Stages of Labor and Birth

10 min readJan 31, 2017

What causes labor to start is one of the great mysteries of the world. Truth is, no one knows. We do, however, know plenty about what happens next.

Before we outline what the average stages of labor look like, it’s important to note that the labor process is totally different for each woman, and your experience will likely vary.

Labor is divided into three stages, with each stage marked by different emotional, mental, and physical experiences:

Cervical Dilation (encompasses three sub-stages of Early Labor, Active Labor, and Transition)
Pushing and Birth
Delivery of the Placenta

Stages of labor (does not show transition sub-stage)

Stage 1a: Early Labor

The onset of labor is most often marked by surges, which most women report feel like very strong menstrual cramps. For some, labor begins with the rupture of the amniotic sac (aka water breaking), although that happens much more often in the movies than real life. All told, Stage 1 lasts from 8–12 hours and sometimes longer for first-time mothers. Early labor accounts for about 2/3 of that time.

If your water breaks and labor doesn’t progress quickly, your healthcare provider may want to encourage labor with a drug called Pitocin. When the amniotic sac is ruptured, your baby is at a higher risk for infection so it’s important that labor move along once you pass that milestone. There is no real need for your water to break during labor. In fact, in some cases babies are born en caul, or still encased within the amniotic sac. This condition is not dangerous and your healthcare provider can remove the sac manually, but with care so as not to damage baby’s skin.

During labor, oxytocin and prostaglandin hormones signal your cervix to prepare for your baby to pass through it. Your cervix begins to efface, meaning it shortens, softens, and becomes thinner. Surges enact dilation, or the opening of the cervix. Your cervix will dilate to three centimeters during early labor. As your cervix thins and opens, the sealing mucus plug may fall out and you will begin to see what’s known as bloody show, or blood-tinted mucus that results from capillaries bursting as your cervix effaces and dilates.

In this beginning stage of labor, surges are less intense and will come and go without much rhythm. As labor progresses, surges will become stronger, more frequent, and will occur at more regular intervals. You can start timing surges in early labor to identify patterns as they emerge, but don’t start timing until you can detect some regularity lest you become a slave to the stopwatch. The chart below shows you how to time surges, however, there are also a number of free apps out there that will do it for you.

Early labor is all about anticipation, which may bring feelings of excitement and happiness, or anxiousness and worry. A range of emotions is possible and all are normal. Stay present, move through the feelings as they come, and focus on thoughts of positivity and strength.

During this time, get comfortable at home and try to stay occupied while conserving energy. Sleeping or resting is encouraged if possible to prepare the body for the hard work of birthing ahead. However, if you find yourself restless, focus on light activities like an easy walk or household tasks. Stay hydrated and eat small snacks to generate and sustain energy. Urinate as often as possible, as a full bladder can impede uterine surges.

Stage 1b: Active Labor

Active labor is characterized by stronger and longer surges coming at more regular intervals. Active labor may last 3–8 hours and your cervix will dilate to eight centimeters.

As a general rule, once surges are five minutes apart, lasting about one minute for one full hour (also known as the 5–1–1 Rule), it’s time to connect with your healthcare provider and head to the hospital or birth center if you’re not birthing at home. Some healthcare providers prefer a call sooner, so clarify this ahead of time.

You may find yourself turning inward as labor progresses and your ability to think and make decisions may diminish as your body begins to focus on moving your baby out.

During this time, endorphins and adrenaline increase to aid the labor process. Keeping these hormones in balance is key to moving labor forward. A lack of endorphins may decrease pain tolerance. Too much adrenaline can activate the fight or flight reflex and stall labor. To keep hormones in balance, the environment around you should be calm, positive, and supportive. Lean on your support network to address any negative influences, external or internal, to ensure that labor stays on track.

Increased surges during active labor may result in discomfort, so change positions often and try a hot shower or bath. Work through your surges instead of working against them — breathe through any pain and visualize integrating surges into dilation. Rest and be still between surges to preserve energy. You may choose to have an epidural for pain management during this stage.

Stage 1c: Transition

Transition is typically the most intense stage of labor, but it is also the shortest. Transition can last 30 minutes — 2 hours and your cervix will become fully effaced and dilate completely to 10 centimeters.

During transition, surges will be at their strongest, longest, and closest together and may cause shaking, shivering, nausea, and vomiting. As the baby descends into the birth canal, you may begin to feel rectal pressure and the urge to push.

Birth expert Ina May Gaskin says that during transition your brain descends into your pelvis. This refers to the fact that women in transition are typically not able to focus on anything other than the impending birth. Small talk, decision-making, and distractions may need to be eliminated. You may begin to make low grunting sounds as your animalistic birthing instincts take over.

Stage 2: Pushing and Birth

When your surges are at their strongest, you will begin pushing to add the strength of your abdominal muscles to the power of your surges to push the baby down and out. As the baby moves past your cervix and through your pelvis, your healthcare provider may start monitoring the baby’s station, or the distance (in centimeters) between the baby’s head and the ischial spines of the pelvis. Stations are measured from -5 to +5.

