Labour and giving birth

A vaginal birth is when your body and your baby work together with the contractions to gradually help your cervix to soften, thin and open. After this happens, your baby moves through the birth canal until they are birthed through the vagina, without the need for additional assistance from instruments or surgery.

A vaginal birth is usually considered the safest option if your pregnancy is uncomplicated and recovery is often quicker than compared to a caesarean birth.

Changing your position during labour, attending antenatal care, feeling supported during labour and discussing your birth preferences with your maternity care provider are all important ways to go into labour feeling more prepared. However, it is important to remember that many factors that influence labour and birth are outside of your control.

An assisted (instrumental) birth is performed by a doctor with extra training to use special instruments such as a soft suction cup or forceps to help guide your baby out during the pushing stage. An episiotomy (a cut to the skin between the vagina and anus) is often recommended during an assisted birth to reduce the risk of more severe tearing.

An assisted birth may be recommended if:

• your cervix is fully open (10cm), but your baby needs extra help to be born
• your baby is showing signs of distress but they are in the correct position for an instrumental birth
• you or your baby would benefit from assistance during the birth
• your maternity care provider recommends that birth as soon as possible is the safest option for you or your baby.

The goal is to help your baby be born safely while avoiding a caesarean section if possible. Your maternity care team will explain why this option is recommended and if there are any alternatives and what to expect. Your support person can usually stay with you, whether the birth happens in a birthing room or an operating theatre. Additional clinicians such as paediatricians may be present in the room in the event additional assistance is required.

Learn more

Assisted birth - Patient fact sheet | RANZCOG

Instrumental vaginal birth - Patient fact sheet | RANZCOG 

Labour and Birth - Patient fact sheet | RANZCOG

A planned caesarean birth is a surgical birth scheduled ahead of time for medical or personal reasons. You will usually have a spinal or epidural anaesthetic so you are awake but numb from the waist down. Your support person can stay with you.

Recovery can take a little longer than a vaginal birth and your maternity care provider will make sure you’re supported in getting up and moving again after the surgery. In some cases, due to factors in your pregnancy, a planned caesarean may be the safest way for your baby to be born. Your maternity care provider can advise the best timing for this, based off your individual circumstances. 

To learn more about the best timing for your baby’s birth and to access information that might help you in your decision, visit: Let's talk timing of birth | Safer Baby - Working Together to Reduce Stillbirth

Learn more

Planned or elective caesarean | Pregnancy Birth and Baby

Elective caesarean section | healthdirect

In Australia, around 4 in 10 babies are born by caesarean. An emergency caesarean may be recommended if concerns arise before or during labour and a vaginal birth is no longer considered the safest option for you or your baby. The word "emergency" can sound alarming but it does not always mean something life-threatening.

Some emergency caesareans need to happen quickly while others can occur in a less urgent timeframe. It will depend on the situation. Your maternity care provider will assess the level of urgency for your individual circumstances.

In some urgent cases, you may be given a general anaesthetic which means you are asleep during surgery. In less urgent cases, there may be time for a spinal or epidural so you can stay awake. If you are awake, your support person can usually stay with you but, if you need a general anaesthetic, they may not be able to come into the operating theatre, your maternity care team will guide you.

After an emergency caesarean, support, reassurance, and time to talk through what happened are important parts of your care.

Caesarean birth – whether it is elective or an emergency - can impact the way you may choose to give birth in the future and the time between pregnancies that is recommended to let your body fully heal. This should be discussed with your maternity care provider.

Learn more

Emergency caesarean | Pregnancy Birth and Baby

Caesarean section | Better Health Channel 

What to expect from a caesarean birth | Raising Children Network

Deciding how you want to give birth after a caesarean birth is a personal choice that will be guided by discussions with your maternity care provider. When thinking about your choice for birth after a caesarean you should consider: 

• the type and number of previous caesarean births you have had
• the reason for previous caesarean birth
• your overall health and pregnancy
• the time between your pregnancies
• what is important to you and why
• if needing an induction of labour would change your choice.

