Phases and Stages of Labor
Although every labor is different, most of them follow the same sequence of events. Here’s the breakdown of how each labor usually progresses:
Breakdown of Phases and Stages:
Stage 1: Dilation
The first stage of labor starts when you begin to feel regular contractions. The first stage is the longest of the three stages and is actually divided into three different phases:
- Phase 1: Early 0-6 cm (Some sources say 0-3 or 0-4 cm, but new ACOG studies show 6 cm)
- Phase 2: Active 6-8 cm
- Phase 3: Transition 8-10 cm
Stage 2: Pushing
Your body goes from dilating to pushing as Baby makes its way down through the pelvis. This phase can last from 15 minutes to several hours.
Stage 3: Placenta
The placenta is typically delivered in 5 – 30 minutes, but the process can last as long as an hour. You will feel some mild contractions but most moms are so focused on their babies that they don’t notice much else going on.
Stage 4: Recovery
After the placenta is delivered, you will continue to have contractions as your uterus works to return to normal size. If you are planning on breastfeeding, it is highly encouraged soon after birth. Nursing right after birth will help your uterus to contract and will decrease the amount of bleeding.
Stage 1 – First Phase: Early Labor
Early labor or the “latent phase” is usually the longest phase in the first stage of labor. Contractions are further apart, shorter, and less intense than they will be later on.
During this phase, you will go from 0 to 6 cm dilated. Some studies suggest this first phase goes from 0-3 or 0-4 cm, but ACOG now suggests active labor doesn’t start until after the 6cm mark.
Contractions can last about 30-45 seconds, with 5-30 mins of rest between them. These contractions are usually more mild and easier to manage.
Most moms will spend this phase at or near home & you should try the “Distract and Deny” method. Some moms will be so excited that they will start walking, timing each contraction, and become hyper-focused on what’s happening. Early labor is not the time for using up all of your energy (you’ll need all of this later) and it’s best to try to ignore your contractions as best you can, while you can.
Talk with your provider and find out when you should head to the hospital/birth center. A common rule of thumb is 4-1-1. That means they are 4 minutes apart, lasting 1 minute each, and this goes on for 1 hour.
Of course, there are always exceptions to this rule (like if your water breaks or you have a history of precipitous labor). Always listen to your body! If contractions become much harder to work through and you feel like it’s time to call or head to the hospital, listen to your instincts!
Stage 1 – Second Phase: Active Labor
Active labor is when labor really starts to get going. Your contractions are intensified and will now require your full attention.
During this phase, you will go from 6 to 8 cm dilated. Again, there are conflicting opinions as to whether this second phase goes to 8 or a full 10 cm. Dilation usually speeds up in this phase – most moms notice about 1 cm per hour.
Contractions can last about 60 seconds, with 3-4 mins of rest between them. Try your best to rest in between contractions to save up some energy for the pushing stage.
Use the restroom every hour – A full bladder in labor can cause the baby to have trouble moving down into the pelvis. It may also prevent a baby from being able to rotate into a good position for birth.
Now is a great time to focus on comfort measures. Create a calm environment (dim lights, soft music, privacy) and increase comfort (walking, slow dancing with a partner, sitting in a bath or shower, or sitting and swaying on a birth ball).
Stage 1 – Third Phase: Transition
The third phase of labor is when you transition from the first stage (dilation) to the second stage (pushing). Your cervix is reaching complete dilation and your baby is descending into your birth canal.
During this phase, you will go from 8 to 10 cm dilated. Your contractions are now between 90 seconds to 2 minutes long and occur every 2-3 minutes. Even though you are still technically in the first stage, your body is showing signs of the second stage.
A lot of moms start to feel like they can’t cope much longer, but you are almost there! Your body can start to secrete adrenaline which can trigger some side effects like nausea, vomiting, hot flashes, chills, or trembling or shakes (check out my previous post on shakes).
Transition usually lasts less than an hour which is usually between 5-20 contractions.
Sometimes as the baby descends, it can increase rectal pressure giving you the sensation of having to poop. You might even have to, which is totally normal!
Birth partners should continue to offer lots of encouragement and praise, avoid small talk, continue breathing with her, and encourage her to relax between contractions.
Second Stage of Labor: the Pushing Stage
The 2nd stage starts when your cervix is completely dilated to 10 cm and ends when baby is born.
Contractions occur about every 2-5 mins, lasting ~ 60-90 seconds.
The pushing stage of labor can last for just a few minutes or as long as 2 to 3 hours. If you have had a baby before, the time from when you start to push to when your baby is born is usually less than an hour.
The space between your pelvic bones that your baby comes through will be the widest if you are not lying on your back. Changing positions will help your baby find the best fit in moving through your pelvis while you are pushing
There are two common ways to push:
Open Glottis Pushing:
▪️Push when you feel the urge to bear down (like you have to poop)
▪️Common to take several breaths in between each push
▪️Most women push 2-3x during each contraction for 5-10 seconds
▪️You can grunt and make deep noises when you are pushing – this is a sign that you are pushing well!
▪️Can increase your pushing time, but usually reduces tearing & fatigue and does not affect blood flow to your uterus, lowering the chances that baby will have heart rate changes
Directed Pushing:
▪️Hold your breath for 6-10 seconds and push like you are pooping. Then take a 3 second break and do that 2 more times with each contraction.
▪️May be asked to not make any noise while you push so you don’t direct your energy anywhere else.
▪️May have more short drops in their baby’s heart rate.
It can also be much more tiring and increase chance of tearing
▪️Typically done if you have an epidural and cannot feel the urge to push or if baby is unstable and you need to speed up pushing time.
It is best for your baby’s head to come out slowly. Your health care provider may ask you to pant, hold back from pushing, or push for short times as the baby is born.
Third Stage of Labor: Placenta
The third stage of labor is centered around the delivery of your placenta after the birth of your baby!
You probably thought contractions stopped once your baby is born, but your uterus will continue to contract as your body pushes out the placenta (afterbirth). This typically takes place 5-30 mins after baby and some moms are so enthralled with their newborn that they hardly notice what’s going on!
The contractions will be mild and close together, and your provider will likely have you push one more time to deliver the placenta. They will then examine your placenta to make sure it is still intact. This is super important because any pieces left behind must be removed to prevent bleeding and infection.
If you are curious about the placenta, you can always ask to take a look at it! It’s about 9” in diameter which is roughly the size of a dinner plate but only about 4cm thick.
After you deliver the placenta, your uterus will continue to contract to help it return to its normal size. Someone might also come by to perform a fundal massage to make sure the uterus feels firm and to help prevent postpartum hemorrhage.
At this point, your provider will start to repair and stitch up any tears you might have. If you didn’t have an epidural, you’ll most likely get a shot of local anesthetic before they start stitching.
Fourth Stage of Labor: Recovery
The fourth stage of labor begins with delivery of the placenta and ends one-to-two hours after delivery.
During this time, you will go through what is commonly known as “The Golden Hour”. This is the first hour of life and many hospitals recognize this period as a special time for bonding between parents and newborns. Usually this includes:
-Skin-to-skin contact for at least an hour
-Performing newborn assessments with baby on mom
-Delaying non-urgent tasks (like bathing baby)
-Early initiation of breastfeeding, nursing soon after birth will help your uterus to contract and will decrease the amount of bleeding.
Studies have shown this hour can help your baby regulate their temperature, decrease stress levels in mom and baby, and improves bonding. If, for whatever reason, you cannot do skin-to-skin, your support person can also help with this!
If you had an epidural, they typically remove the epidural catheter an hour or two after the birth of your baby.
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