Labour: The Stages, The Pain Relief, And The Sentence Worth Learning

About to deliver your baby? Congratulations! Here's everything you could possibly need to know about labour and giving birth in Singapore

Labour is described in stages, which helps you understand it and misleads you about how it feels. The stages aren’t experienced as neat divisions and they don’t run to a timetable.

The stages


Stage	What happens
Early (latent) 0–6cm	The longest and most variable part, often many hours and sometimes days. Contractions are irregular then gradually regular. This is the part to spend at home: eat, sleep if you can, move around, and don’t start timing obsessively at the first twinge.
Active 6–10cm	Contractions strong, regular and close. Usually where you go in, and where most people want pain relief. Faster than early labour.
Transition around 8–10cm	The hardest stretch, and usually short. Shaking, nausea, and a sense of not being able to continue are characteristic. That feeling is often the sign it’s nearly over, not a sign something is wrong.
Second stage pushing	From full dilation to birth. Minutes to a couple of hours. The urge to push often arrives on its own.
Third stage placenta	Usually within 30 minutes, quicker with an injection to help the uterus contract.

When to go in

First baby: commonly contractions five minutes apart, lasting a minute, sustained for an hour. Confirm what your own hospital advises.
Second or later: go earlier. These labours are frequently much faster.

Go in immediately, at any hour, for:

Reduced or changed fetal movement: never wait, never try to provoke movement first
Waters breaking with green or brown fluid
Any bright red bleeding
Constant severe pain, as distinct from contractions that come and go
A severe headache with visual disturbance, or sudden swelling of face and hands
Fever, or waters broken if you’re known to be GBS positive
Waters broken with no contractions: call and ask instead of waiting

Pain relief


Option	What to know
Movement, position, water, breathing	Effective and consistently underused. Upright and mobile is associated with shorter labour and less need for other pain relief.
Continuous support	Not a drug, and one of the better-evidenced interventions in all of obstetrics. Someone with you throughout, partner or doula, reduces intervention and improves satisfaction.
Entonox (gas and air)	Fast on, fast off, you control it. Can make you lightheaded or nauseated. Takes the edge off without removing pain.
Opioid injection	Helps some women and does nothing for others. Can make you drowsy, and if given close to delivery can make the baby sleepy at birth.
Epidural	The most effective. Requires a drip, continuous monitoring and reduced mobility, and can lengthen the pushing stage. Can be topped up for a caesarean. Asking for one isn’t a failure of anything.

Making decisions in labour

Things get proposed quickly in labour. A good habit is to ask, for anything not urgent:

“What are the benefits, what are the risks, what are the alternatives, and what happens if we wait?”

Or more simply: “Can we have a minute to discuss that?” It buys the space in which a real decision can be made. Genuine emergencies are obvious and nobody will wait for a discussion; most of what happens in labour isn’t one.

Nominate your partner or doula in advance to be the person who says it.

Common interventions

Membrane sweep: an attempt to start labour, done at an appointment.
Induction: starting labour medically. Can take one to three days, especially for a first baby.
Breaking the waters to speed things up.
Augmentation: a hormone drip to strengthen contractions. Often makes them more intense with less build-up.
Episiotomy: a cut to enlarge the opening. Should be discussed and consented to, not routine.
Forceps or ventouse: assisted delivery.
Caesarean: planned or during labour.

Immediately after

Ask for delayed cord clamping: a minute or more improves the baby’s iron stores.
Skin-to-skin straight away, including after a caesarean where possible.
First feed within the first hour if you’re breastfeeding, and ask for help with the latch there and then.
Stitches if needed, with local anaesthetic.
The first wee matters more than anyone warns you. Tell someone if you can’t go.
Eat. You’ll be extremely hungry and this is regularly forgotten.

The partner’s job

Stay in the room. Physical presence does more than anything said.
Know the birth preferences well enough to speak to them.
Ask “can we have a minute?” when something is proposed.
Water, ice chips, a cool cloth, counter-pressure on the lower back.
Don’t take anything said in transition personally.
Eat and use the toilet when you get the chance. You can’t help anyone if you faint.

Frequently asked questions

What are the stages of labour?

Early or latent labour to about 6cm, which is the longest and most variable part and best spent at home; active labour from 6 to 10cm; transition around 8 to 10cm, which is the hardest and usually shortest; the second stage of pushing; and the third stage, delivering the placenta.

When should I go to hospital?

For a first baby, commonly when contractions are five minutes apart, lasting a minute, for an hour. Confirm your own hospital’s advice. Go earlier for a second or later baby. Go immediately at any hour for reduced fetal movement, green or brown fluid, bright red bleeding, constant severe pain, or a severe headache with visual changes.

What pain relief is available?

Movement, position and water, which are effective and underused; continuous support from a partner or doula, one of the better-evidenced interventions in obstetrics; Entonox, which you control and which takes the edge off; an opioid injection, which helps some and not others; and an epidural, the most effective option, which requires a drip and continuous monitoring.

What’s transition?

The stretch around 8 to 10cm, usually short and the hardest part. Shaking, nausea and a strong sense of not being able to continue are characteristic, and that feeling is generally a sign it’s nearly over, not that something is wrong.

How do I make decisions during labour?

Ask what the benefits, risks and alternatives are, and what happens if you wait. “Can we have a minute to discuss that?” buys the space to decide. Genuine emergencies are obvious and nobody will wait. Most of what’s proposed in labour isn’t one.

What should I ask for immediately after birth?

Delayed cord clamping of a minute or more, skin-to-skin straight away including after a caesarean where possible, and help with the first feed within the first hour. Tell someone if you can’t pass urine, it’s more important than anyone warns you. And eat.

What to remember

Early labour is long and belongs at home. Active labour is when you go in, earlier for a second baby.

Movement and continuous support are the underrated pain relief. An epidural is the most effective and asking for it isn’t a failure.

Learn one sentence: “can we have a minute to discuss that?” And go in immediately, whatever the hour, for reduced fetal movement.