Pregnancy labor happens in three stages and lasts on average 12 to 24 hours for a first birth. Usually, labor is shorter for subsequent births.
The First Stage of Labor
The first stage is the longest part of labor and can last up to 20 hours. It begins when your cervix starts to open (dilate) and ends when it is completely open (fully dilated) at 10 centimeters. When the cervix dilates from 0 to 3 or 4 centimeters, contractions get stronger as time progresses. Mild contractions begin at 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than 5 minutes apart. This part of labor (called the Latent Phase) is best experienced in the comfort of your home.
When the cervix dilates from 4 to 8 centimeters (called the Active Phase), contractions get stronger and are about 3 minutes apart, lasting about 45 seconds. You may have a backache and increased bleeding from your vagina (called the "bloody show"). Your mood may become more serious as you focus on the hard work of dealing with the contractions. You will also depend more on your support person.
Tips to help you through the Active Phase of labor:
- Try changing your position. You may want to try getting on your hands and knees to ease the discomfort of back labor.
- Soak in a warm tub or take a warm shower.
- Continue practicing breathing and relaxation techniques.
If your amniotic membrane ruptures -- or your "water breaks" -- the contractions may get much stronger. When the cervix dilates from 8 to 10 centimeters (called the Transition Phase), contractions are 2 to 3 minutes apart and last about 1 minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.
It may help to practice breathing and relaxation techniques such as massage or listening to soothing music. Focus on taking one contraction at a time. Remember that each contraction brings you closer to holding your baby.
It is during the active phase of labor that you will go to the hospital or birthing center. Upon arrival, you will be asked to wear a hospital gown. Your pulse, blood pressure, and temperature will be checked. A monitor will be placed on your abdomen for a short time, or continuously, to check for uterine contractions and assess the baby's heart rate. Your health care provider will also examine your cervix during a pelvic exam to determine how far labor has progressed.
An intravenous (IV) line may be placed into a vein in your arm to deliver fluids and medications if necessary.
The Second Stage of Labor (Delivery)
The second stage of labor begins when your cervix is fully dilated at 10 centimeters. This stage continues until your baby passes through the birth canal, vagina, and is born. This stage may last two hours or longer.
Contractions may feel different from the first stage of labor -- they will slow to 2 to 5 minutes apart and last from about 60 to 90 seconds. You will feel a strong urge to push with your contractions. Try to rest as much as possible between intervals of pushing, and only push when the health care provider tells you.
Tips to help you push:
- Try several positions -- squatting, lying on your side with your leg up, or resting on your hands and knees.
- Take deep breaths in and out before and after each contraction.
- Curl into the push as much as possible; this allows all of your muscles to work.
You may receive pain-relieving medications or have an episiotomy if necessary while pushing. An episiotomy is a procedure in which a small incision is made between the anus and vagina to enlarge the vaginal opening. An episiotomy may be necessary to assist the baby out quicker or to prevent large, irregular tears of the vaginal wall.
The location of your baby's head as it moves through the pelvis (called descent) is reported in a number called a station. If the baby's head has not started its descent, the station is described at minus 3 (-3). When your baby's head is at the zero station, it is at the middle of the birth canal and is engaged in the pelvis. The station of your baby helps indicate the progress of the second stage of labor.
When your baby is born, your health care provider will hold the baby with his or her head lowered to prevent amniotic fluid, mucus, and blood from getting into the baby's lungs. The baby's mouth and nose will be suctioned with a small bulb syringe to remove any additional fluid. Your health care provider will place the baby on your stomach and shortly after, the umbilical cord will be cut.
The Third Stage of Labor
The third stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina. This stage is often called delivery of the "afterbirth" and is the shortest stage of labor. It may last from a few minutes to 20 minutes. You will feel contractions but they will be less painful. If you had an episiotomy or small tear, it will be stitched during this stage of labor.