Labour and birth: signs, stages and when to call

When to call your maternity team

Contact your maternity unit immediately if your baby is moving less, has stopped moving, or their usual pattern has changed. Babies should keep moving right up to birth. Having less room is not a reason to dismiss reduced movement. Don’t wait until morning or your next appointment, or use a home Doppler or phone app for reassurance. If you cannot reach your maternity team, go to the nearest hospital maternity or emergency department.

Call your midwife or birth unit when your waters break, contractions become regular and painful, you need more support, or something doesn’t feel right. Tell them immediately about vaginal bleeding, green or brown fluid, fever or ongoing abdominal pain between contractions. If you have signs of labour before 37 weeks, call immediately and go to hospital.

In Australia, call 000 for heavy bleeding, severe headache or blurred vision, collapse, or if birth seems imminent and you cannot safely reach your planned birthplace. Follow the ambulance operator’s instructions.

Your team’s advice about travelling in should account for your pregnancy, distance from hospital and any previous fast birth. A contraction-timing rule should never delay a call about a concern. If you have a planned caesarean and labour starts or your waters break, contact your maternity unit promptly.

Signs labour may be starting

You may feel period-like cramps, backache or tightenings across your abdomen. Labour contractions generally build in strength and length and come closer together. Braxton Hicks contractions tend to be irregular and may ease when you rest or change activity, but symptoms alone cannot always tell you which is happening.

A show is sticky mucus, sometimes streaked with a little blood, released as the cervix changes. It doesn’t tell you exactly when your baby will arrive. Fresh bleeding, more than a small blood-streaked show, needs immediate maternity advice; heavy bleeding is an emergency.

Your waters may break as a trickle or a gush, before or during labour. Note the time and fluid’s colour, put on a sanitary pad and call your maternity team. They will explain whether you need assessment and what happens if contractions have not started. Don’t simply wait at home for labour without speaking to them.

The three stages of labour

1. The cervix thins and opens

The cervix is the opening between the uterus and vagina. In early labour it softens, thins and begins to open. This part can stop and start. As labour becomes established, contractions usually become stronger and more regular. The first stage ends when the cervix is fully open, usually described as 10 centimetres dilated.

There is no single timetable that fits everyone. Your team considers how you and your baby are coping as well as changes in the cervix and your baby’s position. Examinations should be explained and carried out with your consent.

2. Your baby is born

The second stage runs from full dilation until birth. You may feel pressure and an urge to push. Your midwife will guide you, including if an epidural changes what you can feel. Positions such as side-lying, kneeling or being upright may suit different people and circumstances. Ask what is possible with your monitoring and pain relief.

Sometimes an assisted vaginal birth with forceps or a vacuum, or a caesarean birth, is recommended. The team should explain the reason, urgency, benefits and risks. Needing help is not a personal failure.

3. The placenta is born

Contractions continue after your baby is born so the placenta can separate and come out. Your team will discuss management of this stage, including medicine that helps the uterus contract and reduces the risk of heavy bleeding. They check the placenta, your blood loss and whether any tears need treatment.

How your baby moves through the birth canal

A few terms can make conversations with your team easier:

• Presentation: the part of your baby nearest the birth canal. Cephalic means head-first; breech means bottom or feet first.
• Position: which way your baby is facing. In an occiput-anterior position, the back of the baby’s head is towards the front of your pelvis.
• Engagement: the widest part of the head has entered the pelvis. It can happen before labour or during it.
• Station: how far down the presenting part has moved in relation to landmarks inside the pelvis.

During a typical head-first vaginal birth, the head moves down, tucks and rotates to follow the pelvis, then extends as it emerges. These movements help explain why position and progress are checked. They are not a sequence you need to control yourself or a prediction of exactly how birth will unfold.

Comfort, monitoring and feeling supported

If your team advises that early labour at home is appropriate, rest when you can, drink regularly and follow their advice about food. Gentle movement, a warm shower, slow breathing or massage may help you manage contractions. Tell your support person what feels useful, including when you want quiet or less touch.

Pain relief can include gas, medicines and an epidural. You can ask about the benefits and limitations and change your preferences as labour unfolds.

Your baby’s heartbeat will be checked during labour. In a straightforward, low-risk labour this may mean listening at intervals. Continuous electronic monitoring may be recommended if there are additional concerns or particular treatments. Ask why it is recommended and whether wireless equipment is available so you can change position more easily.

Birth is a physical and emotional experience. Familiar support, clear explanations and permission to ask for a pause can help it feel more manageable. You do not have to stay calm perfectly, and anxiety does not mean you have caused a difficult birth.

If labour needs to be started medically, our guide to induction of labour explains the options and questions to ask.

Sources and further reading

• Pregnancy, Birth and Baby: baby movements during pregnancy
• Pregnancy, Birth and Baby: contractions and when to call
• Queensland Government: stages of labour
• Queensland Health: early labour
• Queensland Health: monitoring baby during labour
• MedlinePlus: your baby in the birth canal
• Pregnancy, Birth and Baby: birthing the placenta

This is general information for readers in Australia. Your maternity team can advise you about your own pregnancy and birth.