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Stages of labour and delivery

Read about the three stages of labour. Tips, such as breathing exercises, are provided for dealing with the pain and exhaustion of labour.
Key points

Labour and delivery is divided into three stages, though every woman experiences these stages differently.
The first stage of labour lasts from the time when you start having contractions until your cervix is fully dilated.
Stage one is broken down into the early phase, the active phase and the transition phase.
The second stage is when the baby is actually delivered, usually lasting from 20 minutes to two hours.
The third stage of labour is the delivery of the placenta.

Roughly speaking, vaginal birth, also called labour and delivery, is divided into three stages. The first stage of labour lasts from the time when you start having contractions until the time that your cervix is fully dilated, or open. The second stage is the "pushing" stage where the baby is actually delivered. The third stage of labour is the delivery of the placenta. Each woman experiences these stages differently, and the stages may differ from one pregnancy to another. Sometimes the signs of each stage may overlap.
Stage one of labour and delivery

The first stage of labour lasts from the time when you start having contractions until the time that your cervix is fully dilated, or open. In the weeks leading up to labour, your cervix starts to soften. The contractions of labour open the cervix wide enough to let the baby through. Stage one is divided into the early phase, the active phase, and the transition phase.
The early phase

The early phase of stage one is also called the latent phase, and it can last up to 20 hours. A typical labour might start with contractions coming every five to 20 minutes and lasting 30 to 60 seconds each. Every labour is different, however, and some women might not realize they are in labour until the contractions are relatively close together, about five minutes apart. The contractions will become stronger, longer, more frequent, and better coordinated. During the early phase, your cervix will open to about 3 cm (1 inch).

The pain you may experience during the early phase of stage one will be similar to menstrual cramps, spreading around your abdomen like a tight band. During a contraction, there is a wave of pain across the abdomen. The uterus hardens and tightens intensely, and holds this intensity for a few seconds before relaxing. Some women may feel the pain as a backache instead. The pain of the contractions in the early phase is generally not as severe as that in the active phase. You should be able to talk during the contractions. If you are not able to, contact your health-care provider or proceed to the nearest hospital right away.

During the early phase of labour, try to rest in between contractions, to conserve your energy for what | s ahead. Try to go to the bathroom as often as possible, because a full bladder can hinder your uterus from contracting efficiently. An empty bladder leaves more space for the baby to pass through.
Rupture of the fetal membranes

The fetal membranes often rupture in stage one of labour. This is often referred to as your "water breaking," and it is painless. Once the fetal membranes are broken, amniotic fluid will either leak or gush out. Sometimes, if labour is proceeding slowly and the fetal membranes have not ruptured, the doctor may make a small tear in the membranes with a gadget that looks like a small crochet hook. This is called artificial rupture of the fetal membranes; it should make the contractions stronger and help speed labour along.

If your fetal membranes rupture before the onset of labour pains – a condition known as premature rupture of the fetal membranes – you may need to have labour induced. Call your health-care provider or proceed to the nearest hospital as soon as possible.
The active phase

After your cervix dilates to around 3 cm (1 inch), you will enter the active phase of labour, where things really start to get rolling. For the next few hours, your contractions will be strong, painful, and regular. Unlike the early phase, you may no longer be able to talk through these contractions. Once you have had strong, regular contractions every five minutes for about an hour, you should call your health-care provider or proceed to your nearest hospital. Some health-care providers prefer that you contact them before you reach this point, so make sure to discuss this with them ahead of time.

Usually during the active phase of labour, the contractions will become stronger and more frequent, occurring about every two to three minutes. However, every labour is different and some women do not have contractions more often than every five minutes. In the active phase, your cervix will continue to open, to about 8 cm (3 inches). The baby | s head will descend further and further into the pelvis.

There is no way to deny that the contractions will be painful, but there are ways to deal with the pain. Here are a few non-medical ways to cope with the pain:

Try to relax.
Use breathing patterns to help relaxation.
Make releasing noises like chants, hums, and moans when you feel the need to.
Take advantage of gravity to help push the baby along: try standing and leaning against your partner, sitting and leaning over a chair, kneeling on all fours, walking slowly, or relaxing in the shower.
Try to walk in between contractions.
Sway, rock, and dance to keep your pelvis mobile.
Consider water therapy: soak in the jacuzzi, bathtub, or shower.
Have your partner or a friend give you a massage.
Urinate frequently.
Distract yourself with music, television, or meditation.