If the next birth after a caesarean is a vaginal birth, that is commonly referred to as a VBAC (vaginal birth after caesarean). You may also hear them called NBAC (next birth after caesarean) or TOLAC (trial of labour after caesarean).

To help you to make an informed decision, your maternity care provider should discuss the advantages and disadvantages of each of your options. Potential disadvantages of VBAC that may be discussed include:

• the chance of the uterine scar opening 
• the chance of needing an assisted birth 
• the chance you will need an emergency caesarean
• the risk of injury to the perineum or the pelvic floor.

Learn more

Vaginal birth: a guide | Raising Children Network

Birth after Caesarean - Patient fact sheet | RANZCOG

Vaginal Birth After Cesarean (MFMU) Calculator 

Water immersion is being in water (a bath or birth pool) during labour and waterbirth refers to your baby being born underwater. Both practices are supported by the Australian College of Midwives (ACM). ACM is the peak professional body for midwives in Australia. ACM supports the choice of women to access water immersion in all stages of labour and for birth when supported by a maternity care provider with extra training to facilitate waterbirth. 

Labouring or birthing in water may reduce the intensity of pain during labour and increase feelings of relaxation. Women report higher levels of satisfaction after using water to support their labour or birth. 

Water immersion and waterbirth can be supported if you intend to birth at home or in hospital. Your maternity care provider can talk to you about the benefits and risks of waterbirth and if it is available in your intended place of birth and if it is a safe option for you and your baby. 

Learn more

Water birth | Pregnancy, Birth and Baby

Induction of labour means helping your labour to start. It may be recommended if you go past your due date or earlier if your maternity care provider believes an induction is safer than awaiting labour to start by itself. There can be several parts to an induction, softening and shortening your cervix, breaking the waters around baby and using a synthetic hormone to encourage regular contractions. 

When a pregnancy is without complications, being born as close to your due date as possible and waiting for labour to start on its own is usually considered to be best for you and your baby. 

Sometimes an induction of labour is recommended because it may be safer for you or your baby. Your maternity care provider will discuss the benefits and risks of your options, answer your questions and support you in making the best decision for you and your baby.

Learn more

Home Page | Every Week Counts

Let’s Yarn Timing of Birth | Stronger Bubba Born

The method of induction will depend on your body, your health and how your baby is doing. If your cervix is not yet ready and your maternity care provider cannot break your waters, you may be offered:

• a small balloon placed in the cervix
• a hormone medication inserted into the vagina to help your cervix to soften and shorten.

These methods to soften your cervix can take 12-24 hours. Once the cervix is starting to soften, shorten and open, your maternity care provider will ask to break your waters and a hormone drip may be started to encourage your uterus to contract.

Because induction uses medical methods to start labour, continuous monitoring is recommended for the duration of labour.

Learn more

Induction of labour | Pregnancy Birth and Baby 

Overdue babies | Better Health Channel 

Induction labour pamphlet | RANZCOG

Your maternity care provider may mention having a 'stretch and sweep' or a 'membrane sweep' close to or after your due date. It is a procedure similar to a vaginal examination used to try and help start labour and potentially avoid needing an induction of labour. 

Your maternity care provider uses their finger to gently stretch the cervix and if successful, labour usually starts within 48 hours. Not everyone finds their labour starts following a stretch and sweep. It is okay to say no if this does not feel right for you. The procedure can be repeated but you should discuss with your maternity care provider if stretch and sweep is recommended for you. 

Learn more

Stretch and sweep - membrane sweep | Pregnancy Birth and Baby

An episiotomy is a surgical cut (incision) made in the perineum (the skin between the vagina and anus) during childbirth to widen the vaginal opening. It is performed during the pushing stage (second stage) of labour to assist the birth of the baby or to reduce the risk of severe tearing. 

