Update to phone lines at our Birchmount and General Hospitals: If calling through Birchmount main line (416-495-2400), add “7” when dialing an extension. If calling through General main line (416-438-2911), add “8” when dialing an extension.

Giving Birth

Stages of Labour

As you enter the last months of your pregnancy, you may start to wonder about the future. You may also wonder about what happens when you go into labour. There are four stages of labour. Some will be more challenging than others. In this section, learn more about what to expect during labour.

  • This stage is often the longest part of labour and may take several hours to a day.
  • Cervix softens and shortens (effacement)
  • Cervix dilates from 0 to 3 centimetres (cm)

  • You will have a nurse available to answer questions, coach and guide you and your partner through this stage.
  • Usually lasts several hours
  • Cervix dilates from 3 to 8 cm
  • Contractions are longer, stronger and closer together, intensity has increased and you can no longer concentrate on other activities.

  • A nurse will be present during this stage to help coach you and your partner.
  • Usually the shortest part of labour (30-60 min)
  • 8 cm to full dilation (10 cm)
  • Contractions are very frequent and intense.
  • Some women become irritable, weepy or feel they are not coping well. These are normal reactions.
  • For most women, this is the most difficult part of labour.

  • A nurse will be present at all times to help coach you and your partner while pushing and for the delivery of your baby.
  • May take from 20 minutes to a couple of hours
  • Baby moves down through the vagina.
  • Contractions may not be as frequent.
  • During each contraction, you feel one or more “urges” to push.

  • This will happen 15 to 30 minutes after the delivery of your baby.
  • After the birth of your baby, the uterus will continue to contract.
  • You may be asked to give a small push to help the placenta deliver.

Pain Relief Options

The amount of pain or discomfort a woman has while having a baby varies from person to person and from pregnancy to pregnancy. Only you know how much discomfort you are having. Your nurse, obstetrician, midwife, and anaesthesiologist are available to help discuss pain relief methods that are appropriate for you. The anaesthesiologist is a specially trained doctor who can provide counsel on pain relief during labour.

Your labour and delivery nurse or your midwife can instruct you in breathing exercises and other methods, such as massages. These can all help make you more comfortable during labour. A doula may also be available to assist you. Coupled with these more natural techniques, we offer Jacuzzi tubs and large showers for natural water therapy, which some women find very relaxing.

A mixture of nitrous oxide (laughing gas) and oxygen can be provided for you to breathe. You have to start breathing the gas as soon as you feel a contraction. The gas will make the contraction more comfortable, but it will not take away the pain or harm your baby. You may feel lightheaded.

Your obstetrician can order narcotic medication to be given intravenously or into your muscle. This medication will provide some pain relief, but it won’t take all the pain away. The medication can make you drowsy and nauseous.

All of the previous methods will make you more comfortable, but you will still have some discomfort. Some women will want more pain relief, which can be provided with an epidural anaesthetic, administered by the anaesthesiologist. Epidurals can provide very good pain relief. The anaesthesiologist will speak with you first to determine if it is safe to perform an epidural anaesthetic. In some women, due to certain medical conditions, it may be unsafe to perform this procedure.

Placing an epidural

Local anaesthetic is injected in your skin on your back to numb it and a needle is then inserted through the numb area. A thin plastic tube is then inserted through the needle and the needle is removed. Medication is injected through the plastic tube and this takes away the pain. It usually takes about 20 minutes for the medication to work. The plastic tube allows medication to be given continuously to keep you comfortable as long as you are in labour. It can also be used to provide pain relief for a Caesarean section, should you need it.

Spinal anaesthetic

With a spinal anaesthetic, a small needle is inserted into your back and the sack covering your spinal cord is punctured. A small amount of anaesthetic is injected into the fluid surrounding your spinal cord and the needle is removed. Pain relief is immediate; however, it will only last for one to two hours.

Combined spinal/epidural

With this method, a spinal anaesthetic is performed first and an epidural catheter is placed through the same needle. This provides the immediate pain relief and allows for continued pain relief with the use of the epidural catheter.

Side Effects of Epidural or Spinal Anaesthesia

You blood pressure may decrease. Your nurse will monitor your blood pressure frequently so that any unsafe decrease in blood pressure can be treated. Your legs may become weak and numb. This may prevent you from walking. Your skin may feel itchy.

Complications of Spinal Epidural/Anaesthesia

Your anaesthesiologist is a highly trained physician who will safely perform this procedure; however, despite this, complications can occur. The most common complication is a headache and it happens in 1 out of 100 patients. The headache can be severe and last for several days. Your anaesthesiologist can provide treatment if you require it. Serious complications, such as seizures, death, or permanent paralysis are rare. The risk of permanent paralysis is about one out of 200,000 patients.




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