Understanding the Stages of Labor

Your body has been tirelessly preparing for your baby’s delivery to the outside world for months, and now it’s nearly time. What’s between you and finally holding that sweet baby in your arms? Labor.

At the end of pregnancy, labor looms large, and you may have tons of questions circling:

• When will I go into labor?
• How long will my labor last?
• Will I be able to cope?
• Will my labor go according to plan?

No matter how you’re feeling or what you’re planning for your baby’s birth, understanding the basic physiological stages of labor is the foundation of any sound birth preparation. Set aside time during your pregnancy to become familiar with the progression and common milestones of labor, so that you can be more reassured and confident when you’re in the midst of yours.

How long does labor last?

This is a common question with no simple answer. Labors can be as long as several days and as short as several hours. The middle range is somewhere from 12 to 24 hours for first births and eight to ten hours for subsequent births (source). Recent research shows that labors last, on average, longer now than they did during our grandmother’s time (source), and first labors are usually longer than those for second and third babies.

Stages of labor

Labor is divided into three stages, which include the thinning and opening of the cervix, the descending of the baby through the pelvis and out the birth canal, and the delivery of the placenta.

Stage one: early labor, active labor, and transition

The first stage of labor is the longest and includes three sub-phases within it: early labor, active labor, and transition. It begins with the onset of regular contractions and ends with the full dilation of the cervix. According to the U.S. office on Women’s Health, the first stage of labor is usually 12 to 18 hours, but lengths can vary considerably. Most labors begin quietly and build progressively without a defined starting point. Few labors actually begin with spontaneous water breaking (although you’d never know it from watching TV).

Leading up to early labor, you may notice common signs of your body’s late stages of labor preparation, including loss of the mucus plug followed by some light-colored blood (sometimes called the “bloody show”), lightening, menstrual-like cramping in your lower back and belly, or irregular Braxton Hicks contractions.

Early labor

In early labor, contractions become more regular, meaning that they do not go away with a change of position or activity. If you’re unsure about whether your early contractions are actually the beginning of labor, try this: go for a brisk walk and then lie down to rest. If your contractions are consistent throughout both walking and resting, then labor has likely begun.

With the onset of regular contractions in early labor, your cervix begins the process of effacing (becoming very thin and soft) and dilating (opening wide for the baby to pass through). For first-time mamas, the cervix must efface considerably before it can begin dilating. Your doctor or midwife will likely check effacement and dilation in a vaginal exam. Effacement is estimated in percentages (100% means fully effaced). Dilation is estimated in centimeters (ten centimeters marks full dilation and the end of the first stage of labor). Don’t be discouraged if you’re not dilating quickly: early labor includes a lot of action that precedes any dilation!

As early labor continues, your baby will begin his descent into the pelvis, and the pressure of his head on your cervix will aid in dilation. When your baby’s head is low and pressing on your cervix, your doctor or midwife might explain that the baby is “fully engaged.”

Throughout the first stage of labor, contractions will progressively build to become longer in duration, stronger in sensation, and closer together. During early labor, you’ll likely find that you’re still able to speak freely through contractions and move about easily.

Early labor is a good time to rest, eat nourishing energy-packed foods, and stay as comfortable as possible. If you’re giving birth at a hospital or birth center, you may decide to spend much of early labor in the comfort of your own home. Always stay in contact with your care provider and your birth support team during this time.

Active labor

With the onset of active labor, your contractions will become closer together, longer and stronger. You’ll likely find it difficult to distract yourself from the sensations of contractions, and you’ll need to employ coping strategies to work through each one. As contractions become more intense, the time of rest between each one will become shorter. Remember that what you’re feeling during each contraction is the powerful muscles of your uterus involuntarily working to open your cervix.

Doctors and midwives now define active labor as beginning at six centimeters dilation (source), which means that this phase is short when compared with early labor. Your body will already have established a steady rhythm of contraction and dilation, so you may be in true active labor for 30 minutes to a couple of hours before the transition begins.

