The stages of labor and delivery

What are the stages of labor?

There are three stages of labor. Here's what they include:

Stage 1: Early labor contractions, active labor, and full dilation of the cervix

Stage 2: Pushing and delivering the baby

Stage 3: Delivering the placenta

The first stage of labor is the longest. A lot happens in this stage – so much that it's divided into three phases:

• Early labor: Your cervix gradually thins out and opens to about 6 centimeters (cm) by the end of this phase.
• Active labor: Your cervix begins to dilate more rapidly and opens up further to 10 cm. Contractions are longer, stronger, and closer together.
• Transition: During the last part of active labor, contractions are even longer, stronger, and closer together. This can be the most difficult part of your entire labor.

Every pregnancy is different, and there's wide variation in the length of labor. For first-time moms, labor often takes between 12 and 18 hours. For women who've already had a vaginal birth, labor may last 8 to 10 hours. These are just estimates: For some women labor lasts much longer, while for others it's over much sooner.

First stage of labor

The first stage of labor is the longest stage, especially if you're giving birth for the first time. Early labor usually takes the longest amount of time and transition the shortest.

Early labor

You may have had signs of early labor – such as more frequent Braxton Hicks contractions, loss of your mucus plug, bloody show, and even some cervical dilation and effacement – for days or even weeks now. Or maybe not! Either way, once you start having regular, persistent contractions, you're in labor.

What to expect:

• Contractions start. You'll start having contractions at relatively regular intervals. Early labor contractions are sometimes hard to distinguish from "false labor" (that is, irregular Braxton Hicks contractions). True labor contractions get closer together as time goes on and are more regular than Braxton Hicks contractions. If you aren't sure whether you're in true labor, see whether you can hold a complete conversation. If you have to stop, especially mid-sentence, to breathe through contractions, you're probably moving into early labor.
• Contractions get longer, stronger, and closer together. Eventually they'll be coming every four to five minutes and lasting 40 to 60 seconds each. (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.) Early labor ends when your cervix is about 6 cm dilated and your progress starts to accelerate.
• You may feel some pain. If your labor is typical, your early contractions will be mild enough for you to talk through them and putter around the house, or even doze off between them. But as your labor progresses, your contractions will become painful.
• You may feel pelvic pressure or back pain as your baby moves down. If you have lower back pain with your contractions, you may be having back labor.
• You may see a mucousy vaginal discharge. This 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 doctor or midwife.
• Your water may break. Call your provider if your water breaks. It may feel like a slow trickle of liquid or a strong gush.

What to do:

• Time contractions periodically. Don't become a slave to the 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 your contractions 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.
• Rest. 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.
• Relax. If you're feeling anxious, you may want to try some relaxation exercises, take a warm bath, or do something to distract yourself a bit – like watching a movie.
• Drink plenty of fluids to keep 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.

Active labor

There's no doubt now that your baby is on the way. Your doctor or midwife may have given you instructions about when to go to the hospital or birth center, but usually once you have regular, painful contractions (lasting about 60 seconds each) every four to five minutes for an hour or more, it's time to grab your hospital bag and head out.

What to expect:

• Contractions become intense. Active labor is when things really get rolling. Your contractions become increasingly intense – more regular, longer, and stronger – and you'll no longer be able to talk through them.
• Contractions get more frequent. In most cases, contractions eventually happen every 2 1/2 to 3 minutes, although some women never have them more often than every 5 minutes, even during transition.
• Cervix opens wider. Your cervix dilates more quickly. (The last part of active labor, when the cervix dilates fully from 8 to 10 cm, is called transition, which is described in the next section.)
• Your baby may begin to descend toward the end of active labor, although they might have started to descend earlier, or might not start until the next stage.
• Nausea and vomiting. This is fairly common now, sometimes from epidural anesthesia causing the blood pressure to drop, and sometimes from stimulation of nerves that cause vomiting.

What to do:

• Get pain relief if you need it. Most women opt for pain medication, such as an epidural, at some point during the active labor phase.
• Try relaxation techniques. Many 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.
• Lean on your support person. Your partner, a friend or family member, or a hired doula can be a huge help now. You'll probably appreciate lots of gentle encouragement.
• Move. 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.
• Sit or lie down on your side. If you're tired, try sitting in a rocking chair or lying in bed on your left side.
• Get a massage. This might be a good time to ask your birth partner or doula for a massage to help ease labor pain.
• Take a warm shower or bath if you have access to a tub and your water hasn't broken. Even if your water has broken, a shower is probably okay, as the risk of infection is low. (Don't take a bath if your water has broken.)

