Stages of labor: Baby, it's time!

Every woman's labor is unique, even from one pregnancy to the next. In some cases, labor is over in a matter of hours — or less. In other cases, labor tests a mother's physical and emotional stamina.

When everything goes smoothly, the stages of labor unfold in three distinct parts.

Stage 1: Early labor and active labor

The first stage of labor occurs when the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. This is the longest of the three stages of labor. It's actually divided into two phases of its own — early labor and active labor.

Early labor
During early labor, your cervix will begin to dilate. You may feel mild to moderately strong contractions during early labor. They may last 30 to 60 seconds and come every five to 20 minutes. As your cervix begins to open, you may notice a thick, stringy, blood-tinged discharge from your vagina. This is known as bloody show.

How long it lasts: You may need to be patient. Early labor is unpredictable. It may last for hours or even days, especially for first-time moms. It's often much shorter for subsequent deliveries.

What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. You may feel like doing household chores, taking a walk or watching a movie. Or you might simply continue your daily activities.

It may also help to:

• Take a shower or bath.
• Listen to relaxing music.
• Have a gentle massage.
• Try slow, deep breathing.
• Change positions.
• Drink water, juice or other clear liquids.
• Eat light, healthy snacks.
• Apply ice packs or heat to your lower back.

Active labor
Now it's time for the real work to begin. During active labor, your cervix will dilate to 10 centimeters. Your contractions will become stronger and progressively longer. Near the end of active labor, it may feel as though the contractions never completely disappear. You may feel increasing pressure in your back as well. If you haven't headed to your labor and delivery facility yet, now's the time.

Your initial excitement may wane as your labor progresses and the pain intensifies. Don't feel that you're giving up if you ask for pain medication or anesthesia. Your health care team will help you make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief.

How long it lasts: On average, active labor lasts up to eight hours. For some women, active labor lasts hours longer. For others — especially those who've had a previous vaginal delivery — active labor is much shorter.

What you can do: Look to your labor coach and health care team for encouragement and support. Try breathing and relaxation techniques to combat your growing discomfort. Use what you learned in childbirth class or ask your health care team for suggestions.

It may also help to:

• Change positions.
• Rock in a rocking chair.
• Roll on a birthing ball.
• Take a warm shower or bath.
• Place a cool, damp cloth on your forehead.
• Take a walk, stopping to breathe through contractions.
• Have a massage between contractions.

If you feel the urge to push, try to hold back until you've been told you're fully dilated and it's time to push. It may help to pant or blow. Pushing too soon may cause your cervix to tear or swell, which can delay delivery or cause troublesome bleeding.

Illustration of cervical effacement and dilation

During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. In figures A and B, the cervix is tightly closed. In figure C, the ...

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Stage 2: The birth of your baby

It's time! You'll deliver your baby during the second stage of labor.

How long it lasts: It can take from a few minutes up to several hours or more to push your baby into the world. It often takes longer for first-time moms and women who've had an epidural.

What you can do: Push! You may be encouraged to push with each contraction to speed the process. Or you might take it more slowly, letting nature do the work until you feel the urge to push.

Many women choose to push while lying in a birthing bed. Squatting or sitting works well for others. Some women prefer to get on their hands and knees or kneel while a labor coach supports their upper body. Try different positions until you find one that feels best. When you push, don't hold tension in your face. Bear down and concentrate on pushing where it counts.

At some point, you may be asked to push more gently — or not at all. Slowing down gives your vaginal tissues time to stretch rather than tear. Feeling the baby's head between your legs or seeing it in a mirror can help you stay motivated.

After your baby's head is delivered, his or her airway will be cleared and your health care provider will make sure the umbilical cord is free. The rest of your baby's body will follow shortly.

Stage 3: Delivery of the placenta

After your baby is born, you'll likely feel a great sense of relief. You may hold the baby in your arms or on your abdomen. Cherish the moment. But a lot is still happening. During the third stage of labor, your health care provider must deliver the placenta and make sure your bleeding is under control.

How long it lasts: The placenta is typically delivered in about five to 10 minutes. In some cases, it may take up to 30 minutes.

What you can do: Relax! By now your focus has likely shifted to your baby. You may be oblivious to what's going on around you. You may even want to breast-feed your baby.

You'll continue to have mild contractions. Your health care provider may massage your lower abdomen to encourage your uterus to contract and expel the placenta. You may be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood.

Your health care provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see the placenta.

Your health care provider will also determine whether you need stitches or other repair work. If you do, you'll receive an injection of local anesthetic in the area to be stitched if it's not numb already. You may also be given medication to encourage uterine contractions and minimize bleeding.

Now what?

Savor this special time with your baby. Your preparation, pain and effort have paid off. Revel in the miracle of birth.