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There are three stages to labour. In the first stage the cervix gradually opens up (dilates). In the second stage the baby is pushed down the vagina and is born. In the third stage the placenta comes away from the wall of the womb and is also pushed out of the vagina.

Coping at the beginning of labour
At night, try getting comfortable and relaxed and perhaps doze off to sleep. A warm bath or shower may help you to relax. During the day, keep upright and gently active. This helps the baby to move down into the pelvis and the cervix to dilate. It's important to have something light to eat to give you energy because labour, particularly a first one, may last 12-15 hours or more from the early stages to delivery.

The first stage
The dilation of the cervix
Contractions at the start of labour help to soften the cervix, then the cervix will gradually open to about 4in (10cm). This is wide enough to let the baby out and is called fully dilated. Sometimes the process of softening can take many hours before what midwives refer to as established labour. This is when your cervix has opened (dilated) to at least 1in (3cm). If you go into hospital before labour is established, you may be asked if you would prefer to go home again for a while, rather than spending many extra hours in hospital. You may be able to have drinks and light snacks in established labour, but you will usually not want to eat anything else. Once labour is established, the nurse will check again from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between six and 12 hours. It is often quicker for later ones. Towards the end of the first stage, you may feel that you want to push as each contraction comes. At this point, if the doctor isn't already with you, ring for her. The doctor will tell you to try not to push until your cervix is fully open and the baby's head can be seen. To help yourself get over the urge to push, try blowing out slowly and gently or, if the urge is too strong, in little puffs. Some people find this easier lying on their sides, or on their elbows and knees, to reduce the pressure of the baby's head on the cervix. You can be up and moving about if you feel like it too. As the contractions get stronger and more painful, you can put into practice the relaxation and breathing exercises you learned during pregnancy. The baby's father can help by doing them with you and by rubbing your back to relieve the pain if that helps.

Foetal heart monitoring
Every baby's heart is monitored throughout labour. The doctor is watching for any marked change in the heart rate, which could be a sign that the baby is distressed and that action should be taken to speed up delivery. There are different ways of monitoring the baby's heartbeat:

• Your doctor may listen to the baby's heart intermittently with a hand-held ultrasound monitor (often called a Sonicaid). This method allows you to be free to move around in labour if you wish. The heartbeat and contractions may also be followed electronically through a monitor linked to a machine called a CTG. The monitor will be strapped to your tummy on a belt.

• Sometimes it may be suggested that a clip is put on the baby's head so that its heart can be monitored more exactly. The clip is put on during a vaginal examination, and the waters are broken if they have not already done so. Ask your doctor to explain why they feel the clip is necessary for your baby.

Throughout labour the heartbeat will be followed by a bleep from the machine and a print-out. You cannot easily move around. Some machines use tiny transmitters which allow you to be more mobile. Ask if these are available.

Speeding up labour
If your labour is slow, your doctor may recommend acceleration to get things moving. You should be given a clear explanation of why this is proposed. To start with, your waters will be broken (if this has not already happened) during a vaginal examination. This is often enough to get things moving. If not, you may be offered a drip containing a hormone which will encourage contractions. If you have a drip, the hormone will be fed into a vein in your arm.

The second stage
The baby's birth
This stage begins when the cervix is fully dilated and lasts until the birth of the baby. Your body will tell you to push. Listen to your nurse or doctor who will guide you.

Position
Find the position that you prefer and which will make labour easier for you. You might want to remain in bed with your back propped up with pillows, or stand, sit, kneel or squat (squatting will take practice if you are not used to it). If you are very tired, you might be more comfortable lying on your side rather than your back. This is also a better position for your baby. If you've suffered from backache in labour, kneeling on all fours might be helpful. It's up to you. Try out some of these positions at antenatal classes or at home to find out which are the most comfortable for you. Ask the nurse to help you.

Pushing
You can now start to push each time you have a contraction. Your body will probably tell you how. If not, take two deep breaths as the contractions start and push down. Take another breath when you need to. Give several pushes until the contraction ends. As you push, try to let yourself open up below. After each contraction, rest and gather strength for the next one. This stage is hard work but your doctor will help you all the time, telling you what to do and encouraging you. The baby's father can also give you lots of support. Ask your doctor to tell you what is happening. This stage may take an hour or more, so it helps to know how you're doing.

The birth
As the baby's head moves into the vaginal opening, you can put your hand down to feel it, or look at it in a mirror. When about half the head can be seen, the doctor will tell you to stop pushing, to push very gently, or to puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby's head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and back passage) time to stretch without tearing. Sometimes the skin of the perineum won't stretch enough and may tear. Or there may be an urgency to hurry the birth because the baby is getting short of oxygen. The doctor will then ask your permission to give you a local anaesthetic and cut the skin to make the opening bigger. This is called an episiotomy. Afterwards the cut or tear is stitched up again and heals. Once your baby's head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. You can ask to have the baby lifted straight on to you before the cord is cut so that you can feel and be close to each other immediately. Then the cord is clamped and cut, the baby is dried to prevent him or her from becoming cold, and you'll be able to hold and cuddle your baby properly. Your baby may be quite messy, with some of your blood and perhaps some of the white, greasy vernix which acts as a protection in the womb still on the skin. If you prefer, you can ask the nurse or doctor to wipe your baby and wrap him or her in a blanket before your cuddle. Sometimes mucus has to be cleared out of a baby's nose and mouth or oxygen given to get breathing under way. If this happens your baby will be passed to you as soon as possible.

The third stage
The placenta
After your baby is born, more contractions will push out the placenta. This stage can take between 20 minutes and an hour, but your doctor will usually give you an injection in your thigh, just as the baby is born, which will speed it up. The injection contains a drug called Syntometrine or Syntocinon, which makes the womb contract and so helps prevent the heavy bleeding which some women may experience without it. You may prefer not to have the injection at first, but to wait and see if it is necessary. You should discuss this in advance with your doctor and make a note on your birth plan.

Afterwards
If you've had a deep tear or an episiotomy, it will be sewn up. If you have had an epidural you will not feel this. Otherwise you should be offered a local anaesthetic injection. If it is sore during this repair, then say so; it is the only way that the doctor will know that they are hurting you. Small tears and grazes are often left to heal without stitches because they frequently heal better this way. Your baby will be examined, weighed and possibly measured and given a band with your name on it. The nurse will then help you to wash and freshen up. Then you should have some time alone with your baby and the baby's father, just to be together quietly and meet your new baby properly. If you find this doesn't happen and you would like some time alone, ask for it.