time between contractions | Other signs | What the body is doing |
| 10 cm | 90 seconds | 2-5minutes | An overwhelming urge to bear down, need to feel grounded. | The cervix is fully dilated and the nature of contractions start to change as the baby moves into the birth canal. As the baby moves forward with each contractions, it slips slightly back. As the baby stretches the vaginal tissue and perineum, oxytocin increases to make contractions stronger. The second stage can take 1-2 hours for first labours and less than 1 hour for subsequent births. |
Placenta
Once the baby has been born, the third stage is the delivery of the placenta. Once your baby is born, the release of oxytocin will make the uterus contract and get smaller. This makes the placenta start to separate from the uterus. There are 2 options to consider when deciding how to deliver the placenta.Active Management which involves an injection of a drug called syntocinon or ergometrine into the thigh, soon after your baby is born. It speeds up the delivery of the placenta and happens around 30 minutes after your baby is born. Your midwife will massage your uterus and pull the placenta out by the umbilical cord. Active management can lower the risk of heavy blood loss (haemorrhaging), but it can make you feel sick and increase the risk of high blood pressure. The cord will be cut between 1-5 minutes after giving birth. Early cord clamping reduces the amount of blood your baby gets after birth, by 20%. Physiological Management or Expectant Management. This is often used in midwife led units and at home births. It allows the placenta to be ready to come out mainly by pushing, gravity, contractions and sometimes by nipple stimulation. It is a natural way of delivering the placenta and does not use oxytocin injections. It can take up to one hour for the placenta to be born and skin-to-skin contact and breastfeeding are often used to 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 will push the placenta out once it has separated and moved down to your vagina and the cord is clamped and cut after it has finished pulsating or after the delivery of the placenta. It is mostly used if you are at low risk of heavy blood loss. You can change to active management at any time if you want to.You can also do a combination of active management and expectant management, which is called mixed management. For example, this could involve the process of active management, but delay clamping of the cord.
Knowing what to pack in your hospital bag can be daunting and stressful. You’ll want to aim to have your bags all packed at least two weeks before your due date. Here are some of the things that you might want think about taking with you for mum, baby and birth partner.
Mum should pack all the bags to ensure that everything that is needed is included. Once mum has packed everything, her birth partner should unpack and repack the bags. This way Mum knows that everything she needs is in the bag, and birth partner knows exactly where to find it!
Need a copy to print off? Download our What to pack in your hospital bag checklist here
There is a variety of specialised services offering information on the mental health well-being during maternity.
We at the MVP are sharing accredited information taken from statutory and third sector services.
The maternal mental health alliance shows this information:
https://maternalmentalhealthalliance.org/resources/mums-and-families/covid-19-looking-after-your-mental-health-during-pregnancy-and-after-birth/?fbclid=IwAR3OGHocGAo5fX9826e_Bi6-rufkuEgbOlRswQzelyDMleGd-C26A-dUpHs