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What stages will I go through during labor and childbirth? (Part 1)

What stages will I go through during labor and childbirth? (Part 1)

The process you'll go through during labor and childbirth can be divided into three stages:

The first stage begins with the onset of contractions and the gradual effacement (thinning out) and dilation (opening) of the cervix. That's followed by active labor, when your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. In the last part of active labor (and the end of the first stage), called transition, your cervix dilates fully to 10 centimeters.

The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is often referred to as the pushing stage.

The third and final stage begins right after the birth of your baby and involves the separation and delivery of the placenta.

For first-time moms who are at least 37 weeks along, labor and delivery takes an average of 15 hours, although for plenty of women it lasts more than 20 hours, and for a lucky few it's over much sooner. For women who've been through labor before, deliveries average around eight hours.

First stage: Early labor

Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you're officially in early labor. But unless your labor starts very suddenly and you go from no contractions to fairly regular contractions right away, it can be tricky to determine exactly when true labor starts. That's because these early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may immediately precede them and contribute to so-called "false labor." (If you're not yet 37 weeks and you're noticing contractions or other signs of labor, call your caregiver immediately so she can determine whether you're in preterm labor.)

During early labor, your contractions will gradually become longer, stronger, and closer together. While the experience of labor varies widely, typically it might start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, though the contractions will still tend to be mild and last less than a minute.

Sometimes early labor contractions are quite painful (though they may be dilating your cervix much more slowly than you'd like!). If your labor is typical, though, your contractions now won't require the same attention that later ones will. You'll probably find that you can still talk through them and putter around the house. You may even feel like taking a short walk. If you feel inclined to relax instead, take a warm bath, watch a video, or doze off between contractions if you can.

You may also notice increasing mucousy vaginal discharge, which may be tinged with blood — the so-called "bloody show." This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you're not having contractions yet.

Otherwise, if you're at least 37 weeks along, and unless your caregiver has advised you differently, expect to sit out early labor at home. (When to call your midwife or doctor and when she's likely to have you go to the hospital or birth center are things to discuss ahead of time at your prenatal visits.) Early labor ends when your cervix is 3 to 4 centimeters dilated and your progress starts to accelerate.

How long it lasts?

It's not easy to say how long this phase typically lasts or even (after the fact) how long it lasted for a particular woman. The length of early labor depends in large part on how ripe your cervix is at the beginning of labor and how frequent and strong your contractions are. With a first baby, if your cervix isn't effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter. If your cervix is already very ripe or if this isn't your first baby, it's likely to go much more quickly.

Coping tips

Don't become a slave to your stopwatch just yet — it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously.

Meanwhile, it's important to do your best to stay rested, since you may have a long day (or night) ahead of you. Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to go to the bathroom often even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.

First stage: Active labor

Active labor is when things really get rolling. Your contractions become more frequent, longer, and stronger, and your cervix begins dilating faster — going from 3 to 4 centimeters to 10 centimeters. In contrast to early labor, you'll no longer be able to talk through the contractions. Toward the end of active labor your baby may begin to descend, though he might have started to descend earlier or he might not start until the next stage.

As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. (Some prefer a call sooner, so clarify this with your caregiver ahead of time.) In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes, although some women may never have them more often than every five minutes, even during transition.

How long it lasts

Labor varies widely, but on average it takes about six hours for a woman having her first baby to go from 4 centimeters to full dilation. That's if she's not being given oxytocin (Pitocin) or using an epidural, though. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labor is likely to go much more quickly.

Coping tips

Breathing exercises, relaxation techniques, and a good labor coach can be a huge help now. Massage and lots of gentle encouragement are lifesavers, too. When you get to the hospital or birth center, you should be able to move freely around the room after your caregiver evaluates you, as long as you don't have any medical or obstetric complications.

You may find that it feels good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to take a warm shower or bath, if you have access to a tub, or to ask your partner for a massage. If you've already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to talk to your provider about getting an epidural or systemic medication...

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