Labor is the body’s natural process of childbirth. It lasts on average 12 to 24 hours for a first birth. Usually, labor is shorter for births after that.
Labor happens in three stages. The first stage goes from when you first start having steady contractions to when you’re ready to deliver your baby. It includes an early or latent phase, when contractions are mild and the cervix begins changing to allow the baby to pass through; an active phase, when contractions are strong and most of the work happens to prepare your body for delivery; and a transitional phase when you start feeling the need to push.
The second stage of labor is the actual birth of your baby, and the third stage is the delivery of the placenta.
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.
Early or latent labor
The early or latent phase is when labor begins. You’ll have mild contractions that are 15 to 20 minutes apart and last 60 to 90 seconds. Your contractions will become more regular until they are less than 5 minutes apart. The contractions cause your cervix to dilate and efface, which means it gets shorter and thinner, and more ready for delivery. During the early phase, your cervix dilates from 0 to 6 centimeters, and contractions get stronger as time goes on. During this phase, you may have discharge from your vagina that’s clear to slightly bloody.
This part of labor could take hours or even days. It’s best to spend it in the comfort of your home. Here are some things you can do to help the process along:
- Take a walk.
- Change positions often.
- Continue practicing breathing and relaxation techniques.
- Soak in a warm tub or take a warm shower. If your water has broken, talk to your doctor before soaking in a tub.
- Rest if you can.
- Drink plenty of liquids and have something light to eat.
- Get yourself packed and ready for the hospital if you aren’t already.
Active phase
While the cervix dilates from 6 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"). If your amniotic membrane ruptures -- or your "water breaks" at this point -- the contractions may get much stronger.
This part usually lasts about 4 to 8 hours. Your mood may become more serious as you focus on managing the contractions. You’ll depend more on your support person.
It’s usually during the active phase of labor that you’ll 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. Your doctor may have you limit what you eat and drink at this time if they think it’s possible you’ll need a C-section with general anesthesia.
Some 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.
- Keep walking between contractions.
- Empty your bladder often to make more room for the baby’s head in your pelvis.
- Continue practicing breathing and relaxation techniques.
- Ask your birth partner for a gentle massage.
- Listening to soothing music.
- Focus on taking one contraction at a time. Remember that each one brings you closer to holding your baby.
Transition phase
The transition phase is short, but also intense and painful. It usually takes from 15 minutes to an hour for the cervix to dilate from 8 to 10 centimeters. 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.
You may feel the urge to push, but don’t until your doctor tells you to. Pushing before your cervix is fully dilated may cause it to swell and slow down the process.
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 2 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’ll 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.
Some tips can 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 get pain-relieving medications or have an episiotomy if necessary while pushing. An episiotomy is a procedure in which a small cut is made between the anus and vagina to enlarge the vaginal opening. An episiotomy may be necessary to get your baby out quicker or to prevent large, irregular tears of your 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 hasn’t 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 their 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 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.
Certain terms are used to describe your baby's position and movement through the birth canal.
FETAL STATION
Fetal station refers to where the presenting part is in your pelvis.
- The presenting part. The presenting part is the part of the baby that leads the way through the birth canal. Most often, it is the baby's head, but it can be a shoulder, the buttocks, or the feet.
- Ischial spines. These are bone points on the mother's pelvis. Normally the ischial spines are the narrowest part of the pelvis.
- 0 station. This is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis.
- If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5.
In first-time moms, the baby's head may engage by 36 weeks into the pregnancy. However, engagement may happen later in the pregnancy, or even during labor.
FETAL LIE
This refers to how the baby's spine lines up with the mother's spine. Your baby's spine is between his head and tailbone.
Your baby will most often settle into a position in the pelvis before labor begins.
- If your baby's spine runs in the same direction (parallel) as your spine, the baby is said to be in a longitudinal lie. Nearly all babies are in a longitudinal lie.
- If the baby is sideways (at a 90-degree angle to your spine), the baby is said to be in a transverse lie.
FETAL ATTITUDE
The fetal attitude describes the position of the parts of your baby's body.
The normal fetal attitude is commonly called the fetal position.
- The head is tucked down to the chest.
- The arms and legs are drawn in towards the center of the chest.
Abnormal fetal attitudes include a head that is tilted back, so the brow or the face presents first. Other body parts may be positioned behind the back. When this happens, the presenting part will be larger as it passes through the pelvis. This makes delivery more difficult.
DELIVERY PRESENTATION
Delivery presentation describes the way the baby is positioned to come down the birth canal for delivery.
The best position for your baby inside your uterus at the time of delivery is head down. This is called cephalic presentation.
- This position makes it easier and safer for your baby to pass through the birth canal. Cephalic presentation occurs in about 97% of deliveries.
- There are different types of cephalic presentation, which depend on the position of the baby's limbs and head (fetal attitude).
If your baby is in any position other than head down, your doctor may recommend a cesarean delivery.
Breech presentation is when the baby's bottom is down. Breech presentation occurs about 3% of the time. There are a few types of breech:
- A complete breech is when the buttocks present first and both the hips and knees are flexed.
- A frank breech is when the hips are flexed so the legs are straight and completely drawn up toward the chest.
- Other breech positions occur when either the feet or knees present first.
The shoulder, arm, or trunk may present first if the fetus is in a transverse lie. This type of presentation occurs less than 1% of the time. Transverse lie is more common when you deliver before your due date, or have twins or triplets.
CARDINAL MOVEMENTS OF LABOR
As your baby passes through the birth canal, the baby's head will change positions. These changes are needed for your baby to fit and move through your pelvis. These movements of your baby's head are called cardinal movements of labor.
Engagement
- This is when the widest part of your baby's head has entered the pelvis.
- Engagement tells your health care provider that your pelvis is large enough to allow the baby's head to move down (descend).
Descent
- This is when your baby's head moves down (descends) further through your pelvis.
- Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.
Flexion
- During descent, the baby's head is flexed down so that the chin touches the chest.
- With the chin tucked, it is easier for the baby's head to pass through the pelvis.
Internal Rotation
- As your baby's head descends further, the head will most often rotate so the back of the head is just below your pubic bone. This helps the head fit the shape of your pelvis.
- Usually, the baby will be face down toward your spine.
- Sometimes, the baby will rotate so it faces up toward the pubic bone.
- As your baby's head rotates, extends, or flexes during labor, the body will stay in position with one shoulder down toward your spine and one shoulder up toward your belly.
Extension
- As your baby reaches the opening of the vagina, usually the back of the head is in contact with your pubic bone.
- At this point, the birth canal curves upward, and the baby's head must extend back. It rotates under and around the pubic bone.
External Rotation
- As the baby's head is delivered, it will rotate a quarter turn to be in line with the body.
Expulsion
- After the head is delivered, the top shoulder is delivered under the pubic bone.
- After the shoulder, the rest of the body is usually delivered without a problem.