Beginning stage of labor

Stages of labor

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KEY POINTS

Every woman’s labor is different. And it may be different each time you have a baby.
Learning about stages of labor before your due date can help you know what to expect so you can feel ready for your baby’s birth.
Use a birth plan so your health care provider and hospital staff know what your plans are for labor and after birth.
Having a professional support person, like a doula, during labor can help you have a better experience with labor and birth.
Try to stay comfortable and relaxed through labor. Move around and try different positions to find what works best for you.

What are stages of labor?

Labor (also called childbirth) is the process of your baby leaving the uterus (womb). Labor is divided into three stages:

Labor
Pushing and birth
Delivery of the placenta

Every woman’s labor is different. And your labor may be different each time you have a baby. But there are patterns to labor that are true for most women. Learning about the stages of labor and what happens during each one can help you know what to expect once labor begins.

What is a birth plan?

A birth plan is a set of instructions you make about your baby’s birth. It includes things like:

Where you want to have your baby
Who you want to be with you during labor and birth
If you want medicine to help with labor pain
If there are cultural traditions you’d like to follow during labor and birth
If you plan to breastfeed

Before your due date, use the March of Dimes birth plan to help you think about how you want your labor to be. Share the completed plan with your partner, your health care provider and the staff at the hospital where you plan to give birth.

What is a doula?

A doula is a trained professional who provides information and physical and emotional care and support to women before, during and after childbirth, including continuous support through labor and birth. For example, a doula can:

Help you stay comfortable during labor
Explain what’s happening during labor and birth and any procedures you may have
Encourage you and give you confidence
Support your family and friends who are with you during labor
Let hospital staff know what you need
Help you get started breastfeeding

Having a support person like a doula can be good for you, your baby and your family. It can help you feel good about your birth experience. Having a doula can help:

Shorten your labor
Reduce your need for pain medicine during labor
Reduce your risk of needing a cesarean birth or the need for your provider to use forceps or suction with a vaginal birth
Your baby get a good Apgar score at birth. Your baby gets an Apgar test right after birth to check his overall health. The test checks his heart rate, breathing, muscle tone, reflexes and skin color.

To find a certified doula, ask your provider or go to DONA International.

You also may want to have your partner, a friend or a family member be a support person to help you through labor. They can go to childbirth education classes with you to learn ways to help, like timing your contractions, helping you relax and helping you move around to find a comfortable position. Ask your provider about childbirth education classes in your area.

If you decide to have a doula or another support person help you with labor and birth, put their names and contact information in your birth plan. Share your plan with your provider and with hospital staff.

What happens in the first stage of labor?

The first stage of labor is the longest stage. For first-time moms, it can last from 12 to 19 hours . It may be shorter (about 14 hours) for moms who’ve already had children. It’s when contractions become strong and regular enough to cause your cervix to dilate (open) and thin out (efface). This lets your baby move lower into your pelvis and into your birth canal (vagina). This stage of labor ends when you are 10 centimeters dilated. The first stage is divided into three parts: early labor, active labor and transition to stage 2 of labor.

Early labor

For most first-time moms, early labor lasts about 6 to 12 hours. You can spend this time at home or wherever you’re most comfortable. During early labor:

You may feel mild contractions that come every 5 to 15 minutes and last 60 to 90 seconds.
You may have a bloody show. This is a pink, red or bloody vaginal discharge. If you have heavy bleeding or bleeding like your period, call your provider right away.

What you can do in early labor:

This is a great time for you to rely on your doula or labor support person. Try the methods you learned about in childbirth education classes about how to relax and cope with pain. During early labor:

Rest and relax as much as you can.
Take a shower or bath.
Go for a walk.
Change positions often.
Make sure you’re ready to go to the hospital.
Take slow, relaxing breaths during contractions.

Active labor

This is when you head to the hospital! Active labor usually lasts about 4 to 8 hours. It starts when your contractions are regular and your cervix has dilated to 6 centimeters. In active labor:

Your contractions get stronger, longer and more painful. Each lasts about 45 seconds and they can be as close as 3 minutes apart.
You may feel pressure in your lower back, and your legs may cramp.
You may feel the urge to push.
Your cervix will dilate up to 10 centimeters.
If your water hasn’t broken, it may break now.
You may feel sick to your stomach.

