If we had one wish for Hollywood, we would wish them the ability to create more realistic depictions of the early labor phase of the first stage of labor.
In truth, what you see on TV – woman casually strolling through the mall when she instantly crouches, gasps, grabs her belly and says, “I’m having my baby…” – isn’t anything like most first-stage labors we’ve ever been a part of.
Knowing the Stages of Labor Helps You (and Your Partner) Prepare for Labor & Delivery
The truth of the matter is that labor takes place in four stages, and each one has its own personality. Typically, the first stage begins gradually, intensifies dramatically and becomes just shy of intolerable (assuming you go the natural route) until you’re ready to push. The second stage commences when the cervix is completely dilated (10 cm) through the point at which the baby is delivered, and the third stage concludes with the delivery of the baby’s placenta, and the fourth stage is all about recovery.
That makes it all seem so simple, doesn’t it? Now, let’s go through a more detailed review of what really happens through all that – knowing most the action takes place in the very first stage.
The first stage of labor
Not surprisingly, given that the first stage of labor includes everything from your first contraction and/or the water breaking, all the way through when you start to push, the first stage is divided into three phases:
Early labor phase. This is the period between the time when you first notice you are headed into labor and until your cervix is 3 cm dilated. During this time, a healthy mother in a healthy, full-term pregnancy will be encouraged to nap, eat light snacks, hydrate and prepare for the upcoming phases of labor. This is a good time to take a walk if you can or to get things ready around the house – stopping as needed with contractions. Most women can carry on a conversation at this point, but later on, they’ll smile and say, “Whew! They’re getting stronger…” as they head into the next, active phase.
Contractions are typically mild- to mild-ish, irregular, don’t last longer than 30- to 60-seconds and come more than five minutes apart. Your water might break or it might not, or it might start to leak. Note the time your water breaks so you can tell the labor and delivery staff. It should be clear and odorless – if there is red, orange, pink or brownish color and/or if there is an odor – call the doctor. Typically, hospitals and birth centers want you to deliver the baby within 24-hours after the water breaks.
Unless your contractions are coming every four minutes, and lasting for a full minute, we recommend going gently about your daily routine. If labor begins at night – get as much sleep as you can. Early labor typically lasts anywhere from eight to 12 hours – so there’s no need to rush to the hospital. The longer you can labor safely at home, the less time you’ll spend in a hospital bed before giving birth.
Active labor phase. Things kick up a notch at this point. Not only are contractions more intense, they begin lasting longer and coming closer together – usually lasting about 45- to 60-seconds and with only a three to four-minute rest in between. These contractions don’t leave much room for conversation.
At this point, it’s time to head to the hospital or birthing center. Whether you’re able to eat or drink once you get there is up to the medical team, doctors/midwives and or the agreement you have around your birthing plan. Your cervix will dilate from 4 cm to 7 cm during this phase, and active labor usually lasts about three to five hours.
Transition phase. In some childbirth classes, you might hear instructors talking about how women retreat into their own world during transition – going “behind the veil” – where it’s not easy to reach them verbally – especially during contractions. Now, the mother is entirely focused on how her body is feeling and it can seem as if she’s in an altered state where nothing else exists but the labor process – which is entirely true for a laboring woman!
During transition the cervix dilates from 8 cm to 10 cm, which indicates a woman can push with her contractions and/or whenever she feels the urge. In most cases, transition won’t last longer than 30 minutes to two-hours.
The second stage of labor
Your cervix is dilated to 10 cm and contractions are like nothing she’s experienced thus far because in addition to being intense, they can come in a quick series of waves – with no breaks in between. It’s the uterus, abdomen and pelvis’s last hurrah as they get the baby positioned at the finish line of the birth canal.
The intensity of this stage can cause women to get the chills, feel nauseous, throw up or become very gassy. At this point, she’ll rely heavily on her partner to provide support and physical relief in whatever way feels best for her.
Finally, the baby’s head will crown, the shoulders will emerge, and baby will emerge in a gush of fluids. …but it’s not over just yet.
The third stage of labor
Many women – and partners – forget about the placenta. That amazing source of protection and nourishment has done the good work and its duties are officially done. However, it needs to be expelled from the womb as well – and that is what happens during the third stage of labor.
All of a sudden, the mother – giddy with emotion and post-birth bonding hormones – starts to feel contractions again. What the….?!? These contractions are the uterus’s final efforts, as it contracts to help the placenta detach from its walls. While the contractions aren’t entirely comfortable, they sure beat active labor contractions and pushing out the placenta is significantly easier than pushing out a baby.
When the placenta is completely expelled, the doctor or midwife will inspect it to make sure it is intact. After the placenta is born, the mother may get severe chills or may even begin shaking. This is entirely normal. She should be tucked up in soft warm blankets with her beautiful new baby, skin-to-skin – and all will be well.
The Fourth Stage of Labor
While the bulk of the heavy labor is done – your body will begin the fourth and final stage of labor, when the uterus continues to contract in order to expel any remaining contents. Nursing promotes these contractions, so try to have your baby on the breast as much as he or she will take it. These post-partum, uterine contractions also restore uterine tone. In fact, don’t be surprised over the next few weeks when nursing causes some surprisingly sharp contractions – this is entirely normal.
Throughout this last, critical moment in time, you’ll be cared for by nurses, your midwife and other staff to make sure that all is well, and that all of your questions are answered.
Once you arrive home, we highly recommend doing all you can to enjoy a “baby moon.” You and your baby need nothing more than ample rest, lots of skin-to-skin contact and the ability to relax as much as possible. Your doctor will provide you with information about how to take care of yourself over the next couple of weeks. Be gentle with yourself and allow your body to heal. You can also read, Healing After Childbirth: A Gentle Guide and Timeline, for more information about the immediate, post-partum time.