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Stages of Labor

The Stages of Labor

Not all labors are the same, even if the mother is the same. Some labors come and go within hours, while others take more or less time. Labor is a natural part of the birthing process, in which there are three main stages each woman must go through.

The first stage can be broken down into two parts: early labor and active labor. During early labor contractions begin slowly. Over time, they increase in frequency and strength, progressively changing the cervix until it is fully dilated. During active labor the cervix has not yet dilated, but is drawing close. The contractions become longer, stronger and closer together as they make room for the baby to move into the birth canal. This stage is also known as a transition period. During the second stage, you are fully dilated and the baby travels through the birth canal and out the vagina (delivery). The third stage involves the removal or expulsion of the placenta.

During the process of labor your health care provider may or may not perform an internal vaginal exam. This exam checks for cervical effacement, cervical dilation, and the baby’s position, presentation, and station. Labor and delivery can take place in a hospital, birthing center or in your home.

The First Stage: Effacement and Dilation

During the first stage of labor contractions begin slowly (early labor), which helps the cervix begin opening (dilating). With each contraction, not only does the cervix dilate, it also begins to thin out (effacement). You’ll hear your doctor talk about effacement in percentages, with 100% effacement indicating your cervix is one step closer to stage two: delivery. Dilation is measured in centimeters, with 10 centimeters indicating a full dilation. Once you reach full dilation, contractions intensify in strength, duration and distance apart (active labor). At this point, contractions should be 2-3 minutes apart.

During active labor, the pain is difficult to deal with. This is also known as the transition phase, and by the end of it, your baby will begin to enter the vagina. Mother’s tend to feel a strong urge to push once the baby begins to enter the vagina. Most women typically endure the first stage of labor for about 12 hours with their first baby, 4-8 hours with their second, and possibly fewer hours with more births. Some women endure the first stage of labor for up to 24 hours or longer with their first child. For other women who have birthed many babies, the first stage of labor may only last a couple minutes.

Diagnosing the first stage of labor can sometimes be difficult, since many women experience false labor pains (Braxton Hicks contractions) as early as 3-4 weeks before their due date. The difference between false labor pains and true labor pains is that false ones are irregular, oftentimes not painful and seems to be localized in the lower abdomen and groin areas. True labor pains are consistent, progressively worsening in pain, lengthening in duration, and coming closer together. The pain typically travels from the abdomen and groin areas to the back. During false labor pains, dilation and effacement do not take place. More tell-tell signs include losing your mucus plug, which can be a reddish or pinkish discharge. Losing your mucus plug is a great indicator labor will begin within 24 hours. Some women experience their water breaking. However, it’s not a common enough experience to ‘look for’ as an indicator labor is beginning.

The Second Stage: Delivery

During the beginning of stage two, contractions continue and move the baby down the birth canal. A mother’s pushing helps the baby too. Your health care provider will inform you when to push, which it typically during a contraction since the contractions double the effect of your pushing and allow you to relax between them, which helps you conserve energy. If needed, an episiotomy (surgical incision made to enlarge the opening of the vagina to avoid unnecessary pressure to the baby’s head during delivery) will be performed at the end of this stage, before the baby’s head emerges from the vagina (crowning). The second stage is over once the baby is removed from the vagina. Once removed, the umbilical cord is tied and cut. For first-time mothers, this stage can last up to 3 hours, while subsequent deliveries last up to 2 hours. However, on average this stage lasts no more than 50 minutes.

The Third Stage: Removing the Placenta

Once the baby is delivered, the umbilical cord is tied and cut. The umbilical cord is what attaches the baby to the placenta. It’s not safe or healthy to leave the placenta in your body after you birth your baby, so your health care provider will remove or expel it. Many times, contractions (less painful than labor contractions) will help the placenta leave the uterus. Doctors will oftentimes massage your abdomen and gently pull on the umbilical cord during those contractions to assist the placenta’s delivery. In most cases, the third stage lasts only a few minutes, but it can last up to 30 minutes. Once the placenta is removed, you will be given medications that prevent excessive bleeding. If an episiotomy is performed, your doctor will then stitch the incision. If there wasn’t an episiotomy performed, but your vagina tore, stitches will also be used to close the tears.

Coping Tips for Labor

It’s truly up to you on how you deal or cope with labor. Many women utilize pain management and relaxation techniques they’ve learned through various childbirth classes to help them proceed with a natural birth. Partners, family, friends, doulas and midwives are good labor coaches to help you through the difficult stages of labor. Breathing exercises and visualizations can be beneficial whether or not you’re planning on using medication.

Try walking around between contractions to help you cope. Be sure to take someone with you or walk along side a wall for those moments during a contraction, as they can be painful and make it difficult to stand upright. There are also several different ways you can lay and position yourself to increase your comfort. Try lying on your left side or ask your partner for a massage. If you have access to a tub, try taking a warm bath or shower.

If you’re simply ready to throw in the towel, talk to your health care provider about the different types of pain medications such as epidurals or systemic medications that can help you relieve the discomfort and pain you are experiencing.

[Page updated June 2014]