Transition

The last part of active labor is called the transition period because it marks the shift to the second stage of labor. Your contractions are at their strongest, and your cervix completely opens up so that your baby can pass through.

What to expect:

• A fully dilated cervix. Your cervix dilates from 8 cm to a full 10 cm.
• Very strong contractions. This is the most intense part of labor. Contractions are usually very strong, coming every 2 1/2 to 3 minutes or so and lasting a minute or more. You may start shaking and shivering.
• Pressure on your rectum. 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.
• Discharge. There's often a lot of bloody discharge.
• Nausea. You may feel nauseated or even vomit.
• An urge to push. 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. 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 your baby is in your pelvis.

Second stage of labor

Once your cervix is fully dilated, the second stage of labor begins: pushing and the final descent and birth of your baby.

The entire second stage can last anywhere from a few minutes to several hours.

What to expect:

• More spaced-out contractions. 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.
• Less intensity as pushing begins. 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.
• The urge to push. As your uterus contracts, it exerts pressure on your baby, moving them down the birth canal. 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.
• You might want to take it slow. 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 in the end.
• You may be instructed to push. In many hospitals it's routine to coach women to push with each contraction in an effort to speed up the baby's descent. Let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. This practice, known as laboring down, has been shown to be as effective as coached pushing, although delivery may take a little longer.
• Epidurals can reduce the urge to push. 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. You may need explicit directions to help you push effectively.

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 the birth canal. The descent may be rapid. Or, especially if this is your first baby, the descent may be gradual.

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.

Learn more about how to push during labor.

Crowning

What to expect:

• Your baby's scalp will appear. 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 want to reach down and touch the top of their head.
• A powerful pushing urge. Now the urge to push becomes even stronger. With each contraction, more and more of your baby's head becomes visible. The pressure of their head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. This is called "the ring of fire," and it lasts just a few minutes.
• Instructions to slow down or pant. 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 prevent perineal 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. Sometimes, gently coughing instead of pushing can result in a slower, easier descent of your baby's head.
• The whole head appears. Your baby's head continues to advance with each push until it crowns – that's when the widest part of their head is finally visible. The excitement in the room will grow as your baby's face begins to appear: their forehead, their nose, their mouth, and, finally, their chin.
• Provider removes any blockages. After your baby's head emerges, your doctor or midwife may suction their mouth and nose and will feel around their neck for the umbilical cord. If the cord is around your baby's neck, your caregiver will either slip it over their head or, if need be, clamp and cut it.
• The body emerges. Your baby's head then turns to the side as their shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as their shoulders emerge, one at a time, followed by their body.

Third stage of labor

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, they 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. On average, the third stage of labor lasts just five or six minutes, with 90 percent of placentas delivered by 15 minutes from the birth of your baby.

If the placenta is still attached 30 minutes after birth (or sooner if there's heavy bleeding), your provider might need to take action to assist in its delivery. This might mean giving you a drug to help your uterus contract, massaging the top of the uterus to encourage placental separation, or gently tugging on the umbilical cord.

In the meantime, nurses and doctors will be caring for your baby:

• They need to be dried off with a towel and kept warm.
• Your doctor or midwife may quickly suction your baby's mouth and nasal passages if they seem to have a lot of mucus.
• If there are no complications, they'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at them. Skin-to-skin contact will keep your baby nice and toasty, and they'll be covered with a warm blanket – and perhaps given their 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 a few), and, of course, intense relief that it's almost over. Exhausted as you may be, you'll also probably feel a burst of energy.

What happens after you give birth

• Your uterus contracts. 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 may suffer from a postpartum hemorrhage as you continue to bleed profusely from those vessels.
• You can try breastfeeding. If you're planning to breastfeed, start now if you can. 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. What's more, nursing triggers the release of oxytocin, the same hormone that causes contractions, which helps your uterus stay firm and contracted.
• You may receive oxytocin or other treatments. You may be given oxytocin to help your uterus contract. (Many providers routinely give it to all women at this point). If you're bleeding excessively, you'll be treated for that as well.
• Contractions will subside. Your contractions at this point are relatively mild. 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 such as ibuprofen, which is very effective against this crampy pain and safe for you to take, even if you're breastfeeding.
• You may also have the chills or feel very shaky. Postpartum chills are 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 they'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.
• 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, you'll spend some quiet time together. You and your partner or other loved ones can share this special time as you get acquainted with your new little miracle.

Learn more:

• Moms describe what labor feels like
• What happens to your baby right after birth
• Tips for labor coaches
• Delayed cord clamping