Labour usually progresses much more quickly once your cervix has dilated to four or five centimetres.

Contractions become more frequent, and longer and stronger; your midwife or doctor may call this ‘established’ labour. By this stage, most women need to concentrate completely on coping with contractions.

Pain relief

Some women cope with labour using relaxation techniques, breathing and massage. Many others find that they need something to reduce the pain, as the strength of the contractions increases. 'Gas and air’ (Entonox) can take the edge off the pain, and using a TENS (Transcutaneous Electrical Nerve Stimulation) machine also helps some women.

If you are struggling to cope, getting very tired but still have a long way to go, you may want to use a stronger form of pain relief. Pethidine, given by injection, can help you to relax and distance yourself from the pain. Epidural anaesthesia can give complete pain relief, which can be a wonderful feeling if you have been getting distressed. However, both pethidine and epidurals have their disadvantages. Check out the pros and cons of each here.

Transition

At the very end of the first stage of labour, just as the cervix is opening up to 10 centimetres, many women find that labour becomes even harder. You may feel shaky and cold, or even be sick. You may feel a sense of despair, or that you just want it all to be over. All this is quite normal!

Why it happens - Sometimes it happens because you are nearly there and your body is working really hard to open the cervix that last little bit. Sometimes it’s because you feel ready to push, but a small part of the cervix has not opened and your midwife has asked you not to push yet. Either way, it can be a difficult stage.

How to cope:

You need plenty of support from your midwife and labour partner. They can wash your face, rub your hands and feet, remind you how well you are doing, and that you are nearly there. Gas and air can be a useful form of pain relief at this stage.

• Hang on to your birth companion – literally! Stand with your arms around his shoulders and let him support you, while you focus on relaxing and breathing.
• Find the most comfortable position to cope; you might need to change position every few contractions.
• Greet each contraction with a deep breath and sigh out. Continue to breathe evenly, ‘leaning on’ the out breath.
• Shout if you want to!
• In between contractions, drop your shoulders and relax.
• Ask your birth companion to massage your back if it helps.

Monitoring

Your midwife will listen to your baby’s heartbeat at regular intervals during labour, because his heart rate may change if he runs short of oxygen.

In a normal pregnancy and labour, the midwife can use a hand-held monitor placed against your abdomen. An electronic monitor may also be used. This has straps that go around your bump and links up to a machine that prints out a record of the baby’s heartbeat and your contractions. You may find it difficult to move around and find the best position to cope with the pain while this is done.

Continuous electronic fetal monitoring is usually only used where there is a complication, or concerns about the baby.

Blood sample

If there are signs that your baby is in distress, doctors may take a small sample of blood from the baby’s scalp, called fetal blood sampling (FBS). The blood result will show whether the baby needs to be born immediately, or if labour should continue.