Stages of Labor

What are the stages of labor?

The stages of labor are the process through which you deliver your baby and the placenta from your uterus through your vagina.

In general, the three stages of labor are:

• Stage 1: Labor (contractions)
• Stage 2: Pushing and birth
• Stage 3: Delivery of the placenta

Healthcare providers may call this “normal labor.” They use this definition and the stages to communicate effectively with each other and you. Just because you don’t go through every step of “normal” labor doesn’t mean there’s something wrong with your birthing experience.

You can experience some stages of labor, but your baby may arrive via C-section. Or you may never experience the first part of labor, like if you have a planned or emergency C-section. It may also be different if you have induced labor. Each labor experience is unique.

It can be stressful not knowing exactly what to expect for such a significant event. While pregnancy care providers know the general outline, they can’t predict how your labor will go. But rest assured that they’ll be by your side to guide you through the process. You have the shared goal of a healthy labor and delivery.

The first stage of labor

The first stage of labor begins with regular contractions. It ends with full dilation (opening) and effacement (thinning) of your cervix.

Most healthcare providers will ask that you time your contractions. When timing contractions, start counting from the beginning of one to the beginning of the next. It’s easiest to do this in seconds.

Regular contractions mean they’re strong and regularly spaced about three to five minutes apart. This is different from Braxton Hicks, which are irregular “practice” contractions. You may go into labor spontaneously or through medical induction in a hospital.

The first stage can last anywhere from 12 to 19 hours. If you’ve given birth before, you may go through this stage much faster.

This first stage has two phases:

• Early labor. This is when your cervix dilates to about 6 centimeters. Early labor typically lasts six to 12 hours.
• Active labor. This is when your cervix fully dilates to 10 centimeters. You may feel the urge to push. Active labor typically lasts four to eight hours.

Your pregnancy care provider will likely tell you that you can be at home for early labor. But you should be ready to go to your birthing center (like a hospital). During active labor, you should be at the birthing center.

Managing the first stage of labor

During the first stage of labor, you may find it helpful to:

• Do gentle stretches.
• Meditate.
• Move around and change positions.
• Practice deep breathing.
• Take a warm (not hot) bath or shower.
• Use a birthing ball.
• Walk.

Having a labor support person is also very helpful. This could be your significant other, family member, friend or doula.

If it’s difficult to tolerate the pain, talk to your pregnancy care team about your labor pain relief options.

Can you sleep through early labor contractions?

Everyone tolerates pain and discomfort differently. In general, it’s OK to sleep and rest during early labor if you’re able to. But you might find it difficult to sleep through the contractions.

The second stage of labor

The second stage of labor begins with complete cervical dilation (10 centimeters). It ends with the delivery of your baby. It can last anywhere from half an hour to several hours.

The fetus descends into your vagina with or without your pushing efforts. During the second stage of labor:

• Contractions come every two to five minutes, lasting about 60 to 90 seconds.
• You’ll need to push when you have contractions but can rest between them. Your healthcare provider will tell you when it’s time to push.
• Your baby crowns, which is when their head begins to show.
• Your provider delivers your baby by guiding them out of your vagina.
• Once your baby is born, your provider cuts the umbilical cord.

You may have your baby via a planned or unplanned C-section instead of vaginal delivery.

The third stage of labor

The third stage of labor begins with the delivery of your baby and ends with the delivery of the placenta. It’s the shortest stage and usually doesn’t last longer than 30 minutes.

During the third stage of labor:

• Contractions begin again about five to 30 minutes after birth. These contractions help the placenta separate from your uterus.
• You might need to push. Or your healthcare provider will press on your belly to move the placenta forward.
• You might have heavy vaginal bleeding for a short time during or after the delivery of the placenta.
• Some women experience chills or feel feverish. Tell your healthcare provider if you experience these symptoms.

If you have a C-section, your provider removes the placenta when they remove your baby from your uterus.

Your provider will make sure that all the placenta comes out. Retained products of conception can cause complications. If you had an episiotomy or vaginal tear, your provider repairs it once the placenta is out.

What triggers labor?

Scientists don’t know exactly how labor starts. But they think it results from a series of biochemical changes in your uterus and cervix. Both your body and the fetus have a role in these changes.

Your cervix has to go from firm and closed during pregnancy to thin and dilated. And your uterus has to start contracting (squeezing).

Experts believe that when the fetus is ready for birth, it releases a small amount of a substance that triggers your hormones to start the labor process. For most people, this happens naturally between 37 and 42 weeks of pregnancy. In some cases, a healthcare provider will induce (kickstart) labor.

