Stages of Labor

There are three stages of labor. The first stage occurs from the time true labor begins until the
cervix is completely dilated and effaced. During the second stage the baby is delivered. The third
stage follows the birth of the baby through the birth of the placenta.

 First Stage
 Second Stage
 Third Stage
 Labor and Delivery Checklist

First Stage

The first stage of labor is the longest. There are three phases within the first stage;

 Early or latent phase

 Active phase
 Transition phase

At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first
child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children,
the first stage lasts around 6-7 hours.

Early Labor

During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first
phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing
to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain:
aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more
comfortable than sitting. Most women spend these hours at home, or they may be checked at the
hospital and sent home until labor becomes more active. You may feel eager, excited and social.
It is important that you conserve your energy for the work of labor.

Active Labor

Active labor is marked by regular contractions that become longer, stronger and closer together
over time. Most providers recommend that you go to the hospital when your contractions are five
minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from
the start of one contraction to the beginning of the next.

Your physician will want to know:

 How far apart are the contractions?

  How long they are lasting, and how intense?
 Are you using breathing techniques to manage the pain?
 Has your "bag of water" broken? Your provider will want to know the time this occurred,
and any color or odor.
 Has there been any discharge, such as a bloody show?

If you have had previous deliveries, the active phase of labor can proceed more quickly. Your
physician may want to be contacted sooner.

When you are in active labor, you will be concentrating on the task at hand, and will not feel like
doing anything else. Your labor partner's support is important at this phase. Contractions are
growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart,
lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing
pressure in your back. If you have learned breathing techniques, begin using them now, if you
haven't already. Pain medication is often given at this stage. If you have chosen to have an
epidural anesthetic, it is usually given at this stage. Please see pain management for more
information.

Transition

Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30
minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters.
The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of
your energy is concentrated on doing the work of labor. Try to remain calm and focused as your
uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby
is ready to be born.
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Second Stage

During the second stage the baby is born. This stage of labor lasts anywhere from one
contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin
between the vagina and rectum). This may cause a burning sensation. Some women may feel as
if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or
physician will tell you when it is time to push. It is important that you not push until instructed.
Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as
the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is
born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb
syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the
baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut.
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Third Stage
The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is
the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then
resume to deliver the placenta. You will be observed closely for the next few hours to make
certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your
uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and
get acquainted with your new baby.
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Labor and Delivery Checklist

1. Prior to labor, discuss the following issues with your physician or nurse practitioner:
o What do I do if I think I am in labor?
o What pain management options are available?
o When is an episiotomy necessary?
o What are some reasons you might perform a cesarean delivery?
2. If you have not done so, take a hospital tour so you are familiar with the place where you
will give birth.
3. Arrange for help to care for you and the baby after birth, if you can.
4. Shop and prepare food for the first weeks when you are home with the baby, and collect
take-out menus.
5. Review Preparing for Baby checklist.
6. Make sure you always have gas in the car.
7. Pack your bags. See what to pack for the labor room.

http://www.pamf.org/pregnancy/labor/stages.html