What you can do in active labor:

Make sure the hospital staff has a copy of your birth plan.
Try to stay relaxed and not think too hard about the next contraction.
Move around or change positions. Walk the hallways in the hospital.
Drink water or other liquids. But don’t eat solid foods.
If you’re going to take medicine to help relieve labor pain, you can start taking it now. Your choice about pain relief is part of your birth plan.
Go to the bathroom often to empty your bladder. An empty bladder gives more room for your baby’s head to move down.
If you feel like you want to push, tell your provider. You don’t want to start pushing until your provider checks your cervix to see how dilated it is.

Transition to the second stage of labor

This can be the toughest and most painful part of labor. It can last 15 minutes to an hour. During the transition:

Contractions come closer together and can last 60 to 90 seconds. You may feel like you want to bear down.
You may feel a lot of pressure in your lower back and rectum. If you feel like you want to push, tell your provider.

What happens in the second stage of labor?

In the second stage of labor, your cervix is fully dilated and ready for childbirth. This stage is the most work for you because your provider wants you to start pushing your baby out. This stage can be as short as 20 minutes or as long as a few hours. It may be longer for first-time moms or if you’ve had an epidural. And epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It's the most common kind of pain relief used during labor. The second stage ends when your baby is born.

During the second stage of labor:

Your contractions may slow down to come every 2 to 5 minutes apart. They last about 60 to 90 seconds.
You may get an episiotomy. This is a small cut made at the opening of the vagina to help let the baby out. Most women don't need an episiotomy.
Your baby’s head begins to show. This is called crowning.
Your provider guides your baby out of the birth canal. She may use special tools, like forceps or suction, to help your baby out.
Your baby is born, and the umbilical cord is cut. Instructions about who’s cutting the umbilical cord are in your birth plan. What you can do:
Find a position that is comfortable for you. You can squat, sit, kneel or lie back.
Push during contractions and rest between them. Push when you feel the urge or when your provider tells you.
If you’re uncomfortable or pushing has stopped, try a new position.

What happens in the third stage of labor?

In the third stage of labor, the placenta is delivered. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. This stage is the shortest and usually doesn’t take more than 20 minutes.

During the third stage of labor:

You have contractions that are closer together and not as painful as earlier. These contractions help the placenta separate from the uterus and move into the birth canal. They begin 5 to 30 minutes after birth.
You continue to have contractions even after the placenta is delivered. You may get medicine to help with contractions and to prevent heavy bleeding.
Your provider squeezes and presses on your belly to make sure the uterus feels right.
If you had an episiotomy, your provider repairs it now.
If you’re storing your umbilical cord blood, your provider collects it now. Umbilical cord blood is blood left in the umbilical cord and placenta after your baby is born and the cord is cut. Some moms and families want to store or donate umbilical cord blood so it can be used later to treat certain diseases, like cancer. Your instructions about umbilical cord blood can be part of your birth plan.
You may have chills or feel shaky. Tell your provider if these are making you uncomfortable.

What you can do:

Enjoy the first few moments with your baby.
Start breastfeeding. Most women can start breastfeeding within 1 hour of their baby’s birth.
Give yourself a big pat on the back for all your hard work. You've made it through childbirth!

What happens after your baby is born?

Congratulations! It’s time to hold your baby! Right after birth your provider places your baby skin-to-skin on your chest and covers him with a blanket. Holding your baby skin-to-skin helps your baby stay warm as he gets used to being outside the womb. It’s also a great way to get started breastfeeding. You can start breastfeeding even within an hour of your baby’s birth. Even if you don’t plan to breastfeed, hold your baby skin-to-skin so you get to know each other right away. Your baby will welcome your gentle touch, and this closeness can help you and your baby bond.

After birth, your body starts to change to help you heal. Your provider takes your temperature and checks your heart and blood pressure to make sure you’re doing well. If you had anesthesia during labor, your provider makes sure you’re recovering without any complications.

Last reviewed: March, 2019

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First Stage of Labor | American Pregnancy Association

Early Labor: The onset of labor until the cervix is dilated to 3-6 centimeters
Active Labor Phase: Continues from 3 cm until the cervix is dilated to 7 centimeters
Transition Phase – Continues from 7 cm until the cervix is fully dilated to 10 centimeters

Each phase is characterized by different emotions and physical challenges. Think of it as a big adventure with some important guidelines.

Early Labor Phase

What to do:

During this phase, you should just try to relax. It is not necessary to rush to the hospital or birth center. Try to enjoy the comfort of the familiar surroundings at home. If early labor occurs during the day, do some simple routines around the house.

