Every pregnancy is different, and so is every birth. Some people plan for a vaginal birth, some need or choose a caesarean, and sometimes the plan changes on the day. None of these paths is a failure — the aim is a safe birth for you and your baby.

Dr Mahadik talks through your options with you as part of your antenatal care, so you understand what is involved and what to expect. If your pregnancy needs extra monitoring, that may shape which options are recommended, and she will explain why.

You do not have to decide everything in advance. Having a preferred plan is helpful, and it is also normal to stay flexible, because labour and birth can be unpredictable.

A vaginal birth is when your baby is born through the vagina. For many people it is the first option considered, and it is often possible even after a previous caesarean (see birth after caesarean below).

During your antenatal appointments, Dr Mahadik will discuss what a vaginal birth may involve for you. This includes pain relief options and what happens if extra help is needed.

Labour can begin in different ways, and the early signs vary from person to person.

You may notice one or more of the following:

• Period-like cramps
• Regular, painful tightening of your tummy (contractions)
• A "show" — mucus, sometimes mixed with a little blood, from your vagina
• Your waters breaking — a gush or a slow leak of fluid from your vagina

If you think your waters have broken, contact the hospital. You will usually be asked to come in so your baby's wellbeing can be checked. If it is confirmed that your waters have broken and labour has not started, you may be offered induction of labour. This is generally within about 24 hours, depending on your circumstances and preference.

Labour is described in three stages:

• In the first stage of labour, the cervix dilates (stretches open) in response to regular uterine contractions (which are regular and painful). The cervix opens from 4 cm (considered as the start of active labour) to 10 cm (or fully dilated cervix).
• The second stage is when the baby is born vaginally following full dilatation of the cervix. This involves coordinated maternal efforts during contractions, which facilitate the birth of the baby.
• In the third stage the placenta and membranes (the afterbirth) are delivered.

The first stage has a slower latent phase (up to around 4 cm) and a quicker active phase (from 4 cm to fully dilated).

The length of labour varies a great deal from one person to another, so these are guides rather than fixed timings:

• The latent phase of labour is when the cervix changes from being closed to stretching open up to 4 cm dilatation. This is associated with uterine contractions. The latent phase is variable in length. It is considered prolonged if it lasts more than 20 hours in a first-time labouring mother, or 14 hours in mothers in their subsequent births. During this time you are usually encouraged to stay at home, keep hydrated, stay mobile, and use relaxation techniques or a warm shower to ease the cramps.
• The active stage of labour generally lasts for 10-12 hours in a first-time mother. It is shorter for subsequent births.

If labour is slower than expected, your care team will talk with you about your options.

There are several pain relief options, and you can change your mind during labour. Your care team will help you weigh them up.

You breathe nitrous oxide ("gas") through a mouthpiece during contractions. It takes the edge off the pain rather than removing it, and you use it continuously as each contraction builds. It has few after-effects, though some people feel a little light-headed or nauseated.

Morphine can significantly reduce pain, though it does not take it away completely. If it is given close to the birth, it can cause short-lived breathing difficulties in the newborn. It can also cause side effects for you, including altered perception, nausea and slowed breathing.

An epidural is an injection into the lower back that numbs the pain, often removing it completely. It is given by an anaesthetist. Serious complications are uncommon when an epidural is given by a specialist anaesthetist. Possible effects include a drop in blood pressure, the need for a urinary catheter, itching or shivering, a slower pushing stage, and a slightly higher chance of needing an assisted birth. If you have an epidural, your baby's heartbeat will be monitored continuously.

Sometimes extra help is needed to deliver your baby safely during a vaginal birth. This is called an assisted, or instrumental, birth.

An assisted birth may be recommended for:

• Maternal exhaustion
• Prolonged second stage
• Fetal distress
• Maternal medical conditions like heart disease or severe pre-eclampsia (to reduce the duration of pushing)

You still push — the instrument assists your efforts. A vacuum (ventouse) uses a soft plastic suction cup placed on the baby's head. Forceps are smooth, curved instruments that fit around the baby's head. If there is not enough time or the assisted birth is not successful, a caesarean may be recommended instead.

