It is normal for you to feel both excited and scared about labor and delivery. We hope that this handout helps answer your questions so you will know what to expect during labor.
When does labor begin?
Labor begins when the cervix begins to open (dilate) and thin (called effacement). The muscles of the uterus tighten (contract) at regular intervals. During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft.
How will I know if I’m in labor?
Some women experience very distinct signs of labor, while others don’t. No one knows what causes labor to start, but several hormonal and physical changes may indicate the beginning of labor. These changes include:
Lightening
The process of your baby settling or lowering into your pelvis is called lightening. Lightening can happen a few weeks or a few hours before labor. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently.
Mucus plug
The mucus plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina and may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is discharged or might begin one to two weeks later.
Contractions
Labor is characterized by contractions that come at regular intervals and increase in frequency (how often contractions occur), duration (how long contractions last), and intensity (how strong the contractions are) over time. As time progresses, the contractions come at closer intervals.
Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Some women describe contractions as strong menstrual cramps. You might have a small amount of bleeding from your vagina. Labor contractions are not stopped by changing your position or relaxing. Although the contractions might be uncomfortable, you will be able to relax between contractions.
This part of the first stage of labor (called the latent phase) is best experienced in the comfort of your home.
Timing your contractions
Write down the time at the beginning of one contraction and again at the beginning of the next contraction. The time between contractions includes the length or duration of the contraction and the minutes between the contractions (called the interval).
Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last 45 to 60 seconds and are three to four minutes apart.
The following suggestions may help you cope during contractions:
- Try to distract yourself: take a walk, go shopping, watch a movie.
- Soak in a warm tub or take a warm shower. Ask your health care provider if you should take a tub bath if your water has broken.
- Try to sleep if it is in the evening. You need to store up your energy for labor.
Rupture of the amniotic membrane
The rupture of the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) is also referred to as your "bag of water breaking." The rupture of the amniotic membrane may feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored.
If your "water breaks," tell your health care provider. Tell your health care provider what time your water broke, how much fluid was released, and what the fluid looked like. Labor may or may not start soon after your water breaks.
It is also common to be in labor without your water breaking.
Effacement and dilation of the cervix
Your cervix gets shorter and thins out in order to stretch and open around your baby's head. The shortening and thinning of the cervix is called effacement and is measured in percentages from zero percent to 100 percent. The stretching and opening of your cervix is called dilation and is measured from one to 10 centimeters.
Effacement and dilation are direct results of effective uterine contractions. Progress in labor is measured by how much the cervix has opened and thinned to allow your baby to pass through the vagina.
When should I call my health care provider or go to the hospital?
Please call your health care provider during early labor or when you have questions or concerns. Also call:
- If you think your water has broken (if there is a sudden gush of fluid or a trickle of fluid that leaks steadily)
- If you are bleeding (more than spotting)
- When your contractions are very uncomfortable and have been coming every five minutes for an hour
Your health care provider will give you specific guidelines about when you should get ready to come to the hospital. Be sure to drive carefully.
What happens when I get to the hospital?
When you get to the hospital, you will check in at the Labor and Delivery Desk. Most patients are first seen in the Triage Room for admission to the hospital or for testing. More than one patient might be in this area at the same time. Please have only one person go with you to the Triage Room.
From the Triage Room, you will be taken to the Labor, Delivery, and Recovery (LDR) room.
You will be asked to wear a hospital gown. Your pulse, blood pressure, and temperature will be checked. A monitor will be placed on your abdomen for a short time to check for uterine contractions and assess the baby's heart rate. Your health care provider will also examine your cervix to determine how far labor has progressed.
An intravenous (IV) line might be placed into a vein in your arm to deliver fluids and medications.
Types of delivery
Vaginal delivery is the most common and safest type of birth. When necessary in certain circumstances, forceps (instruments resembling large spoons) may be used to cup your baby's head and help guide the baby through the birth canal. Vacuum delivery is another way to assist delivery and is similar to forceps delivery. In vacuum delivery, a plastic cup is applied to the baby's head by suction and the health care provider gently pulls the baby from the birth canal.
Although vaginal delivery is the most common and safest type of delivery, sometimes
cesarean delivery is necessary for the safest outcome for you and your and baby. A cesarean delivery may be necessary if one of the following complications is present:
- Your baby is not in the head-down position.
- Your baby is too large to pass through the pelvis.
Most often, the need for a cesarean delivery is not determined until after labor begins.
What are the stages of labor?
