The process of labor and birth is divided into three stages:
The first stage begins when you start having contractions that cause progressive changes in your cervix and ends when your cervix is fully dilated. This stage is divided into two phases:
Early labor: Your cervix gradually effaces (thins out) and dilates (opens).
Active labor: Your cervix begins to dilate more rapidly, and contractions are longer, stronger, and closer together. People often refer to the last part of active labor as transition.
The second stage of labor begins when you’re fully dilated and ends with the birth of your baby. This is sometimes referred to as the “pushing” stage.
The third stage begins right after the birth of your baby and ends with the delivery of the placenta.
Every pregnancy is different, and there’s wide variation in the length of labor. For first-time moms, labor often takes between ten and 20 hours. For some women, though, it lasts much longer, while for others it’s over much sooner. Labor generally progresses more quickly for women who’ve already given birth vaginally.
First stage: Early labor
Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you’re officially in labor. But unless your labor starts suddenly and you go from no contractions to fairly frequent and regular contractions right away, it can be tricky to determine exactly when true labor starts. That’s because early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may come right before, contributing to so-called false labor.
(By the way, if you’re not yet at 37 weeks and you’re noticing contractions or other signs of labor, don’t wait to see if your contractions progress. Call your caregiver immediately so to determine whether you’re in preterm labor. If you’re at least 37 weeks pregnant, your caregiver has likely given you instructions on how to track your contractions and when to call.)
Assuming your pregnancy is full-term, though, time will tell: If you’re in early labor, your contractions will gradually become longer, stronger, and closer together. Eventually they’ll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, but the contractions will still tend to be relatively mild and last no more than a minute.
Sometimes early labor contractions are quite painful, even though they may be dilating your cervix much more slowly than you’d like. If your labor is typical, however, your early contractions won’t require the same attention that later ones will.
You’ll probably be able to talk through them and putter around the house. You may even feel like taking a short walk. If you feel like relaxing instead, take a warm bath, watch a video, or doze off between contractions if you can.
You may also notice an increase in mucusy vaginal discharge, which may be tinged with blood – the so-called bloody show. This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you’re not having contractions yet.
Early labor ends when your cervix is about 4 centimeters dilated and your progress starts to accelerate.
How long early labor lasts
It can be difficult to tell exactly when early labor starts, so it’s often not easy to say how long this phase typically lasts – or even, after the fact, how long it lasted for a particular woman. The length of early labor is quite variable and depends in large part on how ripe (dilated and effaced) your cervix is at the beginning of labor and how frequent and strong your contractions are.
With a first baby, if your cervix isn’t effaced or dilated to begin with, this phase may take six to 12 hours, although it can be significantly longer or shorter. If your cervix is already very ripe or this isn’t your first baby, it’s likely to go much more quickly.
Don’t become a slave to your stopwatch just yet – it’s stressful and exhausting to record every contraction over the many long hours of labor, and it isn’t necessary. Instead, you may want to time them periodically to get a sense of what’s going on. In most cases, your contractions will let you know in no uncertain terms when it’s time to take them more seriously.
Meanwhile, it’s important to do your best to stay rested, since you may have a long day (or night) ahead of you. If you’re tired, try to doze off between contractions.
Be sure to drink plenty of fluids so you stay well hydrated. And don’t forget to urinate often, even if you don’t feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
If you’re feeling anxious, you may want to try some relaxation exercises or do something to distract yourself a bit – like watching a movie or reading a book.
First stage: Active labor
Active labor is when things really get rolling. Your contractions become increasingly intense – more frequent, longer, and stronger – and you’ll no longer be able to talk through them. Your cervix dilates more quickly, until it’s fully dilated at 10 centimeters. (The last part of active labor, when the cervix dilates from 8 to 10 centimeters, is called transition, which is described in the next section.)
Toward the end of active labor your baby may begin to descend, although he might have started to descend earlier or he might not start until the next stage.
As a general rule, once you’ve had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it’s time to call your midwife or doctor and head to the hospital or birth center. Some caregivers prefer a call sooner, so clarify this ahead of time.
In most cases, the contractions become more frequent and eventually happen every two and a half to three minutes, although some women never have them more often than every five minutes, even during transition.
How long active labor lasts
For many women giving birth for the first time, active labor will last between four and eight hours, though for others, it can be even longer or as short as an hour.
The active phase tends to go more quickly if you’re getting oxytocin (Pitocin) or have already had a vaginal birth. If you have an epidural or a big baby, it may last longer.
Most women opt for pain medication , such as an epidural, at some point during the active phase.
But many of the pain-management and relaxation techniques used in natural childbirth – such as breathing exercises and visualization – can help you during labor, whether or not you’re planning to receive medication.
A good labor coach can be a huge help now, too. And you’ll probably appreciate lots of gentle encouragement.
It may feel good to walk, but you’ll probably want to stop and lean against something (or someone) during each contraction. You should be able to move around the room freely after your caregiver evaluates you, as long as there are no complications.
If you’re tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to ask your partner for a massage. Or, if you have access to a tub and your water hasn’t broken, you can take a warm shower or bath.
The last part of active labor – when your cervix dilates from 8 to a full 10 centimeters – is called the transition period because it marks the shift to the second stage of labor.
This is the most intense part of labor. Contractions are usually very strong, coming every two and a half to three minutes or so and lasting a minute or more, and you may start shaking and shivering.
By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously – to “push” – and may even start making deep grunting sounds.
There’s often a lot of bloody discharge. You may feel nauseated or even vomit now.
Some babies descend earlier and the mom feels the urge to push before she’s fully dilated. And other babies don’t descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It’s different for every woman and with every birth.
