First Stage: Dilation and Effacement of the Cervix

A. Early (or Latent) Phase — cervix dilates from zero to three or four centimeters

This first step in the journey toward childbirth lasts an average of 6 to 10 hours for a first-time mother, but can be much shorter (especially if you’ve given birth before) or much longer.

What You May Experience:

The beginnings of labor may be subtle or dramatic – and it happens differently in every woman. In some women, the cervix dilates to three centimeters well before any noticeable, real contractions (or labor) begin. Other women can have strong, contractions that don’t change her cervical dilation at all. But, in general, the early phase brings some effacement (thinning and softening of the cervix) and dilation to three centimeters over a period of hours or days. Contractions can be mild and somewhat irregular, coming from 5 to 30 minutes apart, lasting 30 to 45 seconds. You might see some pinkish discharge and feel a bit of abdominal discomfort. The “water” may “break” (rupture of membranes) in this early phase, or this may happen later in the first or second stage, either on its own or with help from your practitioner.

What You Can Do:

The early phase of labor is sometimes (lightheartedly) called “the entertainment phase,” because it’s often helpful to focus your mind on other things so that you can pass the time without worrying about what’s coming. As long as contractions are still relatively mild and spaced farther than five or so minutes apart, most women spend the time at home, and maintain close contact with their practitioner. If you’re looking for something to do while waiting it out, try quiet, relaxing activities, such as listening to music, playing cards, or watching television. If you feel up to it, a short, leisurely walk would be fine, and might even help speed the labor along.

B. Active Phase — cervix dilates from four to seven centimeters

This phase is when the serious prep work for childbirth begins, and when most women begin to labor more intensely. It can last an average of three to six hours for first babies, and about half that for subsequent births.

What You May Experience:

During the active phase, contractions usually come steadily, gradually increasing in intensity and frequency, from three to five minutes apart. Pains may be centered in the lower back, abdomen, or thighs, and they may be intense enough to make it hard for you to talk. You might also experience an increased amount of pinkish or brownish discharge, or what’s sometimes called a “bloody show.”

What You Can Do:

You should empty your bladder, drink fluids, and practice whatever breathing or relaxation techniques you learned during childbirth class. Rely on your labor partner to help and encourage you. Accept that it’s normal to be nervous and even a little scared. If your practitioner okays it and the facilities are available, a warm shower may help you relax . If you choose to have an epidural, it’s likely to be administered during this phase. (For more on this, see our ultimate guide to labor pain relief).

C. Transition phase — cervix dilates to eight to ten centimeters

The final phase of the first stage can last 20 minutes to two hours for first babies, and may go quite quickly in subsequent births.

What You May Experience:

Contractions during this phase are usually intense, spaced about one to three minutes apart. Increasing fatigue, shakiness, and nausea are all common in this phase, as your body does the hard work of reaching complete dilation and effacement. You may feel a strong urge to push or bear down, along with pressure in the rectal area and stinging in the vaginal area as the baby’s head moves down toward the vaginal opening. But you should NOT push — wait until your practitioner gives you the go-ahead, which will happen when the cervix is fully dilated.

What You Can Do:

With the help of your labor partner, focus on those breathing and relaxation techniques that seem to be working best for you. If you have a very strong urge to push and it’s not time yet to do so, medical staffers should be able to show you breathing techniques that can be helpful for resisting the urge. Don’t worry if you feel like you’re “losing control” — it’s perfectly normal to feel like you’ve gone a bit “haywire” in this phase. Remind yourself it won’t be long now until you see your baby.

Second Stage: Pushing and Birth

The second stage of childbirth begins when the cervix is fully dilated. It lasts about an average of one-half hour to two hours in first-time moms. In subsequent births, it may last anywhere from a few minutes to two hours.

What You May Experience:

The overwhelming urge to bear down continues, and as soon as your cervix is fully dilated, your practitioner will probably give you the go ahead to push. Contractions don’t stop now, though they often come farther apart. Some women experience nausea and vomiting. As you begin pushing, you may become increasingly breathless and fatigued — you are getting what is likely the hardest workout of your life. You may feel intense pain around your vaginal and perineal areas as the baby’s head crowns, or protrudes at its widest part outside the vaginal opening. If you have an episiotomy (an incision made in the area between the vagina and the rectum to widen the vaginal opening) it will probably happen at this point. You may be asked to push more gently or slowly as the rest of your baby’s head and body emerge. Finally, with one last push, your baby is out in the world!

What You Can Do:

When you get the green light, push! Make sure your practitioner or labor nurse tells you the best way to breathe and to push. You want to make every movement count at this point. Follow their lead and hang in there — you’re about to meet your baby.

Third Stage: Delivery of the Placenta

The incredible moment of baby’s birth is followed swiftly by the delivery of the placenta (sometimes called “the afterbirth”). This usually takes anywhere from a few minutes to a half hour.

What You May Experience:

You’ll likely be so absorbed in getting to know your newborn that you won’t notice much about this phase. Your practitioner may ask you to push to expel the placenta. You may experience cramping and pain as this process takes place.

What You Can Do:

You may be asked to put the baby to your breast, as this stimulates uterine contractions, or your practitioner may gently massage your abdomen to help stimulate placental separation. As the third stage ends and the drama of childbirth comes to a close, you’ll probably feel an overwhelming sense of fatigue. There’s bound to be a good deal of hubbub around you, but, as soon as you can, you should close your eyes and get some rest.