Stages of Labor & Birth: Explained By a Nurse-Midwife

Did you know there are three stages of labor — labor, birth, and delivery of the placenta?

The first stage of labor is divided into three phases — early labor, active, and transitional. It’s by far the longest stage, lasting anywhere from a few hours to a couple of weeks.

If you’re expecting, it’s essential to be aware of what will happen during this life-changing time. Having some knowledge helps ease your mind, prepare, and feel ready for what’s to come.

Stage One of Labor

The first stage in childbirth is by far the longest. It’s divided into three phases — early, active, and transitional ⁽¹⁾. This period is going to be emotional, exciting, and you’ll likely feel a little impatient.

Here are the first phases:

1. Early Labor (Latent)

The early labor, or latent phase, makes up the majority of the first stage. It can last anywhere from a few hours to a couple of weeks if you’re experiencing a long labor. However, for most, it’s between eight to 12 hours.

For many women, it’s the least acute stage, with mild contractions in long intervals. For others, the contractions are more noticeable, which can indicate you’re progressing a little faster.

During early labor, your cervix begins to dilate. Every time you have a contraction, your cervix opens a little. This phase lasts until you’re at 3 centimeters open, and the cervix thins out. It may sound strange to discuss this process in centimeters, but even in the United States, centimeters are used to describe labor progress.

How to Tell You’re in Early Labor

The signs differ between women — it highly depends on how fast you’re progressing. Most will feel contractions that are mild to moderate, lasting about 30 to 45 seconds with roughly 20 minutes between each. Don’t look for patterns yet, as they’re likely irregular at this time.

As you progress, they will start to occur consistently closer together. However, it’s not unusual for some expectant mothers to not notice anything until they’re in the active phase.

Other early labor signs you may experience can include:

• Nausea.
• Backache.
• Cramps.
• Diarrhea.
• Indigestion.
• The bloody show (slight bloody discharge).
• Water breaking.

If you’re experiencing rapid labor, the onset of contractions is intense and close together, and you’ll progress in a matter of hours. In such cases, call your provider. Quick delivery can take as little as three hours from the first contraction to the birth of the baby ⁽²⁾.

What to Do During Early Labor

If you’re progressing normally, there’s not much to do other than stay patient. Don’t rush to the hospital or birth center — they will send you home until your cervix dilates more. Instead, notify your doctor, doula, or midwife — let them know things are starting to change so they can prepare.

Otherwise, for now, occupy yourself — try to rest, eat something light, and drink plenty of water. If the contractions occur during the day, continue with your routine. Perhaps take a shower, do some light cleaning — anything to keep yourself occupied.

If the contractions begin during the night, it can be challenging to fall asleep again. Try to fall asleep, if you can. Some women benefit from taking magnesium or smelling lavender to promote sleep. Others take half a Unisom sleep tablet, safe in pregnancy, to encourage sleep. If you’re in true labor, the contractions will awaken you from even the deepest sleep.

If you can’t sleep, occupy yourself by preparing your hospital bag or getting your papers ready. You could also make some food for after delivery- cut-up fresh fruit or nut and date bars make great snacks.

This is also a great time to prepare a coping strategy. Try out some different relaxation techniques when a contraction occurs, no matter the intensity. Avoid breathing exercises — you can do some — but they may exhaust you before the actual labor begins.

I recommend my patients have an “early labor project”. First and foremost, sleep if you are able. It will help you rest up for the big event. If it starts in the middle of the day, start your project. Laboring people can knit, binge watch a new series on Netflix, or even paint a portrait for the baby’s room. Have a plan in place to distract you from the contractions or it will seem to take forever!

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

What Health Care Staff Will Do

If you’ve already called your practitioner, good — you may even have discussed when to notify them at an earlier appointment. There’s not much for them to do during this phase.