In Australia, episiotomy is not routine practice and maternity care providers are encouraged to be selective in who they offer an episiotomy. This means only women with a clear clinical indication such as:

• the baby needs to be born quickly
• forceps or vacuum are going to be used
• to help prevent severe tearing of the perineum.

If you have experienced female genital mutilation/cutting (FGM/C), or you’re unsure if you have, your healthcare team will discuss any additional care that may be needed during labour and birth to support a safe vaginal birth.

Supporting women affected by FGM/C in Victoria | health.vic.gov.au

Female genital cutting or circumcision (FGC) | Better Health Channel

Your maternity care provider will discuss an episiotomy if recommended and they must obtain your consent before going ahead with the episiotomy. The episiotomy is repaired soon after birth just the same as a tear and usually heals well with the appropriate hygiene and care. 

Even with the best care, tears and episiotomies have a small risk of becoming infected. Your maternity care provider will ask to check the area over the next few weeks to ensure it is continuing to heal well. They may also suggest dietary changes that can help when needing to open your bowels to minimise discomfort. 

Learn more

Episiotomy | Pregnancy, Birth and Baby

The third stage of labour is when the placenta is birthed after the birth of the baby, this is a normal and expected part of birth. This can occur through physiological (natural) management, where contractions push the placenta out on its own without medication, or assistance. 

Active management is when a medication is given to make the uterus contract and help the placenta come away more quickly. Active management is more commonly used because it reduces the risk of excessive bleeding (postpartum haemorrhage). 

In physiological management, the process may take longer but involves fewer medical interventions. The choice depends on the preference of the mother in consultation with her maternity care provider. It is a good idea to discuss the type of management you feel is right for you with your maternity care provider prior to birth so they can discuss the benefits and risks of each approach. 

Learn more

About the placenta – role and complications | Pregnancy, Birth and Baby

Giving birth - third stage of labour | Pregnancy Birth and Baby

Some women experience a vaginal or perineal tear during birth while others may have an episiotomy. The aim is to repair the perineum soon after birth. The degree of the tear will determine if it can be repaired in the same place you birthed, with appropriate pain relief or if it needs to be repaired in the operating theatre. The type of tear or procedure you have experienced may influence your recovery:

• First or second-degree tears usually heal well with stitches dissolving naturally over several weeks.
• Third or fourth-degree tears involve the anal sphincter and require additional follow-up and recovery support.
• Episiotomies generally heal in a similar way to tears and may take several weeks to recover.
• Forceps or ventouse births may be associated with increased swelling, bruising or perineal discomfort.

Good care and hygiene help the tear to heal. Your maternity care provider will explain what type of tear you have, if it needs stitches and what to expect during recovery and beyond.

Pelvic floor physiotherapy (accessed through some public health services or private providers) and perineal massage during late pregnancy has been shown to lower the risk of more significant tears during vaginal or assisted vaginal birth. 

Learn more

Better Births for Women Collaborative | Safer Care Victoria

Perineal Tear | Birth Trauma Australia

Perineal tears | Safety and Quality in Healthcare

Perineal Tears | Women's Healthcare Australasia

Perineal tears | Pregnancy, Birth and Baby

Perineal massage | Pregnancy Birth and Baby

Care teams routinely monitor bleeding after birth closely by checking the amount of blood loss at regular intervals, feeling the uterus by pressing on the abdomen (this may feel uncomfortable) and your observations. An excessive amount of bleeding is called a postpartum haemorrhage (PPH) and can occur after birth or it may occur any time in the 6 weeks following birth. 

It is recommended that maternity care providers weigh all blood loss after birth. If blood loss is assessed as excessive (500mls or more), staff are trained to act quickly and use treatments such as medications, IV fluids and other interventions to help the uterus contract. Staff are trained to recognise and intervene early to reduce complications. Ongoing monitoring continues after treatment to support recovery and ensure bleeding stays under control. If you didn’t birth in a hospital, you may need to be transferred into hospital, usually by ambulance, to receive additional care.

Learn more

Postpartum haemorrhage | Pregnancy Birth and Baby