Unlike in the movies, labor and delivery isn't always scripted. No one knows exactly what triggers labor, though hormones are suspected to play a role. And though labor is divided into three stages, each woman may not go through it the same way. For first-time moms, labor can last 12 to 24 hours on average. For some women it will be faster and for others slower. Here's what you need to know.
What to expect: This stage of labor is the longest and can range from 12 to 20 hours for women having their first baby. Labor begins when you have uterine contractions -- which may be mild at first, occurring every 15 or 20 minutes -- and when your cervix begins slowly dilating and effacing (thinning). It ends when your cervix is dilated 3 or 4 centimeters (about 1 to 1 1/2 inches).
Contractions last anywhere from 30 to 70 seconds and can feel like a backache or menstrual cramps. As labor progresses, contractions become more regular, frequent, and intense, increasing to every seven to 10 minutes, then every five to seven minutes.
What to watch for: You may notice a "bloody show," pink or brown-tinged mucus -- a normal discharge as your cervix opens. This discharge may happen days before or at the start of labor.
The rupturing of amniotic membranes can occur spontaneously in stage one labor or later in the process and feel like an obvious gush or just a feeling of wetness -- or your water may not break until a doctor does this for you, says Tiffany A. Moore-Simas, MD, MPH, MEd, FACOG, director of the Obstetrics and Gynecology Research Division at the University of Massachusetts Medical School.
How to manage: It's good to call your doctor when you begin contractions, but you may not need to go to the hospital yet. Healthy, first-time moms can usually go through this stage of labor at home, says Moore-Simas. When should you go to the hospital? "When you're contracting every five minutes, that's a good time to come in," says Moore-Simas. "If you're leaking fluid, that might [also] be the time to come in."
Meanwhile, rest and make yourself as comfortable as possible, perhaps by listening to music or soaking in a warm bath.
Stage One: Active Phase
What to expect: At this stage, contractions are stronger and more painful, occurring about three minutes apart and lasting approximately 45 to 60 seconds. Your cervix is dilating much more rapidly, about 1.2 centimeters an hour, says Moore-Simas.
When your cervix dilates from 8 to 10 centimeters, you are in "transition stage," the last part of stage one labor; contractions now come approximately every two to three minutes and last for a minute or more. You may feel nauseous and have increased back pain.