However, if you experience any of the following, contact them right away:

• Greenish fluid: When your water breaks, it should be clear ⁽³⁾. However, if it’s greenish, it means your baby has already passed its first bowel movement. This could cause a breathing problem called meconium aspiration syndrome.
• Amniotic Fluid with an Odor: If there’s an odor, it can mean that an infection has occurred in your amniotic sac. Contact your provider immediately.
• No fetal movement: It’s not easy feeling your baby’s movements while you’re distracted by contractions. However, they should still be moving. If you haven’t felt a kick, drink some juice, walk around, and then lie down to count the movements.
• Continuous bleeding: A little blood-tinged discharge can mean that your cervix is starting to open. However, bleeding can indicate a problem with the placenta such as placenta previa or an abruption. If it becomes bright red or you release excessive amounts, it requires immediate medical attention.

Tips for the Support System

It’s always good to surround yourself with one or two people you trust and enjoy being around. Be choosy about who you involve though- make sure it is someone caring and sympathetic like your partner, a sibling, parent, or best friend.

Here are some tips for that person:

• Practice timing: A good support buddy must learn to time contractions — the laboring woman already has a lot on her plate. Practice how to time them, or perhaps download an app to assist. You only need to time a few each hour, unless it seems that things have become more painful.
• Good distractions: Without being overbearing, suggest some small activities to distract her. This is the perfect time to think about your early labor project. If you haven’t thought of one, options include taking a walk, watching a favorite movie, or any other thing she likes.
• Be supportive: Be patient, give reassurance if needed, and be there if she needs a pep talk. Avoid talking about pain, things that could go wrong, or other distressing topics.
• Stay calm: Be the soothing influence amidst this hectic time.
• Remember yourself: Yes, you’re there for support, but chances are it could take a long time. Remember to take care of yourself as well because your strength will be needed soon, too. Eat something light, stay hydrated, and get some rest when you can, especially if you’re the designated driver.

2. Active Labor

Welcome to the active labor phase. Some professionals believe that it starts at 4 centimeters, while contemporary research places it closer to 6 centimeters. It usually lasts anywhere from two to four hours, or until your cervix dilates to 7 centimeters. It’s considerably more intense, and you’re likely to be heading to the hospital or birth center.

How to Tell You’re in Active Labor

You know that you’re in the active phase of labor when the contractions are more powerful and intensify consistently. They begin to last longer, around 40 to 60 seconds each time, and they feel much stronger. The timing is also more frequent — now about three to four minutes apart.

However, the pattern may still be irregular, but you should time them to notice any changes. If pain relief, such as an epidural, is in your birth plan, the anesthesiologist or nurse anesthetist will be called to administer that now. If not, you may feel some of the following symptoms:

• Increasing discomforts like backaches and contractions.
• Bloody show.
• Fatigue.
• Heaviness or discomfort in the legs.
• Water breaking.

What to Do During Active Labor

If you’re not already in the hospital or birth center, you’d better get going. Things can progress fast during this phase. Get your support buddy and keep them close to distract you and time the contractions.

Now is also the time to start your breathing exercises. Because the contractions are so intense, breathing helps you cope. Try to remember some of the relaxation methods you practiced earlier and put them to use.

Move More. Do what you need to stay comfortable. It’s not the best to lie in the same position — if it’s safe, get up and walk around. Doing this can help relieve some of the back pain you’re experiencing.

Hydrotherapy. Taking a warm bath or shower are excellent ways to distract yourself and relax. The contractions may feel less intense while you’re submerged in warm water.

You can opt for an epidural at any time during this phase. But you must let your practitioner know when you want some relief. An epidural usually requires around 20 minutes to take effect, and it may take longer for the anesthetist to arrive in the room to perform the procedure ⁽⁴⁾.

Finally, drink lots of water. You’re going to sweat and feel tired, so energize yourself with plenty of hydration. Don’t forget to use the restroom as well — laboring on a full bladder is neither fun for you nor your provider.

Sometimes a full bladder can slow down labor and the baby’s ability to come down into the birth canal. If you have an epidural, your bladder will be emptied with a catheter. If you are laboring without medications, you should regularly empty your bladder on your own.