The average labor lasts 12 to 24 hours for a first birth and is usually shorter for other births. Labor happens in three stages.
First stage
The first stage is the longest part of labor and can last several hours. It begins when your cervix starts to open and ends when it is completely open (fully dilated) at 10 centimeters. When the cervix dilates from zero to five centimeters, contractions get stronger as time progresses. Mild contractions begin at 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. This part of labor (called the latent phase) is best experienced in the comfort of your home.
When the cervix dilates from five to eight centimeters (called the active phase), contractions get stronger and are about three minutes apart, lasting about 45 seconds. You may have a backache and increased bleeding from your vagina (show). Your mood may become more serious as you focus on the hard work of dealing with the contractions. You will also depend more on your support person.
Hints to help with the active phase:
- Try changing your position. You may want to try getting on your hands and knees. This helps ease the discomfort of back labor.
- Soak in a warm tub or take a warm shower.
- Continue practicing breathing and relaxation techniques.
If your amniotic membrane ruptures, the next contractions may be much stronger. When the cervix dilates from eight to 10 centimeters (called the transition phase), contractions are two to three minutes apart and last about one minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.
It may help to practice breathing and relaxation techniques such as massage or listening to soothing music. Focus on taking one contraction at a time. Remember that each contraction brings you closer to holding your baby.
Second stage
The second stage of labor begins when your cervix is fully dilated at 10 centimeters. This stage continues until your baby passes through the birth canal or vagina and is born. This stage may last two hours or longer.
Contractions may feel different -- they will slow to two to five minutes apart and last from about 60 to 90 seconds. You will feel a strong urge to push with your contractions. Try to rest as much as possible between intervals of pushing.
Here are some helpful hints for pushing:
- Try several positions (squatting or getting on your hands and knees).
- Take deep breaths in and out before and after each contraction.
- Curl into the push as much as possible. This allows all of your muscles to work.
You may receive anesthetics (pain-relieving medications) or have an episiotomy if necessary. An episiotomy is a procedure in which a small incision is made between the anus and vagina to enlarge the vaginal opening. An episiotomy may be necessary to assist the baby out quicker or to prevent large, irregular tears.
The location of your baby's head as it moves through the pelvis (called descent) is reported in a number called a station. If the baby's head has not started its descent, the station is described at minus three (-3). When your baby's head is at the zero station, it is at the middle of the birth canal and is engaged in the pelvis. The station of your baby helps indicate the progress of the second stage of labor.
When your baby is born, your health care provider will hold the baby with his or her head lowered to prevent amniotic fluid, mucus and blood from getting into the baby's lungs. The baby's mouth and nose may be suctioned with a small bulb syringe to remove any additional fluid. Your health care provider will place the baby on your stomach and shortly after, the umbilical cord will be cut.
Third stage
The third stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina. This stage is often called delivery of the "afterbirth" and is the shortest stage of labor. It may last from a few minutes to 20 minutes. You will feel contractions but they will be less painful. If you had an episiotomy or small tear, it will be stitched during this stage of labor.
Questions to ask your health care provider about labor and delivery
Here are some questions to ask your health care provider about labor and delivery:
- At what point do you recommend that I come to the hospital/birth center?
- How soon after I come to the hospital will my health care provider see me?
- How much time will the health care provider spend with me during labor?
- If I write a birth plan, will it be honored?
- How often are vaginal exams performed during labor?
- Are showering and bathing allowed during labor?
- Does this birth center/hospital allow water births? What facilities are available for water births?
- How many people are allowed to be with me during labor and delivery? How many people are allowed to be with me during a cesarean delivery?
- What is the birth center or hospital’s policy regarding other children attending the birth?
- Are eating or drinking allowed during labor?
- What laboring positions are recommended?
- Is videotaping allowed?
- Can my partner cut the cord?
- How long will I be able to stay in the hospital? Can I leave earlier if I want to?
Here are some questions for you to consider before your "Birth" Day:
- Is there someone available who can take you to the hospital at any time?
- How will you get in touch with that person? (Note: many hospitals and birthing centers offer a pager service where you can rent a pager for a few months so you can be sure that you’ll be able to contact your labor partner).
- Do you have your route to the hospital planned? Consider if it may take longer to get to there during certain times of the day, such as rush hour.
- Do you have other children at home that you need to take to a babysitter, or will they attend the birth?
- If you work, have you discussed your maternity leave with your supervisor?
- Have you decided how you are going to notify your friends/co-workers about your good news?
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.This document was last reviewed on: 4/1/2007
