what are the stages of labor?
By Kimberleigh Weiss-Lewit, IBCLC & Birth Doula
You may feel like you have been pregnant forever or you might feel like the experience has flown by, but almost universally toward the end of your pregnancy, you may start wondering “when will I know I am in labor?,” “what are the stages of labor?,” and “what can I expect?”. Just like every pregnancy is different, experiences of birth can vary greatly. While your experience will be uniquely your own, there are some patterns to physiological labor and birth that can be helpful to know as you prepare.
The most common questions birth professionals, including doulas like me, get about labor are “When does the water break?” and, “When should I go to the hospital or call the midwife to come over?”. Timing of both water breaking (this can happen before labor starts or may not happen at all with a tiny percentage of babies born en caul—in their amniotic sac!) and how rapidly labor progresses are two of the most variable aspects of labor and birth. Pregnant people having their first baby tend to have the longest labors. This may mean more hours of coping with contractions but it also means that it is incredibly rare for a first-time labor to go so quickly that a person doesn’t make it to their birth location or doesn’t have their provider with them.
So how do most births unfold? Labor is often divided into four stages: Dilation, Pushing, Placenta and Recovery. The first stage of labor can be subdivided into three substages.
First Stage of Labor: Dilation (0-10cm)
Early Labor (0-6cm)
Early labor can start without you even realizing it! Your body may have had Braxton hicks or practice contractions for months before your baby is ready to come but eventually, you will begin having mild contractions that make changes to your cervix. At first, you might think they are the same Braxton hicks contractions or cramping that you have grown used to, but over the course of days or hours, you will start to notice these contractions getting longer, stronger and closer together. While you will likely have learned and prepared some specific coping tools for labor, you may find that you can move through this stage with good hydration, nutrition, rest, love, and some healthy distraction! Counting and timing every contraction isn’t necessary or advised but from time to time you might take note that there is a pattern and intensification to the tightening or cramping you are feeling.
The changes in your cervix mean that the long, hard, closed cervix that was keeping your baby in all these months is starting to soften, thin out, and open. We tend to focus on the number of centimeters that we are dilating (during this phase we may open to 4-6 cms) but equally important is the softening and thinning or effacement of the cervix. Other bodily changes that can happen during this phase are period-like cramps, increased vaginal discharge, and even some blood-tinged discharge. Your water may break before or during this early phase—if it does avoid intercourse or placing anything in your vagina—but it is more than fine if it doesn’t! If it does break, take note of the time, color and odor and let your provider know. Amniotic fluid should be clear but sometimes it can be green or brown if your baby has passed stool in utero and your provider will probably want to see you sooner than later in that situation. A foul odor may indicate an infection. Connect your provider right away if you notice bright red or period-like bleeding.
Active Labor (6-8cm)
It used to be that “active labor” was defined as starting at 4 centimeters of dilation—this meant that providers were expecting your labor to start picking up and for you to make steady progress after that point. In recent years, the clinical definition has shifted to 6 centimeters which is great news for parents because once you are truly in active labor the time it takes to get to full dilation (10cm) is quicker. Going from 6-10 centimeters, or full dilation takes much less time. This shift in parameters also means, however, that you may be feeling strong contractions and go to the hospital or have your midwife come over only to be told you are “still in early labor”. So while officially this active stage starts at 6 centimeters dilation, your contractions may intensify well before you hit this milestone.
In active labor, you are using your coping tools—ideally moving, breathing, making sound freely during each contraction, and resetting and releasing tension during each break. Active labor is undeniably hard work and taking the time between contractions to rest is key. Hydration and peeing also become very important during this stage so be sure to drink water and electrolyte drinks and to use the bathroom frequently. Dehydration can make contractions feel stronger (amount other issues) and a full bladder can impede the labor process.
Active labor is also the time when you may be leaning (literally, sometimes!) on your partner, loved ones, and doula for physical and emotional support. There is no one way to labor and move through contractions—some birthing people love to be held, touched, and pressured and others crave quiet and solitude.
During active labor, some birthing people opt for non-pharmacological pain relief from hydrotherapy (a bath or shower can do wonders to lessen pain and help the birthing person feel refreshed), or from medications such as an epidural or nitrous oxide. Don’t hesitate to let your providers know what you need or want in labor, having a pre-written birth preferences sheet (a.k.a a birth plan) can be great, but also know this is your birth and you can change your mind or ask for more information on interventions anytime!
