Stages of Labor & What to Expect

The first stage of labor begins with the onset of regular uterine contractions that dilate (open) the cervix. Labor is complete when the cervix is completely or fully dilated at 10 centimeters (about 4 inches).

During the latent phase of labor, contractions are usually irregular (occurring every five to 20 minutes) and mild to moderately uncomfortable. The contractions may feel like gas pains, bad menstrual cramps or back discomfort. Bloody show (discharge) may appear during this time, and your bag of water may break.

This phase of labor may last several hours with a first pregnancy, even as long as 20 hours. During this latent phase of labor, the cervix typically dilates to 4 centimeters. While at home in the latent phase of labor, you should:

• Alternate between walking and resting.
• Keep yourself well hydrated and nourished by drinking plenty of fluids and eating lightly.
• Spend time in a bathtub or shower during this phase to help relieve some discomfort.
• Use slow, deep breathing during the contractions to help you relax.

If a care team in our labor and delivery unit evaluates you and determines that you’re in the latent phase of labor, you will go home until your labor is more active. If you go home in early labor, you may receive a medication (Serax) to help you rest while at home.

The active phase of labor usually begins when the cervix is 4 or 5 centimeters dilated. The contractions are:

• More regular (every three to five minutes).
• Of longer duration (45 to 90 seconds).
• Stronger.

Progress during this phase is more rapid. You should use controlled breathing to help cope with the contractions. Finding a comfortable position becomes more difficult during this phase of labor, as does remaining focused on breathing and relaxation techniques. Your care team may provide you with pain relief options during this phase of labor.

The final part of the active phase of labor (transition) is from 8 to 10 centimeters, or full dilation. This is the shortest phase of labor for many patients but also may be the most intense. Strong contractions — lasting for 60 to 90 seconds each — occur every two to three minutes.

Rectal pressure — along with an urge to push (bear down) — may increase at this time. Your provider will help you determine when to bear down actively. During this last stage of labor, it may be too late to receive injected pain medication because it could make your baby sleepy at birth. However, during this period you may opt for epidural anesthesia, which doesn’t pass into your baby’s system.

Ongoing Monitoring and Support

Throughout the active phase of labor — including transition — your care team will check your progress every two hours, or more often if needed. If at any time the progress of your labor slows down or stops, your provider will discuss with you and your partner options to help with continued progress. These options include breaking your bag of water (amniotomy) or giving you medication (Pitocin) to both strengthen your contractions and increase their frequency.

Your care team will monitor your baby by asking you about the baby’s movements and by using an electronic fetal monitor to record the baby’s heart rate. Your care team will get an initial 20- to 40-minute reading (strip) of your baby’s heart rate. If you have a normal risk pregnancy and the results of this fetal monitor strip are as expected, your care team will continue to monitor your baby’s heart rate throughout labor and delivery.

The second stage of labor begins with complete or full dilation of the cervix (10 centimeters). The second stage of labor may last anywhere between 15 to 30 minutes and several hours.

Your primary nurse will help you with breathing and pushing techniques. We’ll encourage you to push with your contractions, holding your breath as you do so. Some patients prefer other methods of pushing.  Your primary nurse will help with whatever technique you prefer.

Sensations felt during the second stage of labor are different from earlier stages. Without anesthesia, most patients have a strong urge to push, which you’ll likely feel as rectal pressure. If you’ve received epidural anesthesia, you should be able to push with the sensation when you feel pelvic pressure.

Many positions are acceptable for pushing. Changing positions when pushing for a long time may be helpful. During this second stage of labor, your provider will check your progress at least every hour.

As with the first stage of labor, if the progress of pushing slows down or stops, your provider will discuss with you options to help with continued progress. These may include strengthening your contractions through the use of Pitocin. Occasionally, it is necessary to help in the delivery of your baby’s head by using a vacuum extractor or forceps. Your provider may suggest using these instruments if:

• There are signs your baby is being stressed.
• You are too exhausted to continue pushing out your baby.
• Your baby needs to be delivered quickly.

As your baby’s head is about to be delivered (crowning), your provider will decide if you need an episiotomy. An episiotomy is an incision in the perineal area (between the vaginal opening and the rectum) that enlarges the opening of the birth canal to help with the delivery of your baby’s head. Often, providers successfully deliver babies without an episiotomy. Sometimes your perineal tissue may tear with or without an episiotomy.

The third stage of labor is the delivery of the placenta (afterbirth). The uterus continues to contract after the delivery of your baby, leading to the separation of the afterbirth from the uterus. This separation usually occurs within five to 15 minutes after the delivery. You may need to push to help deliver the placenta. Your provider may massage your uterus through your abdomen to help the uterus contract and to slow down any bleeding.