First stage of labour: signs, coping and when to go to hospital

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).

Call your midwife at any stage if you have any questions or concerns.

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.

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.

(RCM, 2012)

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, or you have any questions or worries, give your midwife a call.

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.

(WHO, 2013)

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)

This page was last reviewed in August 2018.

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.