Keep yourself occupied while conserving your energy. Drink plenty of water and eat small snacks. Keep track of the time of your contractions. If early labor begins during the night, it is a good idea to try to get some sleep. If you are unable to fall asleep, focus on doing some light activities like cleaning out your closet, packing your bag, or making sack lunches for the next day.

What to expect:

Early labor will last approximately 8-12 hours
Your cervix will efface and dilate to 4 centimeters
Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions
Contractions are typically mild and somewhat irregular but become progressively stronger and more frequent
Contractions can feel like aching in your lower back, menstrual cramps, and pressure/tightening in the pelvic area
You may see a mucousy vaginal discharge with a trace of blood. This is known as bloody show as is normal.
Your water might break – this is known as amniotic sac rupture and can happen anytime within the first stage of labor

When experiencing contractions, notice if they are:

Growing more intense
Following a regular pattern
Lasting longer
Becoming closer together

When your water breaks (amniotic sac rupture), note the following:

Color of fluid
Odor of fluid
Time rupture occurred

Tips for the support person:

Periodically time the contractions
Be a calming influence
Offer comfort, reassurance, and support
Suggest simple activities that draw her focus from the labor
Keep up your own strength. You will need it!

Active Labor Phase

What to do:

Now is time for you to head to the hospital or birth center. Your contractions will be stronger, longer and closer together. It is very important that you have plenty of support. It is also a good time to start your breathing techniques and try a few relaxation exercises between contractions.

You should switch positions often during this time. You might want to try walking or taking a warm bath. Continue to drink plenty of water and urinate periodically.

What to expect:

Active labor will last about 3-5 hours. If this is your first baby, or if you have an epidural, labor could last longer.
Your cervix will dilate from 4cm to 7cm
Contractions during this phase will last about 45-60 seconds with 3-5 minutes rest in between
Contractions will feel stronger and longer
This is when you can receive pain relief such as an epidural

Tips for the support person:

Give the mother your undivided attention
Offer her verbal reassurance and encouragement
Massage her abdomen and lower back
Keep track of the contractions (if she is being monitored, find out how the machine works)
Go through the breathing techniques with her
Help make her comfortable (prop pillows, get her water, apply touch)
Remind her to change positions frequently (go with her on a walk or offer her a bath)
Provide distractions from labor such as music, reading a book or playing a simple card game
Don’t think that there is something wrong if she is not responding to you

Transition Phase

What to do:

During this phase, the mother will rely heavily on her support person. This is the most challenging phase, but it is also the shortest. Try to think “one contraction at a time” (this may be hard to do if the contractions are very close together). Remember how far you have already come, and when you feel an urge to push, tell your health care provider.

What to expect:

The transition will last about 30 min-2 hrs
Your cervix will fully dilate from 8cm to 10cm
Contractions during this phase will last about 60-90 seconds with a 30 second-2 minute rest in between
Contractions are during this phase are long, strong, intense, and can overlap
This is the hardest phase but also the shortest
You might experience hot flashes, chills, nausea, vomiting, or gas
Some babies descend earlier and the mom feels the urge to push before she’s fully dilated. Other babies descend later and the mom reaches full dilation without feeling pressure.

Tips for the support person:

Offer lots of encouragement and praise
Avoid small talk
Continue breathing with her
Help guide her through her contractions with encouragement
Encourage her to relax between contractions
Don’t think that there is something wrong if she seems to be angry – it is a normal part of the transition

Want to Know More?

False Labor
Inducing Labor
Cord Blood Banking: Your Three Choices Explained

Compiled using information from the following sources:

1. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 17.

2. Pregnancy, Childbirth and the Newborn: The Complete Guide. Simkin, Penny, P.T., et al, Ch. 9.

Important to know - Health of a Petersburger

The total duration of childbirth and their course

The total duration of childbirth depends on many factors: age, physique and physical condition of the woman, her psychological mood, the speed of cervical dilatation, first pregnancy or repeated, the size of the child, the type of presentation and a number of other points.

Labor activity proceeds differently for all women, but the main periods of childbirth are clearly distinguished: 1st period - the period of contractions, the longest and most intense, 2nd period - the direct birth of a baby, 3rd period - the birth of the afterbirth (placenta).

First stage of labor (opening period)

As the name implies, during this period there is a gradual opening of the cervix as a result of regular contractions of the uterine muscles. Contractions occur with a decreasing interval, while they themselves become longer and more frequent.
The dilation period is the time elapsed from the onset of regular contractions until the cervix is fully dilated. During this period, the birth canal is prepared for the passage of the fetus through them with all the fetal formations.

