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Stages of labor

  • Early labor

    Early labor contractions pull on the cervix, which looks a bit like the neck of a turtleneck sweater. Contractions shorten or thin the cervix. This process is called effacement and is measured in percentages.

    Your cervix starts out three to four centimeters long. When it is 50 percent effaced, it is about two centimeters long. When it is 100 percent effaced, it is "paper-thin."

    Effacement can happen over days before labor starts. Or, it can happen over hours as labor progresses. With a first labor, it can take quite a while for the cervix to completely efface.

    active labor

    First stage active labor

    Labor may start slowly because the cervix first thins and then dilates.

    Dilation is measured in centimeters, one to 10. Dilation to three to four centimeters is considered to be part of early labor. After four centimeters, labor is considered to be active and contractions are more intense.

    In early labor, you may only need to use distraction and relaxation techniques. Active labor, however, requires more coping skills.

    When contractions become longer, stronger, and closer together, the key to coping is to relax between the contractions. During the contractions do whatever technique helps you deal with them.

    First stage of labor

    The first stage of labor ends when the cervix is fully dilated and your baby's head slips through the cervix.

    The last two to three centimeters of dilation are called transition because it is the transition between the first and second stage of labor.

    This is the time that contractions are the most intense.

    First stage transition

    First stage transition

    Second stage of labor

    Second stage is the work of pushing your baby through your vagina (birth canal).

    It is more difficult than the distance suggests because your baby must turn to fit through your pelvis.

    The drawings below show your baby's journey to birth.

    Cervix thins and dilates during labor. As your baby moves through your pelvis, her head usually rotates to face down.

    purple arrow

    As your uterus pushes your baby through your pelvis, her head begins to show, or purple arrow Most of your baby's head is born. As her shoulders move through your pelvis, she begins to rotate again.

    purple arrow

    Your baby's head and shoulders are born, and the rest of her body slips out.

    Cervix thins and dilates during labor. As your baby moves through your pelvis, her head usually rotates to face your spine.

    As your uterus pushes your baby through your pelvis, her head begins to show, or "crown."

    After most of your baby's head is born, her shoulders move through your pelvis and she begins to rotate again.

    After your baby's head and shoulders are born, the rest of her body slips out.

    Third stage of labor

    The third stage is the shortest and easiest. It is the birth of the placenta.

    Stages of labor: What happens, how it feels

    Stage or phase What happens during labor How it feels

    First stage

    Early phase

    • cervix effaces (thins) and dilates (opens)
    • may occur gradually over several hours or days
    • most effacement, and dilation from 0 to 4 centimeters (cm), occurs
    • lasts 8 to 12 hours or more for first labor
    • contractions last 30 to 45 seconds and begin every five minutes or so

    Each phase feels different. Contractions are mild to strong. You may feel comfortable between contractions. You may feel nervous, nauseated, or excited.

    Try to relax and work with the rhythm of your body.

    Active phase

    • dilation from 4 to 7 cm occurs
    • typically last 3 to 5 hours
    • contractions last 45 to 60 seconds and begin every 3 to 5 minutes

    Contractions are stronger. Your attention is focused inward. You may have a dry mouth, chills and nausea, or feel sweaty. Concentrate on staying relaxed between contractions to conserve your energy.
    Transition phase

    • dilation from 7 to 10 cm occurs
    • can last 30 minutes to 2 hours
    • contractions last 60 to 90 seconds; there are 30 seconds to 3 minutes rest in between contractions

    Contractions are intense and close together. You may have hiccups, nausea, vomiting, shaking and pelvic pressure. You may feel like giving up. Take one contraction at a time.
    Second stage (pushing)

    • uterus pushes baby out
    • typically lasts 20 minutes to 2 hours or longer
    • contractions last 45 to 60 seconds and begin every 3 to 5 minutes

    You may experience a "rest period" before you feel an urge to push. You might get a surge of energy. Pushing can feel like pressure, stinging, burning, or pain. Pushing can take a long or a short time. This depends on the position of your baby, the effects of medicine, and how well you are able to push. Focus on using your abdominal muscles to push down, out and away. This is what you do when you are trying to urinate faster. (Or, the opposite of a Kegel exercise.)
    Third stage

    • the placenta separates from the uterine wall and is expelled.
    • typically lasts 3 minutes to 30 minutes after your baby's birth.

    Contractions are less intense and may even be easy while you expel the placenta. Push gently when your health care provider asks you to do so.

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