If contractions are still irregular by the time active labor begins, your doctor or midwife might check on the baby’s positing. Some babies need extra help getting into an optimal position in order to keep labor progressing steadily. If your baby is not head down with his back toward your belly, you may try changing positions or moving around in order to encourage your baby’s descent.

Most women will relocate to the place where they plan on giving birth by the time active labor begins. They will have their birth team and medical provider close by for monitoring and support during this time.

Transition

Transition includes the very final, most intense, (and thankfully brief) stretch of the first stage of labor. Your cervix will be close to full dilation by this time and contractions will be at their peak intensity with very short periods of rest in between.

In preparation for the second stage of labor, when your body will have to exert extra effort pushing, many women experience a strong surge of adrenaline during transition. The effects of this adrenaline rush can include shaking, sweating, and nausea.

With such intense sensations surging throughout the body, it’s common to feel helpless and out of control during this phase. You may be unsure about how much longer you can be in labor. Keep your birth partner and support team close for extra support and encouragement. Your doctor or midwife will likely be nearby, as they can recognize this intensity as a sure sign that your cervix is almost fully dilated and that the second stage of labor will soon begin.

Stage two: pushing and birth

Once your cervix is fully dilated, your baby can now pass through the pelvis, twisting his way out of the birth canal and into the world. This is the second stage of labor, and it often begins with the laboring mama feeling an urge to begin pushing and ends with the birth of the baby.

The second stage of labor is significantly shorter than the first, but like the first stage, it can vary in duration from mother to mother and labor to labor. It may take first-time mothers some extra time to discover the most effective way to push and to establish a rhythm that works for her body and her baby.

Most women will find it most effective to push during contractions and to rest in between. You may find that you benefit from the encouragement and coaching from your partner, doula, or nurse, or you may prefer to push in a more spontaneous way without any outside coaching.

In general, the second stage lasts anywhere from 15 minutes to three hours (source). Most hospitals and birth centers have guidelines on the time limits of the second stage of labor. Talk to your doctor or midwife for more information about these policies, and what to expect as a result.

As your baby’s head begins to crown, pushing usually becomes more controlled and steady. Your midwife or doctor might ask you to slow down your breathing and pushing in order to allow your baby’s head and shoulders to emerge gently with minimal risk of injury or tears to your skin.

Stage three: delivery of placenta

Once your baby is born, the hard work of labor is over. Take a deep breath, gather yourself, and welcome your baby into your arms. During this time, your doctor or midwife will attend to you and your baby according to the details of your birth plan. They may place the baby on your chest for immediate skin-to-skin contact, cut the baby’s umbilical cord, or give the baby routine medications.

Anywhere from five to thirty minutes after your baby is born, you’ll begin to feel contractions again, signaling that your body is ready to deliver the placenta. This is the third and final stage of labor.

Placing your baby on your chest skin-to-skin often encourages the natural delivery of the placenta. The intense surge of the love hormone oxytocin that you’ll feel in this moment of bonding with your new baby will trigger uterine contractions, while your baby’s newborn kicking reflex will gently massage your belly (source).

As you birth the placenta, you’ll only need to give a few gentle pushes. Once the placenta is delivered, your midwife or doctor will give you any necessary stitches while you take this time to rest and marvel at your new baby.

Can I move around during labor?

Many women find that staying active during labor is essential to coping with contractions and helping labor progress. Increasingly, doctors are encouraging women to move around while they’re in labor and hospital policies are shifting to accommodate this. If you have concerns about your ability to move around during labor at your chosen birth location, speak with your doctor or midwife about this concern during your pregnancy.

Most positions and movement that are effective for the first stage of labor can be helpful in the pushing stage as well. You may find gentle, repetitive movement, like rocking and walking during contractions, to be soothing. Try circling your pelvis on a birth ball or swaying from side to side while holding onto your partner or doula. Squatting and kneeling are both great ways to increase the intensity of labor and encourage your baby’s descent through the pelvis.

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What about you?

How long did your labor last? What were your experiences with the different stages of labor? Did your labor progress as you expected? Did anything completely surprise you? We’d love to know.

Additional references

Simkin, P. (2013). The Birth Partner. Beverly, MA: The Harvard Commons Press.