Cervical dilatation occurs gradually: at first the cervix is smoothed out, then the pharynx opens up to 3-4 cm and at the end of the first stage of labor up to 10 cm. This is already a complete dilatation of the cervix. With it, during contractions, the fetal bladder becomes tense and bursts at the height of one of them, the anterior portion of amniotic fluid is poured out.

The first stage of labor is the longest and consists of three phases:

1. Latent phase (lasts 5-6 hours). It is characterized by the establishment of regular contractions, with an interval between them of 10-15 minutes. Latent, or hidden, this phase is called because the contractions of the uterus during it are painless or slightly painful. By the end of the phase, the cervix is definitively flattened and opens about 4 cm.

2. Active phase (lasts 3-4 hours). Contractions become more intense, last at least 20 seconds, and the interval between them is reduced to 5-6 minutes. Normally, during the active phase, amniotic fluid is poured out, which contributes to a faster full disclosure of the uterine pharynx. By the end of the phase, the uterus opens by 8 cm. This phase is not always clearly manifested, but it is nevertheless distinguished due to the usual weakening of contractions during disclosure from 8 to 10 cm. The child's head descends and stands in the narrow part of the small pelvis, which necessitates a slower and smoother process. Already in the transitional phase, the woman in labor feels the desire to push, to push the baby out. But in order for the head to pass through the birth canal without the risk of injury, it is necessary to achieve cervical dilatation up to 10 cm.

Second stage of labor (exile period)

The period of exile is the time from the moment of full opening of the pharynx until the birth of the fetus.

It is the second stage of childbirth that is their culmination, because for a short time (compared to contractions) the long-awaited birth of the baby takes place.

After the discharge of amniotic fluid, contractions temporarily stop. The volume of the uterine cavity decreases, the uterine cavity and vagina appear as a single birth canal. Contractions reappear and become more intense. They are joined by attempts - contractions of the muscle press (abdominal wall, diaphragm and pelvic floor). The frequency and intensity of contractions and attempts are constantly increasing. The head descends and compresses the nerves of the sacral plexus. A woman has a strong desire to squeeze the head out of the birth canal, she is looking for supports for her arms and legs to strengthen her efforts.

Pushing is a lot of physical work. During attempts, a woman experiences maximum physical stress (blood pressure rises, pulse and respiration become more frequent). During the attempts, the woman holds her breath, and in the intervals between them she rests and "gathers her strength for a new attempt."

In the process of one of the attempts, the head is born. Next, the shoulders are born (first the front, then the back) and the torso. Following the fetus, the posterior amniotic fluid is poured out with an admixture of cheese-like lubricant.

A woman in labor, having experienced severe fatigue, rests after hard work (pulse and respiration rate decrease).

Third stage of labor (postpartum period).

The afterbirth period is the time from the birth of the fetus to the birth of the placenta. During this period, the placenta separates from the walls of the uterus and the birth of the placenta (placenta with membranes and umbilical cord).

In the process of separation of the placenta from the walls of the uterus, the uteroplacental vessels are damaged, which is normally accompanied by blood loss in the amount of 100-200 ml, without adversely affecting the woman's condition. After the birth of the placenta, the uterus contracts sharply, becomes dense, which is necessary to stop bleeding in the area of the placental site; its bottom is in the middle between the womb and the navel.

During this period, the woman's pulse and respiration normalize. Her demeanor is calm. Chills can sometimes be observed (as a reaction to the transferred strong physical stress).

The third period is no longer as exciting and tense as the previous two. The child was born and the matter remains for the small - the separation of the placenta, or placenta. Nature provides for the resumption of contractions a few minutes after the birth of the baby, necessary for effective exfoliation from the uterus of tissues that nourished the fetus during pregnancy (placenta, membranes, umbilical cord).

Three periods of physiological labor - the natural end of a nine-month wait. Most likely, during the birth process itself, the woman in labor will not care what the period or phase of childbirth is now, but it is still desirable to know about them, at least for greater certainty before going to the hospital.

How to behave in childbirth? Learning to give birth quickly and with problems

Childbirth is a natural process laid down by nature. The whole sequence of events that take place during this period is predetermined, but by your actions you can either speed up the birth of a baby, or complicate his birth.

Childbirth is the final and most important stage of pregnancy. How you behave and how accurately and skillfully you follow the instructions of the obstetrician depends on how you will feel and how quickly your baby will be born. What does a newborn need to know? Let's try to answer the most important questions.