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

What Will Health Care Staff Do

During normal labor that’s progressing safely, health care staff shouldn’t bother you. They may remain in your room, but out of your way to let you work. They will, however, monitor you from time to time — this is what they check and do:

• Monitor your baby’s heart rate with a fetal monitor or Doppler.
• Check your blood pressure, pulse, and temperature.
• Evaluate the bloody discharge for abnormalities.
• Monitor the strength and time of your contractions.
• Place an IV if you’re opting for an epidural or need antibiotics.

If your labor begins to slow down at this phase, your OB provider may give it a boost ⁽⁵⁾. This could be by rupturing your membrane if it’s still intact, administering Pitocin, or advising nipple stimulation. However, if both you and the baby are doing fine, the team can wait before inducing.

Tips for the Support System

Due to the intensity of this phase, being the support person can be a challenge. Here are some tips:

• Be reassuring: Tell her what she needs to hear — she can do it, it will be over soon, and everything will be fine. Let her know how strong she is and how proud you are.
• Show attention: Put all your attention on your laboring partner/sibling/friend. Show that you’re there whenever she needs something.
• Help with relaxation: Offer a back massage, perform hip squeezes or knee presses, roll a tennis ball across her lower back, or provide some pillows as needed. Try to keep water close, so it’s ready when wanted.
• Be a reminder: Help to remind her to switch positions now and again. Encourage a short walk around the room or outside if allowed. However, don’t press her if she’s too uncomfortable.
• Help to distract: Bring cards, games, or music — anything to take her mind off the pain. Just check with the health care staff to make sure the music is at an acceptable level.

3. Transitional Labor

Now you’re almost there. The third phase of stage one is called transitional labor, and it’s indicated by dilation of 7 centimeters. The period lasts until you’re ready to push and your cervix is at 10 centimeters.

This is the shortest, but most intense phase, which many dub the most painful. It usually lasts anywhere from 30 minutes to two hours, although it’s not unusual for it to last longer.

How to Tell You’re in Transitional Labor

Once in the transitional phase, the intensity picks up. Your contractions are getting more powerful and last 60 to 90 seconds.

You can expect to experience highly intense peaks during the contraction. If this isn’t your first rodeo, you may encounter several, but at least it will usually be shorter.

During the transitional phase, contractions come in quick intervals, two to three minutes apart. It can be hard getting a break to breathe before the next begins, so keep focusing on your exercises.

Here are some things you can expect to feel and experience:

• Intense pressure in your lower back and perineum.
• An increase in bloody discharge.
• Nausea, and possibly vomiting.
• Leg cramps, and perhaps shaking.
• Hot flashes with sweating, or chills and shakiness.
• Fatigue.
• Drowsiness.
• Rectal pressure, an urge to poop, and possibly an urge to push.
• Tightening sensations in throat and chest.

What to Do During Transitional Labor

Because the last phase of this stage is so intense, you may rely heavily on your support system. This phase drains you both physically and mentally — it’s completely normal to feel impatient, overwhelmed, and perhaps a bit disoriented. There’s not much to do other than listen to your body.

It’s important to remember to speak up if you feel uncomfortable. You may prefer people to stop touching you or speaking with you while you’re getting close to giving birth. When you have a small break from contractions, remember your breathing and relaxation techniques.

Once your cervix has reached 10 centimeters, your body tells you it’s time. Once you feel an urge to push, let your nurse know. You’ve progressed to the second stage of labor — giving birth.

What Health Care Staff Will Do

Health care staff will keep a closer eye on you during this phase. They will continue to check your baby’s heart rate and how it is tolerating contractions. Your medical team will check your temperature, pulse, and blood pressure. Your doctor will also review how low your baby’s head is in the birth canal.

Stage Two of Labor — Delivering Your Baby

In the birthing room, it’s time to push. While many women fear this stage, in truth, it feels amazing to push. For so long you’ve been experiencing contractions and unable to respond in any effective way. When you push, it feels better and it helps to minimize the intensity of the contractions. Once the baby crowns, you may experience a burning sensation known as the “ring of fire”. Don’t be afraid, it means your baby is so close to being on your chest and in your arms!

This stage goes by the fastest — it can take anything from 2 minutes to four hours ⁽⁶⁾. However, many things are happening, and soon, you get to greet your baby.

