Stages of Labor
There are three stages of labor that can occur over many hours or even a few days. The first stage is labor. During the second stage, you deliver the baby. The final stage is delivering the placenta.
First stage of labor
The first stage of labor is divided into three phases: early labor, active labor, and transition.
Early labor
Early labor is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Contractions:
- Are mild to moderate (you can talk while they are happening) and last about 30 to 45 seconds.
- May be irregular (5 to 20 minutes apart) and may even stop for a while.
- Open (dilate) the cervix to about 4 cm (1.6 in.) to 6 cm (2.4 in.). Those who are delivering for the first time can have many hours of early labor without the cervix dilating.
It's common for those in early labor to go to the hospital and be sent home until they are in active labor or until their "water" (amniotic sac) breaks.
Active labor
Active labor starts when the cervix is about 5 cm (2 in.) to 6 cm (2.4 in.) dilated. This stage is complete when the cervix is fully effaced and dilated and the baby is ready to be pushed out.
During this phase, contractions get stronger, are more frequent (every 2 to 3 minutes), and last longer (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing center. If your amniotic sac hasn't broken before this, it may now.
You may be restless and excited, and you may feel the need to shift positions often. This is good because it improves your circulation.
As your contractions get stronger:
- You may want to use comfort measures, such as breathing techniques or massage, to control pain and anxiety. Or you may want medicine for pain, such as epidural anesthesia.
- You may be given intravenous (I.V.) fluids.
Transition
Transition is the end of active labor. As the baby moves down, contractions become more intense and longer and come even closer together. Delivery isn't far off.
During transition, you may be self-absorbed, focused on what your body is doing. You may want others nearby for support but be annoyed or distracted by their attempts to help. You may feel more and more anxious, nauseated, exhausted, or fearful.
If you're delivering for the first time, transition may take up to 3 hours. If you've had a vaginal birth before, it will usually take no more than an hour. Some people have a very short and intense transition.
Second stage of labor
The second stage is the actual birth, when the baby is pushed out by the contractions. This pushing stage can be as short as a few minutes or as long as several hours. You are more likely to have a fast labor if you have given birth before.
In the second stage:
- Your contractions may feel different. They are usually regular, but they may slow down to every 2 to 5 minutes and last 60 to 90 seconds.
- You may have a strong urge to push or bear down with each contraction.
- You may need to change position several times to find the right birthing position for you.
You may feel a burning pain when your baby's head comes through the vagina (crowns). You can have a mirror positioned so you can watch your baby's head crown.
If the baby is coming quickly, your doctor or midwife may ask you not to push with every contraction. This may give the perineum a chance to stretch without tearing.
Then after a final push, your baby is born, and you get to hold and look at this new person for the first time. But your body still has some work to do: stage three, delivery of the placenta.
Third stage of labor
The third stage of labor is when the placenta is delivered. You will still have contractions. They make the placenta separate from the inside of the uterus, and they push the placenta out.
The third stage can be as quick as 5 minutes. But in most cases, the placenta is delivered within 30 minutes. Your contractions will continue until after the placenta is delivered, so you may have to focus and breathe until this uncomfortable process is complete.
Your care provider will help you during this time. If the placenta doesn't fully detach, your doctor or midwife may remove by hand what's left inside. You'll also be watched for any problems, such as heavy bleeding, especially if you have had it before.
You may be given medicine after the placenta is delivered. Oxytocin (such as Pitocin) is used to make the uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labor.) Breastfeeding right away can also help the uterus shrink and bleed less.