Three Stages of Labor

You may know that you are getting close to labor if your due date is approaching, your baby has moved into the vertex position, or your doctor has noticed your cervix beginning to dilate. Signs that you are going into labor include feeling regular contractions and pain in the belly and lower back. You may experience some contractions before going into true labor—the difference is that contractions that signal labor are regular and get stronger. Additionally, you may see a “bloody show,” a bloody mucous discharge. Your water may also break. Your “water breaking” is when the amniotic sac that surrounds the baby in the womb ruptures. When this happens, you will notice a watery discharge or sensation.

The first stage of labor, also called early labor, is by far the longest. It begins at the onset of labor and continues until the cervix is fully dilated. Cervical dilation is critical—the cervix is an extremely narrow passageway between the uterus and vagina that needs to stretch and thin to allow the baby to fit through. For reference, the cervix needs to grow from one inch, the size of a small grape, to ten inches, the size of a grapefruit, during this stage. So this is easily the longest stage of delivery. 

This early stage is divided into two phases, the latent and the active phases. It usually takes around 20 hours from start to finish for first-time mothers.

The latent phase of labor lasts anywhere from five to twenty hours or more and is complete when the cervix is dilated to about 4 centimeters. Cervical dilation is measured by feeling the cervical opening with two fingers. Contractions are mild, and pain is minimal during this phase. Most mothers stay home during the latent phase, as it is the longest phase and medical attention is not usually needed.

The active phase of labor lasts an average of two to eight hours during which time contractions become stronger and more rhythmic, signaling that it’s time to go to the hospital. Throughout the active phase, the cervix becomes fully dilated to 10 centimeters and the baby’s head descends into the pelvis.

Pain Gets Worse Over This Stage

Unfortunately, labor gets more and more painful as the cervix nears complete dilation. Widening from 6 centimeters to 10 centimeters, called the transition phase, can be especially difficult because it often happens within an hour. Pain management methods like epidurals and pain medications may be used from the active phase onward.

Doctors and nurses in the delivery unit closely monitor fetal heart rate and cervical dilation during the first stage of labor. This is so that they can intervene if the baby becomes distressed or the labor is not progressing. If the amniotic sac has not ruptured, doctors may perform an amniotomy to rupture the membrane.

The second stage, also called active labor, is the pushing stage of labor. The second stage is the most painful stage of labor.

The baby passes through the cervix, through the pelvis and birth canal, and out through the vaginal opening. On average, it takes one to three hours from the time that the cervix becomes fully dilated to the birth of the baby. Because the baby’s head has moved from the uterus to the birth canal, uterine contractions must be replaced by the mother pushing herself (which is a big reason why stage two is the most painful stage of labor).

Midwives, doulas, and family members may be especially important during active labor to help coach the mother through the hard work of pushing. During the second stage, doctors watch carefully for signs of complications affecting either the mother or child. They closely monitor the baby’s heart rate and position to make sure that he or she is not in distress or stuck.

The third stage consists of the delivery of the placenta, also known as afterbirth. The duration of the third stage is short. Usually, it takes only a few minutes for the placenta to follow the baby.

While waiting for the placenta, doctors continue to check on the health of the baby and mother, including the baby’s heart rate and vital signs. If the placenta is not delivered, it must be surgically removed to prevent serious health complications.

Every labor takes a different amount of time for reasons that doctors cannot entirely explain. In general, though, first-time mothers take a longer time to give birth than those who have given birth before.

Some factors that may lengthen labor include giving birth to twins, having a large baby, being overweight or obese, or having a baby that is in an abnormal position. Conversely, standing and walking may shorten the first stage of labor.

Epidural Anesthesia Can Make the Second Stage Slow Down

Epidural anesthesia can slow the second stage of labor by up to an hour. An epidural is an injection of anesthetic into the mother’s lower spine that relieves the pain of labor—this may slow the second stage of labor because the mother is less able to control her pushing. This also means that epidurals are associated with operative delivery, namely the use of forceps, to assist labor.

However, evidence shows that epidurals are the best at relieving the pain of labor and that fetal outcomes are the same for epidurals versus other pain relief methods or no pain relief. In the end, childbirth is extremely painful, and using or not using an epidural is a personal decision.

Drugs to Induce Labor

What about induced labor? Drugs like Pitocin (oxytocin) can be used to induce labor into starting. Sometimes, doctors induce labor to start because there is a medical reason to do so. For example, a doctor may induce labor if the mother has preeclampsia or diabetes, there is not enough amniotic fluid, or if the amniotic sac has ruptured but labor has not begun on its own.

Recently, elective induction has become more popular—that is, inducing labor without a medical reason. Induction may slow the process of labor, and it is still unclear to researchers if elective induction creates more risks than benefits in normal pregnancies.

Pitocin can also be used to expedite spontaneous labor that doctors think is taking too long to progress, Pitocin does not seem to improve pregnancy outcomes apart from shortening labor. By strengthening contractions, Pitocin can shorten labor by up to two hours, which some women may decide is right for them.