The first stage of active labor starts when the cervix is about 3 cm to 4 cm dilated. This stage is complete when the cervix is fully dilated and effaced and the baby is ready to be pushed out. See an illustration of cervical effacement. During the last part of this stage (transition), labor becomes particularly intense.

Compared with early labor, the contractions during the first stage of active labor are more intense and more frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing center. If your amniotic sac hasn't broken before this, it may now.

As your contractions intensify, you may:

• Feel restless or excited.
• Find it difficult to stand.
• Have food and fluid restrictions. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted because the stomach digests food more slowly during labor. An empty stomach is also best in the rare event that you may need general anesthesia.
• Want to start using breathing techniques, laboring in water, acupuncture, hypnosis, or other calming measures you've chosen to manage pain and anxiety.
• Feel the need to shift positions often; this is good for you, because it improves your circulation. You may not know which birthing position is right for you for a while.
• Want pain medication, such as epidural anesthesia.
• Be given intravenous (IV) fluids.

Should I use epidural anesthesia during childbirth? (For more information about pain medication options, see the Labor and Delivery: Your Birthing Options section of this topic.)

Transition phase

The end of the first stage of active labor is called the transition phase. As the baby moves down, your contractions become more intense and longer and come even closer together than before. When you reach transition, your delivery is not far off. During transition, you will be self-absorbed, concentrating on what your body is doing. You may be annoyed or distracted by others' attempts to help you but, nevertheless, feel you need them nearby as a support. You may feel increasingly anxious, nauseated, exhausted, irritable, or frightened.

A mother in first-time labor will take up to 3 hours in transition, and a mother who has vaginally delivered before will usually take no more than an hour. Some women have a very short, if intense, transition phase.