Two main components of triggering and maintaining labor include:

• Prostaglandins. Uterine cells produce prostaglandins (hormone-like substances) to help dilate your cervix and cause uterine contractions.
• Oxytocin. When the fetus’s body pushes against your cervix, it stimulates your pituitary gland to release oxytocin (a hormone). The oxytocin travels to your uterus and stimulates contractions.

Several pre-labor signs might hint that labor will start soon. These signs can include:

• Backaches
• Bloody show (losing your mucus plug)
• Diarrhea
• Nesting (cleaning and organizing your home)

What are the signs of early labor?

It can be difficult to know when you’re in true labor. If this is your first time, it can be easy to mistake other symptoms or irregular practice contractions (Braxton Hicks contractions) for true labor. True labor has a pattern and progresses steadily over time.

There are three things you’ll want to look for when you’re in true labor:

1. Frequency. How often are your contractions happening? Keep track of them with a journal or labor app on your phone to make sure they’re coming at regular intervals.
2. Duration. How long are each of your contractions? As your labor continues, your contractions will last longer and longer. Use a stopwatch, watch a clock or keep the timer on your phone handy so you can record the length of each contraction.
3. Intensity. Are your contractions getting stronger? You might feel them more intensely as you move through the stages of labor. Keep track of how your contractions feel over time.

What is abnormal labor?

To protect the health of the fetus and you, healthcare providers follow guidelines that define abnormal labor. This is so they know when they may need to intervene to try to prevent complications. Before any sort of medical intervention, your care team will explain their concerns and the options.

Abnormal first stage

Healthcare providers consider early labor to be prolonged if:

• You’re giving birth for the first time, and it lasts more than 20 hours.
• You’ve given birth before, and it lasted more than 14 hours.

Providers consider active labor to be prolonged if:

• Your cervix doesn’t dilate past 6 cm after four hours of contractions with ruptured membranes (your “water breaks”).
• Your cervix doesn’t dilate past 6 cm after six hours of contractions, with ruptured membranes, and despite getting oxytocin (Pitocin®).

Abnormal second stage

Providers consider the second stage of labor to be prolonged if:

• You’re giving birth for the first time, and it lasts more than three hours without an epidural or four hours with an epidural.
• You’ve given birth before, and it lasted more than two hours without an epidural or three hours with an epidural.

Abnormal third stage

Providers consider the third stage to be abnormal if the placenta remains in your uterus more than 30 minutes after the delivery of your baby.

When should I go to the hospital for labor?

Ideally, you should be at your birthing center while you’re in active labor. This is the second phase of the first stage of labor.

Once your contractions are every five minutes for at least one hour, call your pregnancy care provider or the hospital labor floor. If your water breaks, whether or not you notice contractions, call your provider or the hospital labor floor. Even if it’s early in the first stage of labor, or if you think you’re having Braxton Hicks contractions, let your care team know what’s going on.

Get help right away if you experience:

• Chest pain
• Dizziness or fainting (syncope)
• Severe nausea and vomiting
• Shortness of breath (dyspnea)
• Swelling (edema) in your legs, arms or face
• Heavy bleeding
• Significant decrease in fetal movement

What happens when I get to the hospital?

When you get to the hospital, you’ll check in at the labor and delivery desk. You’ll probably go to a triage room first. This is part of the admission process. Hospitals usually recommend that you only bring one person with you to the triage room.

From the triage room, you’ll go to the labor, delivery and recovery (LDR) room:

• You’ll change into a hospital gown.
• A healthcare provider will check your pulse, blood pressure and temperature.
• They’ll place an external fetal monitor around your abdomen to check for uterine contractions and measure the fetal heart rate.
• Your provider will do a cervical exam to see how far labor has progressed.
• A provider might place an IV line in a vein in your arm to give you fluids and medications.

How long will I be in the hospital?

The length of your hospital stay depends on the hospital and the type of delivery you have. Typically, you’ll stay in the hospital longer if you have a C-section because it’s a surgical procedure. You may also need to stay in the hospital for longer if you have any complications or health issues during your delivery.

Is there a fourth stage of labor?

Some experts consider the two to three hours after the delivery of the placenta to be a fourth stage of labor. This is the time when you may start to bond with your new baby. Your uterus also relaxes, and healthcare providers monitor you for any abnormal bleeding.

How long does labor take on average?

The average labor lasts 12 to 24 hours for a first birth and is typically shorter (eight to 10 hours) for subsequent births. The first stage of labor is usually the longest.