What is early labour (the latent phase)?

Early labour, also known as the latent phase of labour, is defined by the NICE guidelines as a period of time, not necessarily continuous, when:

• there are contractions and
• there is some cervical change, including cervical position, consistency, effacement and dilatation up to 4 cm.

This definition obviously requires a vaginal examination to assess the cervix - something which really isn’t necessary for all women. When we support women in early labour we can see that this is the phase they’re in without doing a vaginal examination. It’s also always your choice to have a vaginal examination - you should never be pressured into having one.

From a hormone perspective (labour and birth are hormonally driven processes), your uterus will be primed with oxytocin receptors and your circulating oxytocin will be rising. Oxytocin is what makes your uterus contract and your contractions are what open (dilate) your cervix. In early labour you also have adrenaline floating around and you might be feeling excited or perhaps a little anxious. Adrenaline counteracts oxytocin, which is why in early labour if you move from home to hospital, you may notice your contractions slow down or stop altogether as your adrenaline increases upon being in a new environment, with bright lights and unfamiliar faces.

The presence of adrenaline keeps your neocortex, or the ‘thinking part’ of your brain switched on so you can make preparations for your birth. This might look like ensuring any other children are cared for (or any fur children you might have!) or getting to wherever you’ve planned to give birth, if not at home. In early labour there is a delicate balance between oxytocin and adrenaline.

In her book, Reclaiming Childbirth as a Rite of Passage, Rachel Reed offers an alternative view to the phases of labour with less rigid definitions than the medical model of childbirth suggests and we believe more in line with women’s actual experiences. It’s well worth a read if you’re expecting!

What does early labour feel like?

This will vary for everyone, but typically you’ll start having contractions and it’s entirely normal for them to be irregular in length, strength and frequency at this point (remember what we said about the adrenaline/oxytocin balance above. You might first notice them as a period-like pain wrapping around your lower belly and back - and if you feel your abdomen, you might notice that it feels harder than normal during those sensations as your womb contracts.

You might experience contractions overnight that settle in the morning when the sun comes up. Labour starting at night is common as your sleep hormone, melatonin promotes the function of oxytocin. This is also why generally a brightly lit space isn’t very oxytocin friendly - worth thinking about particularly if you’re not planning to give birth at home.

There might also be other signs like losing your mucous plug (aka your show) or having loose bowel movements. Some people can feel quite sick and vomit during labour - even in the early phases.

How long does early labour last?

Early labour can vary in length from person to person - for some it might feel like it only lasts a few hours and others might have several days of early labour. A longer labour doesn’t automatically mean there’s a problem - particularly if you’re otherwise feeling well and you’re happy with your baby’s movements. A longer early labour can however be very tiring and we always suggest thinking about what support techniques you can have in place in the event that you do experience this.

Melanie the Midwife of the Great Birth Rebellion Podcast talks about having a box of support tools that you and your birth partners can access during labour. Things you could include in your support box are: aromatherapy massage oil blends, a TENS machine, a Rebozo scarf (if you have someone who knows how to use it!), a wheatbag, a flannel (for cooling), a birth comb and perhaps even a cheatsheet of hypnobirthing breathing techniques. Having this labour support box means your partner will be able to make suggestions instead of trying to think on the spot of ways they can support you.

What should you do during early labour?

As mentioned above, during your pregnancy start thinking about what support techniques and tools you can gather for your labour. You might end up using all of them, or only some of them, but we think it’s better to be prepared and have many tricks up your sleeve! There’s some school of thought to suggest trying to ‘carry on as normal’ until you can no longer ignore the contractions and sensations you’re feeling might be helpful. The benefit of this would be that it might mean you’re less likely to be clock watching (we’d actually recommend you not watching the clock at all!).

There’s also a lot to be said for listening to your body. Over the years we’ve heard advice given to women to ‘stay active’ and ‘keep moving’ to keep labour going. If those things feel right to you, then crack on. But we can’t stress enough the importance of also resting if you’re feeling tired. Remember that labour is hormonally driven - so resting when you have some downtime is not going to ‘slow your labour down’. If you do feel the need to rest, doing so lying on your left side with lots of supportive pillows is a great shout. You might have a pillow between your knees and one under your bump - anything that feels comfy and cosy to you.