A detailed assessment is undertaken to assess suitability of instrumental birth. Instrumental births are performed with due precautions and diligence and generally do not have any major issues.

Complications, if they occur, are uncommon and can include significant maternal perineal tears (3rd or 4th degree tears). Fetal injuries may include minor bruising under the scalp. Rarely, there can be significant bleeding under the scalp, which may need nursery admission and monitoring, as well as nerve injuries. Forceps delivery may rarely be associated with skull fractures. Your obstetrician will only recommend an assisted birth when the benefit outweighs the risk, and will explain the reason at the time.

Induction of labour means starting labour with medical help, rather than waiting for it to begin on its own. It is recommended when the risks of continuing the pregnancy are thought to outweigh the risks of starting labour.

Common reasons include going past your due date, your waters breaking without labour starting, or a medical reason to bring the birth forward for your health or your baby's. Dr Mahadik will explain why induction is being recommended in your situation.

The method depends on how ready your cervix is, your previous births, and the reason for the induction. It may involve:

• Cervical ripening — softening and opening the cervix with a prostaglandin (gel, pessary or tablet) or a balloon catheter. This can take from several hours up to a day or more.
• Breaking your waters — a small procedure to release the fluid around your baby.
• An oxytocin drip — a hormone given through a drip in your arm to start or strengthen contractions.

Often more than one method is used, one after another.

An induced labour is monitored more closely than one that starts on its own. You can expect your baby's heartbeat to be monitored, and vaginal examinations roughly every four hours to check your progress. Induction can take time, particularly for a first baby, and your care team will keep you informed at each step.

A caesarean (c-section) is when your baby is born through a cut in your lower tummy. It is a common operation, and for some pregnancies it is the safest way to give birth. Most caesareans are done under a spinal or epidural anaesthetic, so you stay awake and your support person can usually be with you.

A caesarean may be planned (elective) — known during pregnancy — or done as an emergency during labour.

A planned caesarean is usually carried out after 39 weeks. Reasons can include:

• A previous caesarean birth
• Your baby not lying head-down (for example, breech)
• The placenta lying low in the uterus
• A twin pregnancy where the first twin is not head-first

There are other reasons too, which Dr Mahadik will discuss with you if a planned caesarean is recommended.

An emergency caesarean is done during labour — for example if labour is not progressing, labour is obstructed, or your baby is not coping well with labour.

A caesarean is generally safe, but, like any operation, it carries some risks. Infection is the most common. Others, which are less common, include:

• Bleeding
• Damage to nearby organs such as the bowel or bladder
• Blood clots
• A reaction to the anaesthetic
• Risks in future pregnancies, such as a repeat caesarean or problems with how the placenta attaches

Your care team is trained to reduce these risks, and will talk them through with you.

Recovery from a caesarean takes time. In general:

• You will not be able to move around for the first 8-10 hours after the operation.
• You will need regular pain relief for a few days.
• You will have a drip in your arm giving you fluids.
• You will have a catheter in your bladder to drain urine, usually removed the next day.
• You will usually stay in hospital for 2-3 days.
• Full recovery takes around 4-6 weeks. During this time you will need support at home and should avoid heavy lifting, too many stairs, and driving.

For more on the weeks after the birth, see postnatal care.

If you have had a caesarean before, you may be able to plan a vaginal birth next time. This is called VBAC — vaginal birth after caesarean. Alternatively, you can choose a planned repeat caesarean. Dr Mahadik will help you weigh up which suits your individual circumstances.

For many people, yes. Among women who plan a VBAC, around 60-80% go on to have a vaginal birth, depending on individual factors such as the reason for the previous caesarean and whether you have given birth vaginally before.

The main risk is a tear in the scar from the previous caesarean (uterine rupture). This is uncommon — around 0.5% (roughly 1 in 200) for women with one previous lower caesarean scar. Because of this, a planned VBAC is supported by continuous monitoring of your baby's heartbeat during labour. If a VBAC is not recommended or not successful, a repeat caesarean is planned, usually from 39 weeks.

Whether a VBAC is a suitable option depends on your history and your current pregnancy. Dr Mahadik will discuss the benefits and risks with you so you can make an informed choice.