During and after birth - what to expect

Written by Peppy Health | October 10, 2021

While no two birth experiences will be exactly the same, it can be helpful to have an idea of what to expect once you go into labour.

Labour and birth are split into 3 stages – the first stage comprises: early (latent) labour, active labour and transition. The second stage is where you are actively birthing your baby and ends once your baby is born, and the third stage is where you birth the placenta and membranes.

Regardless of where you plan to have your baby, the physiological process is the same. However, some women may find that they have a very quick first stage; for others, especially if it is their first baby, it could take longer. Particularly with this stage, there may not be an obvious distinction between each of the three phases. You may find it unhelpful to focus too much on this. Allowing your labour and birth to progress and thinking about things you can do to encourage your baby to move further down into your pelvis, trusting your body to do what it needs to do, may feel more natural and productive.

First stage of birth

Early or latent labour

Your cervix is dilating from 0-3cms and can last anything from hours to days.
Contractions are irregular – there is no real pattern to their frequency.
If you are planning on a hospital birth, staying at home during this early stage offers many advantages – see our article (insert link to ‘Preparing for the unpredictability of birth’) for some suggestions on positive ways of managing early labour at home.

Active or established labour

Contractions are coming regularly (every 5 minutes or less) and lasting for at least a minute.
Your cervix will be between 4-8cms dilated.
You might notice that you struggle to breathe through these more intense contractions and feel the need to get into different positions to ease the pressure of your baby pushing on the cervix.
If you have been at home until this point and are going to a hospital or midwifery-led unit, or having a home birth, now is the time to contact your midwife. They will likely ask you some questions to see how you respond during contractions.

Transition

The final part of the first stage of labour (8-10cms dilation), right before you start bearing down to birth your baby.
It's the shortest stage – contractions will increase in intensity and come very close together.
There's usually an instinctive need to push and sometimes feelings of doubt of being able to carry on (thanks to a surge of adrenalin), however, these are signs that your baby is very close to being born and those around you should encourage and support you.

Second stage of birth

Once your cervix is fully dilated (around 10cms) you'll start actively bearing down with each contraction. This stage ends with the birth of your baby.
It can last anything from a few minutes to around 2 hours.
As each powerful contraction is moving your baby down through the birth canal, finding ways to relax and regain your strength between contractions (closing your eyes, resting your head, changing positions), whatever works for you, will really help.

Third stage of birth

Once you have birthed your baby, you'll then birth the placenta.
Depending on whether you have a managed or physiological third stage, this could last between 10 minutes to around 1 hour. This stage is where the uterus contracts and becomes smaller and the placenta and membranes separate from the wall of the womb.
A managed (or active) third stage involves the midwife asking your consent to have an injection of synthetic oxytocin into the thigh (syntocinon). Should you choose to wait instead (expectant management), then increasing oxytocin levels through skin-to-skin with your newborn and breastfeeding will help encourage this.

Remember that the birth of your baby will not be defined by timescales and it is likely that you may not notice the transition between every stage – this is simply a guide as to what will be happening. Your birth will follow its own unique path.

How your body recovers after birth: A step-by-step guide to help

It took nine months to grow and birth your baby, and it takes time to recover afterwards, too. Here’s what you can expect

Your vagina

Your vagina may feel looser, wider and drier than it did before you gave birth. It may also feel, and look, bruised and swollen. All this is normal, and should start to settle down within a couple of weeks of giving birth.

Here are two steps you can take when you’re ready:

Pelvic floor exercises– These help tone and strengthen the muscles in the vagina, as well as the pelvic floor. Help for dryness – If you’re breastfeeding, your oestrogen levels will be much lower than when you were pregnant. This can lead to vaginal dryness. After you stop breastfeeding and your periods return, your oestrogen levels will go back to normal and the dryness should be less of an issue. In the meantime, you can use a lubricant or vaginal moisturiser, if it’s making sex difficult or painful.