How to Tell You’re in Stage Two of Labor

Your practitioner will likely tell you, and you’ll begin to feel strong urges to push. The contractions now last 45 to 90 seconds, with three to five minutes of rest in-between.

Pressure around your rectum is normal, and you may even urinate or have a bowel movement. This is common, and the health care staff are ready for this.

What to Do During Stage Two of Labor

Push, push, and push — it’s as simple as that. Follow your body — everything will come naturally. Ask your practitioner if you could try a different position if necessary — preferably one where gravity can help you.

Once you feel a push, use everything you have. Then as the intensity wears down, remember to relax.

What Health Care Staff Will Do

Your nurse will be there to guide you through every push. They also help to minimize the tears to your tissue after crowning. They will make sure mom and baby are doing well.

Once your baby is out and is healthy, your doctor or midwife may place them on your chest for the first bonding session.

Stage Three of Labor — Delivering the Placenta

The final and shortest stage is the delivery of the placenta. This process usually takes five to 30 minutes.

How to Tell You’re in Stage Three of Labor

Shortly after your baby’s entrance into the world, you’ll begin to feel minor contractions again. Your placenta is starting to separate from the uterine wall. It’s also called the afterbirth.

During the afterbirth, you may feel shaky or experience chills. It’s completely normal as the placenta disengages, but report any feelings that make you uncomfortable.

What to Do During Stage Three of Labor

Your OB provider will lead the way. There’s no pushing required on your side, just some patience. However, if you have a strong urge to push as the placenta detaches, go with it! It will make the experience easier and speed along the process.

What Health Care Staff Will Do

Your provider may apply some pressure to support your uterus. They may pull gently on the umbilical cord to get it out.

If your blood type is negative, your doctor or midwife will draw blood from the umbilical cord to check your baby’s blood type. This is painless for both you and baby. If you’ve chosen to store umbilical cord blood, then your health care provider will do this now.

Signs That Labor Is Nearing

Before labor even starts, you may be able to notice a couple of the following signs:

• Lightening: This is where your baby “drops” to the bottom of your pelvis, usually occurring weeks before birth. You may feel lighter — less shortness of breath, but heavier in your lower abdomen toward your pelvic floor.
• Nesting: A burst of energy, like an urge to paint the baby’s room ⁽⁸⁾. It’s prevalent and generally occurs a few days before labor begins.
• Bloody show: You may notice pink or brownish spots in your discharge. It means the capillaries in your cervix are bursting as the pressure is increasing. It may happen hours before labor begins or weeks.
• Braxton Hicks: These are mild, irregular contractions, which don’t cause any changes to the cervix. They may intensify as true labor approaches.
• Nausea and diarrhea: You have hormonal changes to thank for this. These changes can easily cause a sick feeling in the stomach.
• Water breaking: This can sometimes occur before labor has begun. It can be a small trickle or a gush of fluids ⁽⁹⁾. It’s essential to notify your practitioner once your water breaks.

Stages of Labor FAQs

What is the Longest Stage of Labor?

The first stage, which includes early and active labor, is usually the longest, lasting up to 20 hours or more for first-time mothers.

What is Prodromal Labor?

Prodromal labor, also known as “false labor,” involves early contractions that might feel like the start of labor but don’t lead to immediate birth.

What Do the First Contractions Feel Like?

First contractions can feel like strong menstrual cramps or tightening across the abdomen. They gradually become more intense and regular.

How Far Dilated Do You Have to Be to Be Admitted Into the Hospital?

Hospitals typically admit women who are about four to six cm dilated, showing regular contractions and progressing labor.

Can You Sleep Through Active Labor?

It might be difficult, but some women manage to rest or even sleep lightly during early labor. Active labor is usually too intense for sleep.

How Long After Pitocin Does the Baby Come?

The timing varies greatly; some women deliver within a few hours, while others might not deliver for 24 hours or more.

How Long is the Average Pushing Time For a First Baby?

Pushing can last from a few minutes to several hours, with first-time moms often pushing for 1-2 hours.