Your labour partner can also help you to deal with the pain by doing the following:

reassuring you with loving words and slow, steady movements
offering praise, not criticism
trying to distract you
helping you to take one contraction at a time
letting you stand and lean against them (or her), in an effort to have gravity push the baby along
mopping your forehead with a wet cloth
bringing you ice chips to chew on, and other drinks and food if permitted by your health-care provider
giving you a massage if you want it
encouraging you to rest between contractions if you are able to
encouraging you to resist pushing until your health-care provider says that you should

Some women prefer to receive pain medication during childbirth. Choices for pain relief include narcotics and tranquilizers, and regional blocks such as epidurals.
The transitional phase

In the transitional phase, your cervix will open from 8 to 10 cm (3 to 4 inches), which is the diameter that the baby | s head needs to pass through the birth canal. At this point, your contractions will be intensely strong, occurring about every two to three minutes. Each contraction may last 60 seconds or more. You may feel shaky or nauseous at this point. Continue to use the same coping tips you tried during the active phase of labour.

The baby | s head continues to descend further into the pelvis during the transitional phase. By the end of this phase, a birth canal will have formed. This is a single passage of the open womb, open cervix, and vagina for your baby to pass through. The time for pushing will soon be at hand.
Stage two of labour and delivery

This is the "pushing" stage where the baby is actually delivered! The second stage of labour is very exciting, and it usually lasts from 20 minutes to two hours. For some women, stage two may last only five minutes; for others, it could last up to three hours. During this stage, you will still have strong and regular contractions, every one to three minutes. Each contraction will help to move the baby | s head farther down into the pelvis, along the birth canal.

Some women find the second stage of labour easier to manage than the active phase of the first stage, because they can bear down, which offers some relief to the pain. When you feel the unbearable urge to bear down, hold your breath and push like you are having a very large bowel movement. Go naturally with each contraction. Follow what your body tells you to do.

If you have an epidural in place, you may not be able to feel what is happening, and you will find it difficult to push effectively. Your health-care provider can help you manage this challenge, by carefully coaching you through the pushing stage.

With each contraction and push, your abdominal muscles put pressure on the baby to move through the birth canal. When a contraction finishes, the uterus relaxes and the baby | s head recedes slightly. After a while, the area between your vagina and anus, called the perineum, will start to bulge and the baby | s scalp will become visible.

The top of the baby | s head will emerge at the end of stage two. This is called "crowning." At some point, you may be asked to stop pushing, even if you have the overwhelming urge to do so. This allows the baby | s head to work at its own pace to stretch out your vagina and perineum. If you can resist the urge to push at this point, it can help to prevent tearing in the perineal area.

The doctor or midwife will gently guide the baby | s head through the birth canal, followed by one shoulder and then the other. The rest of the body follows easily. There may be a gush of water. If necessary, your health-care provider may suction the baby | s nose and mouth; baby will take his dramatic first breath. The umbilical cord will be clamped and your partner may be offered the opportunity to cut the cord. If there are no complications, the baby will be quickly cleaned up and placed on your chest so that you can admire them and warm them with your body.
Stage three of labour and delivery

This short, 10-minute to one-hour stage is pretty anticlimactic compared with the previous two stages. The third stage of labour is the delivery of the placenta. Now that you have your newborn baby in your arms, you might not even notice the placenta coming out. The placenta is usually expelled with a few painless contractions. You may be asked to push briefly during this time. The blood vessels that were supplying your baby in the womb rapidly close down, and the womb becomes smaller and compact. Your health-care provider may massage your womb to stop any bleeding.

During the third stage of labour, your focus will be on your newborn baby, and you might not even notice the contractions that your uterus makes to expel the placenta. If you need stitches because you had a tear or an episiotomy, you will be given a local anesthetic so that the doctor can perform the suturing. You can hold your newborn baby while this is being done, if you wish. Try to cherish the first few moments after your baby is born: get to know your baby and revel in the miracle of his birth.