If you’ve had an epidural, the pressure you’ll feel will depend on the type and amount of medication you’re getting and how low the baby is in your pelvis. If you’d like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.
How long transition lasts
Transition can take anywhere from a few minutes to a few hours. It’s much more likely to be fast if you’ve already had a vaginal delivery.
If you’re laboring without an epidural, this is when you may begin to lose faith in your ability to handle the pain, so you’ll need lots of extra encouragement and support from those around you.
Consider a massage. Some women appreciate light touch (effleurage), some prefer a stronger touch, and others don’t want to be touched at all.
Sometimes a change of position provides some relief – for example, if you’re feeling a lot of pressure in your lower back, getting on all fours may reduce the discomfort.
A cool cloth on your forehead or a cold pack on your back may feel good, or you may find a warm compress more comforting.
On the other hand, because transition can take all of your concentration, you may want all distractions – music or conversation or even that cool cloth or your partner’s loving touch – eliminated.
It may be useful to focus on the fact that those hard contractions are helping your baby make the journey out into the world. Try visualizing her movement down with each contraction.
The good news is that if you’ve made it this far without medication, you can usually be coached through transition – one contraction at a time – with constant reminders that you’re doing a great job and that the your baby’s arrival is near.
Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them.
Many women find their contractions in the second stage easier to handle than the contractions in active labor because bearing down offers some relief. Others don’t like the sensation of pushing.
If your baby is very low in your pelvis, you may feel an urge to push early in the second stage (and sometimes even before). But if your baby’s still relatively high, you probably won’t have this sensation right away.
As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything’s going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push. Waiting a while may leave you less exhausted and frustrated in the end.
In many hospitals, however, it’s still routine practice to coach women to push with each contraction in an effort to speed up the baby’s descent – so let your caregiver know if you’d prefer to wait until you feel a spontaneous urge to bear down.
If you have an epidural, the loss of sensation can blunt the urge to push, so you may not feel it until your baby’s head has descended quite a bit. Patience often works wonders. In some cases, though, you’ll eventually need explicit directions to help you push effectively.
Your baby’s descent
The descent may be rapid. Or, especially if this is your first baby, the descent may be gradual.
With each contraction, the force of your uterus – combined with the force of your abdominal muscles if you’re actively pushing – exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby’s head will recede slightly in a “two steps forward, one step back” kind of progression.
Try different positions for pushing until you find one that feels right and is effective for you. It’s not unusual to use a variety of positions during the second stage.
The first glimpse
After a time, your perineum (the tissue between your vagina and anus) will begin to bulge with each push, and before long your baby’s scalp will become visible – a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
Now the urge to push becomes even more compelling. With each contraction, more and more of your baby’s head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch.
At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby’s head has a chance to gradually stretch out your vaginal opening and perineum. A slow, controlled delivery can help keep your perineum from tearing. By now, the urge to push may be so overwhelming that you’ll be coached to blow or pant during contractions to help counter it.
How the head emerges
Your baby’s head continues to advance with each push until it “crowns” – the time when the widest part of her head is finally visible. The excitement in the room will grow as your baby’s face begins to appear: her forehead, her nose, her mouth, and, finally, her chin.
After your baby’s head emerges, your doctor or midwife will suction her mouth and nose and feel around her neck for the umbilical cord. (If the cord is around your baby’s neck, your caregiver will either slip it over her head or, if need be, clamp and cut it.)
Your baby’s head then turns to the side as her shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you’ll be coached to push as her shoulders emerge, one at a time, followed by her body.
Out at last!
Once your baby hits the atmosphere, he needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby’s mouth and nasal passages again if he seems to have a lot of mucus.
If there are no complications, he’ll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he’ll be covered with a warm blanket – and perhaps given his first hat – to prevent heat loss.
Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps – or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it’s all over. Exhausted as you may be, you’ll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long the second stage lasts
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and about 20 minutes if you’ve had a previous vaginal delivery. If you’ve had an epidural, the second stage may last longer.
Third stage: Delivering the placenta
Minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall.
When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that’s not at all difficult or painful.
How long the third stage lasts
On average, the third stage of labor takes about five to ten minutes.
After delivery: Now what?
After you deliver the placenta, your uterus should contract and get very firm. You’ll be able to feel the top of it in your belly, around the level of your navel.
Your caregiver, and later your nurse, will periodically check to see that your uterus remains firm, and massage it if it isn’t. This is important because the contraction of the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn’t contract properly, you’ll continue to bleed profusely from those vessels.
If you’re planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but try holding your baby’s lips close to your breast for a little while. Most babies will eventually begin to nurse in the first hour or so after birth if given the chance.
Early nursing is good for your baby and can be deeply satisfying for you. What’s more, nursing triggers the release of oxytocin, the same hormone that causes contractions, which helps your uterus stay firm and contracted.
If you’re not going to nurse or your uterus isn’t firm, you’ll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you’re bleeding excessively, you’ll be treated for that as well.
Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you.
If this is your first baby, you may feel only a few contractions after you’ve delivered the placenta. If you’ve had a baby before, you may continue to feel occasional contractions for the next day or two.
These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also have the chills or feel very shaky. This is perfectly normal and won’t last long. Don’t hesitate to ask for a warm blanket if you need one.
Your caregiver will examine the placenta to make sure it’s all there. Then she’ll check you thoroughly to spot any tears in your perineum that need to be stitched.
If you tore or had an episiotomy, you’ll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you’re getting stitches – it can be a great distraction. If you’re feeling too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. This takes just a second and doesn’t hurt.
Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of birth.