Your perineum

Even after a straightforward birth where there is minor damage to this area, it’s normal for it to feel bruised and sore.

Try not to sit or stand for long periods
Avoid tight clothing
Pat, rather than wipe, after you’ve been to the toilet.

Your uterus

Your womb will start to shrink back to pre-baby size straight after the birth. You may feel mild contractions (afterpains) as the uterus closes off open blood vessels where the placenta was attached.

By the time your baby is a week old, your uterus will be half the size it was after you gave birth
A week after that, it will be fully back inside your pelvis
After four weeks, it will be back to its pre-pregnancy size.

This process is called involution.

Your abdominal muscles

You must be patient when your abdominals are recovering from pregnancy. Your tummy may look (and feel) significantly bigger for a few weeks (or even months) after the birth but with gentle exercises you can start to make a difference. ‘Our abdominals are not designed to be flat,’ says Jane Wake, postnatal exercise specialist. ‘They’re designed to move with the diaphragm and pelvic floor - and extend to accommodate the growth of your baby. ‘If the abdominal muscles remain extended after birth, you may want to assess your ‘tummy gap’ (or, diastasis recti). You can follow these simple instructions:

Lie on your back, knees bent to take pressure off your lower back
Take three fingers and, holding them vertically, just above your belly button
Bring your head and neck up, so your abdominals are slightly engaged, and support your head with your other hand
Turn your fingers so that they’re now horizontal to your belly button. You’ll feel a gap - gently push your fingers into it. You may be able to fit in all three, or just one or two
The more fingers you can fit into the gap, the wider it is. It’s normal for a women’s abdominals to separate during pregnancy and they’ll start to knit back of their own accord.
What’s important is that every time you check this (every three weeks or so) the gap is smaller and the fascia (the connective tissue between abdominal muscles) is getting stronger
Think of this fascia as a bridge between each side of your body - ideally, it’s strong and straight, rather than bowed.

‘You can start exercising your abdominals again from eight weeks postpartum but please do get the OK from your doctor first. Believe it or not, your abs have the potential, with the help of movement, to be stronger than even before you were pregnant. So take it slow and sure and enjoy witnessing an amazing change.’

Your pelvic floor

Your pelvic floor is an area of the body that takes a lot of stress during pregnancy and birth. It’s a group of muscles in the pelvis that form the base of what we refer to as the ‘core’. It’s made up of several layers of muscle and ligaments and stretches, a bit like a sling, from the pubic bone at the front of the body to the coccyx (tail bone) at the back. It supports your bladder, bowel and uterus (particularly important during pregnancy) and works with the deep abdominal and back muscles to support your spine. It’s also integral to essential bodily functions like peeing and pooing. Your pelvic floor is the muscle that takes the most stress during pregnancy, birth and postnatally. It’s important to locate and connect to it, to enable you to strengthen it effectively. 1 in 2 women experience urinary incontinence postnatally, while for 1 in 3, this lasts a lifetime. The pelvic floor is made up of three layers of muscle. The first is superficial, the second is the sphincter muscle and the third is a really deep layer of muscle. It’s this third layer of muscle we really want to engage.

Do this via the sphincter muscle:

Tense it as though you were holding in a fart at the back and a wee at the front
Hold from back to front and repeat
If you feel your tummy muscles coming in as well, so much the better!

There are two exercises that will very effectively strengthen your pelvic floor. These are:

The scoop

Take a deep breath in and feel your diaphragm lift (your pelvic floor will be lifted too). Exhale, and as you do so remember to ‘stop a fart, stop a wee’. At the same time, ‘scoop’ with your pelvic floor muscles to really work the area from back to front

The lift

As above, take a deep breath in and feel your diaphragm lift. Exhale, and ‘stop a fart, stop a wee.’ At the same time, visualise lifting your pelvic floor as though it was a lift going up. Count from one to five floors, and relax as you release the muscles in reverse. Do these exercises as often as you remember, and aim for 10 repetitions, or ‘contractions’, every time.

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