If you’re able to, keep eating and drinking normally. We say ‘drink to thirst’ because you can overdo it and overhydrate which can mess with your sodium levels - something we don’t want to do. Drink as you normally would rather than feeling like you have to be constantly sipping. Once you slip into active labour your appetite will probably disappear - so if you can eat, now's the time. You might not be up for a full meal, but eating nutritious snacks such as dates & peanut butter, bananas or berries is a great option.

Start practising your breathing during these milder contractions - it will really help you when the contractions are stronger and more frequent later on. You want to focus on a long exhale - your inhale will happen automatically - and keep your jaw and face floppy.

Tune in to your baby, babies will still have active and sleep phases in labour - so you should still have periods of time when you can feel your baby moving. If you’re worried about your baby’s movements at any point, you should ring your local maternity triage to let them know and they’ll invite you in for some monitoring of your baby’s heartbeat.

What is active labour?

The NICE guidelines in the UK define active (or established) labour as being when:

• there are regular contractions and
• there is progressive cervical dilatation from 4 cm.

Interestingly, the American College of Obstetricians and Gynaecologists (ACOG) changed their guidelines to state that active labour is defined as the cervix being 6cm dilated plus regular contractions. This recommendation was made in view of labour dystocia (a slowing down or stopping of labour) being the main reason for caesarean births in the US, with no improvement in maternal or neonatal outcomes.

As with the definition of early labour - if we follow NICE, confirming you’re in active labour would require a vaginal examination to know how dilated your cervix is. What we have learnt from observing physiological birth - that is birth that unfolds by itself with no medical intervention - is that there are many other ways of knowing that you’ve moved into the more active phase of labour that don’t require a vaginal examination.

What does active labour feel like - and how is it different?

When you’re in active labour, generally your neocortex has been quietened and the more instinctive part of your brain is lit up. From an observers perspective - it’s like you’ve gone into a different land. You’re no longer chatty between contractions and have to really focus through each surge. You might make sounds during contractions that you weren’t before and start moving instinctively during them. Your contractions will be stronger, longer and regular. But this again can look different for everyone. We’ve supported women in active labour who had 2 contractions in a 10 minute period and still birthed a baby and we’ve supported those who have had 4-5 contractions in a 10-minute period and also birthed a baby.

Hormonally, your oxytocin levels are high and in response to the sensations of the contractions, your very clever body releases beta-endorphins - which are your natural painkillers and have a similar effect as opioids. Powerful stuff! Beta-endorphins can put you in a bit of a trance-like state - or as it’s affectionately called, ‘labour land’. Whereas in early labour your contractions can stop if your adrenaline levels rise, in active labour you’re more likely to be in a flow state with little that can stop your labour.

When should you call your midwife?

You should call your midwife when you feel like you’d like extra support. That might be in early labour or it might be when you’re in a more active phase. It’s worth knowing that if you’re planning a hospital birth you'll generally be advised to call the hospital when you think you’re in labour. It might be that the midwife on the other end of the phone says come in and agrees that it seems like you’re in labour, or if they think you’re still in the early phases and everything else sounds otherwise well, you might be encouraged to try and stay at home until your labour is more established. It’s fine to call the hospital more than once to check in about your labour and if you do feel like you need extra support but have been told to stay at home, it’s also fine to go into hospital if that feels right for you.

How we support you through every phase of labour

Having an independent midwife means having a trusted person who’s on-call for you from when you’re about 36/37 weeks pregnant. This means that anytime you need us - 24/7 - you can call us. If you think your labour is starting and need some reassurance - we can offer that either over the phone or in person. You can check in with us as often as you like and you can decide when you want us to come to you. We’ll never tell you it's ‘too early’ - if you need support, we’re there for you.

Sometimes it might be that we come to you, have a check in, offer support techniques and potentially go home and wait for your labour to establish if all is well - the beauty of independent midwifery care is the flexibility, the trusting relationship and that we take on microcaseloads of women so we can really devote our time and attention to you and your labour and birth.

It might be that you don’t call us until you’re in the throes of active labour - you get to decide when you want the support and we’ll be there when you call.