The time between active labor and bearing down or “pushing” your baby out into the world is called transition. Transition is often the shortest phase of labor as both your contractions (now likely 2-3 minutes apart) and the pressure of your baby’s head moving down help your body finish dilating and clear the way for your baby to be born. During this time there is a huge shift in hormones and the birthing person may throw up, feel shaky, and have a big increase in rectal and vaginal pressure as their baby makes its way down to the birth canal. Especially for those without pain medication, transition can also be a time when the coping skills that got them through active labor feel less useful and it is very common for the birthing person to express feeling overwhelmed or having feelings of self-doubt. As much as they can, everyone supporting the birth person can work to stay calm and grounded. Transition can feel very primal and the birthing person needs freedom to move and vocalize. Transition is intense but also exciting as it means you are so close to meeting your baby!
Second Stage of Labor: Bearing down and Birth (pushing)
The wildness of transition gives way to a big shift in energy and focus as the birthing person starts using their contractions to move their baby down the birth canal and into the world. This stage starts when you are fully dilated and ends with the birth of your baby. If you have an epidural you will likely feel the pressure of your baby moving down even if you are not feeling your contractions. Your provider and support people may use monitoring to let you know when you are having a contraction so you can bear down, or push, with each one. If you do not have an epidural, you may not need much guidance at all as you naturally shift into this stage, and pushing may be involuntary. Most unmedicated birthing people will feel an overwhelming, undeniable urge to push. Whether or not you are using medication, resting between contractions is important to allow you and your baby time to rest, and oxygenate. Let yourself fully relax and take slow deep breaths. Partners can offer sips of water or other beverages and offer you cool compresses and encouragement during these breaks.
Movement is so important in labor and birth and during this stage, you may find yourself wanting to be upright in a squatting position, on your hands and knees or on your side. Changing positions can be key to helping your baby find their way into the world—gravity and space in your pelvis can really make this pushing easier for you both! This stage can be quite short, especially if this isn’t your first vaginal birth, but may take several hours. When your little one makes their way to your vaginal opening and starts crowning (head almost fully out), it is usually just a few more pushes until they are born.
Third Stage of Labor: Birth of your Placenta
Once your sweet baby is born and placed right on your chest (where most normal newborn assessments can take place), your body still has some work to do. Your placenta has provided nourishment to your baby throughout your pregnancy and birthing this amazing organ is the completion of the birth process. Lots of birthing people worry about this final stage but especially if your baby is in skin-to-skin your experience of the contractions and birth of your placenta should be much easier than birthing your baby! The placenta detaches from your uterus and passes through your birth canal, usually with a small push or two. After your placenta is born, your provider will also see if there are any tears that need repair—with local anesthesia and stitches—and will massage your uterus several times to help it contract down to about the size of a grapefruit. This massage called a fundal massage is definitely not the most comfortable of massages but it is important to make sure your bleeding is controlled.
Fourth Stage of Labor: Skin-to-skin, Recovery and Stabilization
Sometimes this stage gets overlooked but it is of paramount importance! After birth, you and your baby will spend time in skin-to-skin adjusting to being together in this new way. Your body is your baby’s ideal environment so even if there is early separation for medical reasons, offer skin-to-skin as soon as you are both able to. The fourth stage is a time for your body to stabilize after the tremendous work of giving birth. Eating warm, soft, easily digestible foods and drinking lots of fluids is important even if you don’t yet feel hungry. Your baby will also ideally start nursing within the first hour after birth which will encourage your uterus to begin the process of involution. If you choose to give donor human milk or formula, give a small amount during this time. Oftentimes both the birthing parent and baby will fall into a deep sleep within a couple of hours after birth. Your nurse or midwife will be keeping a watchful eye on you both while allowing you to rest. Limiting visitors and interruptions during this time will give space for your family to bond.
Everyone’s experience of giving birth will be uniquely their own. Knowing the stages of labor and some of what you can expect, can help you approach the process with confidence. You have many options and choices to make along the way and having the support of your provider, loved ones and a trained birth doula can make a world of difference.