Stations of birth; this baby is between +3 and +4 station

As the baby’s head emerges, or crowns, you may feel a burning or stinging sensation as the tissues of your perineum stretch. Your healthcare provider may ask you to slow your pushing to allow for stretching and avoid tearing. The urge to push will be strong during crowning so if you do need to slow down, focus on blowing out through pursed lips or panting.

Once the head emerges, your healthcare provider will suction the baby’s mouth and nose to remove any fluids that may interfere with baby’s first breaths. They will also feel for the umbilical cord to ensure that it’s not wrapped around the baby’s neck. If all is in place, you’ll continue pushing out the baby’s shoulders and body.

If there are no complications, your healthcare provider will place your baby on your bare belly or chest to keep them warm and promote instant bonding. The umbilical will then be clamped and cut, which may be delayed if you choose. Delayed cord clamping allows more blood to transfer from the placenta to the baby, providing an increased dose of iron, which aids healthy brain development. If possible, it is recommended to delay cord clamping for at least three minutes.

The birth of your baby will bring a wave of oxytocin, and feelings of euphoria and relief. Oxytocin is sometimes called the “love hormone” and spikes after birth to promote mother-child bonding. Request a delay in baby’s first bath and other non-urgent post-birth procedures to keep your baby physically close in these first few moments. Nursing may begin immediately.

Stage 3: Delivery of the Placenta

After baby is born, surges will continue in order to detach the placenta from the womb and allow for delivery. Your doctor may ask you to push gently one or two more times to aid delivery, however, these pushes should feel relatively easy and painless. Your doctor may aid the delivery of the placenta by tugging gently on the umbilical cord, applying external pressure on the uterus, or potentially give you a dose of Pitocin to speed up surges. Some bleeding may occur with the delivery. Once the placenta is delivered, your health care provider will attend to any tears in your genital area.

If you want to take your placenta home, you’ll need to make arrangements in advance to ensure that it is properly handled after birth. Some women choose to consume their placenta, particularly given the high concentration of the hormones estrogen and progesterone, which is believed to help combat postpartum depression. On the other hand, some believe that consuming an organ that processes waste could result in infection or illness. There is little to no scientific proof of the risks or benefits of consuming placenta. If you do choose to consume, the placenta can be dried and encapsulated for consumption, or cut up and frozen in chunks for use in smoothies or food.

Next Steps for Baby

Immediately following birth, keep your baby close to promote immediate bonding. If there are any issues, your baby may need to be taken elsewhere, and you can request that your partner (if applicable) go with her. Eventually, your health care provider may take the following steps, most of which are optional and up to your discretion:

After initial skin-t0-skin contact if you choose, your baby will be dried and wrapped in a blanket and hat for warmth.
An Apgar assessment will be performed twice between 1–5 minutes after birth to test your baby’s vitality. The assessment includes checking heart rate, breathing, muscle tone, reflex response, and color and can be done with your baby on you.
Breastfeeding can start immediately if mother and baby are ready.
Erythromycin eye ointment may be administered to protect your baby against infections that may cause blindness. These infections are typically caused by exposure to bacteria associated with gonorrhea and chlamydia, and are fully treatable if contracted. Application of eye ointment is required in the United States, however, if you have tested negative for gonorrhea and chlamydia, you may choose to skip it by signing a waiver.
A Vitamin K shot may be administered to aid blood clotting and prevent bleeding. Scientific studies are overwhelmingly in favor of the Vitamin K shot. Those that oppose it believe that it can traumatize the newborn, or simply oppose vaccines in general. The shot is optional, and you can request that it be administered while your baby is on you or in your arms.
A full bath may be given once your baby’s temperature has stabilized. You can request a delay in bathing if you prefer to keep your baby close to you.
Your baby will be weighed, footprinted, and tagged with an ID band.

A day or two after birth, you can expect the following procedures:

Before you leave the hospital, your baby may receive a hepatitis B shot. It may be administered sooner if you have tested positive for hepatitis B. You may choose to opt out of this vaccine, or delay it until a later pediatrician visit.
Within a few days of birth, your baby will have a heel prick blood test to check for serious metabolic diseases like sickle cell anemia and cystic fibrosis. This testing is required in the United States but the diseases screened vary by state. Check with your care provider ahead of time to understand which tests they will run, and request additional tests as desired.
A hearing test will be performed.
Circumcision may be performed in the hospital if you choose, but can also be delayed a few weeks if desired for religious purposes or otherwise.

Going Home

If you give birth in a hospital or birth center, once you and your baby have stabilized and all necessary tests have been performed you will be sent home. To make this as smooth as possible, you’ll want to do the following a few weeks ahead of your estimated due date:

Purchase a car seat and install it properly in your car.
Make sure your home is stocked with essential groceries and baby supplies.
Decide if/when you want visitors in the hospital and/or your first few days at home and communicate accordingly with friends and family. Remember that the first few days after birth are a time of bonding and bodily healing for mom so make sure to create the space you need.