1. When is it time to go to the maternity hospital?

Childbirth is a natural result of hormonal changes that occur in your body during the final stages of pregnancy. The sagging belly and heaviness in its lower part and the lumbar region speak of the imminent denouement of the story. Periodically, weak contractions occur, the stomach tenses and pulls down, but these sensations quickly pass, the uterus relaxes again and becomes soft. Such contractions are harbingers of childbirth, but they are far from real labor activity.

The signal to call an ambulance should be sufficiently strong contractions that are repeated at regular intervals, the appearance of mucous secretions from the genital tract, slightly stained with blood, or the outflow of amniotic fluid.

2. First stage of childbirth: we breathe for two!

From the moment the contractions become regular, the first stage of labor begins, during which the strength, frequency and duration of uterine spasms increases and the cervix opens.

During spastic contraction of the uterine muscle fibers, the blood vessels that carry arterial blood to the placenta and fetus are compressed. The fetus begins to experience a lack of oxygen, and this involuntarily makes you breathe deeper. The reflex increase in the rate of contractions of your heart will ensure the delivery of oxygen to the child. Nature has provided that these processes take place regardless of your consciousness, but you should not completely rely on it.

In the first stage of labor, during each contraction, you need to breathe calmly and deeply, trying not to hold your breath while inhaling. At the same time, the air should fill the upper sections of the lungs, as if raising the chest. You need to inhale through the nose, slowly and smoothly, exhale through the mouth, just as evenly.

3. Auto-training in the prenatal ward

To speed up the opening of the cervix, you need to walk more, but sitting is not recommended, while blood flow in the limbs is disturbed and venous blood stagnation occurs in the pelvis. From time to time it is useful to lie on your side, stroking your lower abdomen with both hands in the direction from the center to the sides, focusing on breathing and saying to yourself: "I am calm, I am in control of the situation, each contraction brings me closer to the birth of a baby."

4. To relieve pain

Acupressure of the lower back can help relieve pain. Find the outer corners of the sacral rhombus on your lower back and massage these points with clenched fists.

Monitor the frequency and duration of contractions and if they weaken or sharply increase, immediately inform your doctor. In case of severe pain, you can ask for an anesthetic, but you should remember that you should not take the medicine too often, this is fraught with narcotic depression of the newborn and a decrease in his adaptive abilities.

If dilatation of the cervix has caused reflex vomiting, rinse your mouth with water and then drink a few sips to replace the lost fluid. Do not drink a lot, this can provoke a recurrence of vomiting.

5. The maternity ward is not a place for tantrums

They say that difficult childbirth is a person's retribution for walking upright. Childbirth is actually a painful process, but the presence of reason allows us, representatives of the genus Homo sapiens, to control our emotions. Screaming, crying, tantrums and swearing have no place in the maternity ward. This creates a tense environment, interferes with the normal course of childbirth, complicates diagnostic and therapeutic measures, and ultimately affects their outcome.

6. Second stage of labor - pushing and expulsion of the fetus

After the baby's head slips through the dilated cervix and finds itself on the bottom of the pelvis, the pushing period of labor begins. At this time, there is a desire to push, as it usually happens during a bowel movement, but at the same time many times stronger. At first, the attempts are controllable, they can be "breathed", but by the beginning of the third stage of labor, the expulsion of the fetus, they become unbearable.

With the beginning of the straining period, you will be transferred to the delivery room. Having settled down on the delivery table, rest your feet on the special steps, firmly grasp the handrails and wait for the midwife's command.

While pushing, inhale deeply, close your mouth, tighten your lips tightly, pull the handrails of the birthing table towards you and direct all the energy of exhalation down, squeezing the fetus out of you. When the top of the baby appears from the genital slit, the midwife will ask you to ease your efforts. With gentle movements of her hands, she will first release the baby’s forehead, then his face and chin, after which she will ask you to push again. At the moment of the next attempt, the baby's shoulders and torso will be born. After the newborn is born, you can breathe freely and rest a little, but the birth is not over.

7. The third stage of labor and the final stage

The third stage of labor is the afterbirth period. At this time, weak contractions are observed, due to which the fetal membranes gradually exfoliate from the walls of the uterus.

About 10 minutes after your baby is born, your midwife will ask you to push again to deliver your afterbirth. The doctor will carefully examine it and make sure that all parts of the membranes have come out. After that, with the help of mirrors, he will examine the cervix and make sure that it is intact.