Childbirth and the Stages of Labor

Pregnancy is an exciting time, but you may experience feelings of anxiety and stress, especially leading up to your due date. Understanding the stages of labor will help you feel more confident and prepared to give birth.

“Many movies and television shows dramatize childbirth by showing birthing people going into labor when their water breaks,” notes Carolina Bibbo, MD, a maternal and fetal medicine provider at Mass General Brigham. “While this can make for a good comedy, in reality, the majority of individuals don’t experience their water breaking before the onset of labor.”

This is just one of several misconceptions about labor, which is a different experience for everyone. In this article, Dr. Bibbo explains the three stages of labor and what you can expect before, during, and after birth. Dr. Bibbo cares for patients at Brigham and Women’s Hospital and Newton-Wellesley Hospital, and is director of the Comprehensive Care Center for Multiples at the Brigham.

Know the signs and symptoms of labor. 

Contractions—when the muscles of your uterus tighten, and then relax—are a common way to know if you’re going into labor. When your contractions become frequent and occur every 5 to 10 minutes, you may be going into early labor. 

Other signs and symptoms of labor include: 

• Feeling pain in your lower back and belly. The discomfort won’t go away when you try changing positions.

• Baby “dropping” lower, down toward your pelvis. Also called lightening, this is when your baby moves to a lower position in your belly to get ready for birth.

• Expulsion of the mucus plug. A little mucus mixed with blood can come out of your vagina and may appear pink, red, or bloody. 

• Amniotic sac breaking. Also known as “water breaking,” this is when the sac of fluid your baby has been growing in breaks to prepare for birth. You may feel just a trickle or a big rush of water.  

If you think you might be in labor, call your health care provider right away. They will let you know if you need to go to the hospital. 

Stage 1: Dilation 

Latent phase, or early labor

In this latent phase of labor, your cervix dilates, or opens, about 3 to 4 centimeters and will also thin out (called effacement). Your contractions may begin to feel persistent. If this is your first time having a baby, this phase may last for 12 hours or even a few days. You can spend the time at home or wherever you’re most comfortable.

Not all contractions mean you’re going into labor, so it’s important to keep track of them. Record how long each contraction lasts and how much time passes between each one. You may be going into true labor if your contractions: 

• Are consistent and happen closer together over time 

• Get stronger over time 

• Happen even when you’re moving around

“If your water breaks, chances are you will go into labor on your own within 24 hours,” says Dr. Bibbo. “If labor doesn’t start on its own, you may be able to wait at home for a few hours, but your provider will ask you to come for an evaluation and decide on the best next steps.”

They may recommend induction or labor augmentation. This means your care team may use medications to help your body start your labor. This is done to avoid infections and complications during birth.

Active phase

When this phase begins, it’s time for you to go to the hospital if that is part of your birth plan. A birth plan is a set of goals that describe your labor experience preferences.

You may want to have a support person help with your labor, such as your partner, family member or friend, but you may also want a professional support person, like a doula. You share your birth plan with your provider and hospital staff ahead of time.

During the active phase: 

• Your cervix dilates faster, all the way up to 10 centimeters. 

• Your contractions are more regular, stronger, and more frequent. Each one may last 45 seconds and can be as close as 3 minutes apart.

• The baby’s head moves further down your pelvis, toward your vagina.

• Your water may break if it hasn’t yet.

• You may feel nauseous and experience pressure in your lower back, cramping in your legs, and an urge to push.

Dr. Bibbo notes that there are several things you can do during this time to help prepare for birth. “You can eat and drink clear liquids, like water and ice, juice, sports drinks, popsicles, gelatin, and broth,” she says. “To help with pain, you can use deep breathing exercises, as well as birthing bars or balls.”

The anesthesiologist, a doctor who specializes in pain management, can advise you about different medication options to control pain, such as IV medication, nitrous oxide (also known as laughing gas), or epidural. An epidural is the most effective form of pain relief during childbirth which lasts through your entire labor. It involves inserting a small needle into your lower spine through which medication blocks pain signals.

Other steps you can take during active labor include:

• Using the bathroom often. Your baby has more room to move down when your bladder is empty.

• Walking around or changing positions in bed.

• Staying relaxed as best you can. Try not to think about when the next contraction is coming.

• Communicating with your care team. If you have the urge to push, tell your provider first so they can check how dilated your cervix is.

Stage 2: Pushing and delivery 

When your cervix is fully dilated, it’s time to start pushing. You’ll push so the baby can pass through the birth canal and come out into the world. This phase lasts from 30 minutes to 3 hours, or longer if it’s your first pregnancy.

During this stage:

• Your contractions may slow down.

• Your baby’s head can be seen (called “crowning”).

• Your provider guides the baby out of the birth canal and vagina.

Sometimes, a cesarean delivery (c-section) is necessary for your health or the health of your baby. A c-section is where your provider makes an incision on your stomach and uterus to deliver the baby. Your care team now uses family-centered or “gentle cesarean” methods to make your c-section a more natural birthing experience. You may be able to see your baby being born and can touch the baby right away.

Stage 3: Placental delivery 

What to expect after birth 

Once all three phases of labor are complete, you can finally hold your baby. Dr. Bibbo notes that she encourages skin-to-skin contact, whether you had a vaginal delivery or a c-section. This helps your baby get to know you right away and keeps them warm as they get used to being outside of your womb.

Your care team makes sure you and your baby recover without any complications. They check your temperature, heart rate, and blood pressure, as your body changes to help you heal after birth.

“Lactation consultants and postpartum nurses will help you learn about recovery and how to care for your baby,” adds Dr. Bibbo. If you want to breastfeed, you can begin to do so even within an hour of your baby being born.

Postpartum warning signs to watch for

If you had a vaginal delivery, you’ll likely be in the hospital for 2 nights, or 3 to 4 if you had a c-section.

Your health care team continues to support you and your baby after birth. They watch for signs of any complications like extra vaginal bleeding or elevation in your blood pressure, which could lead to postpartum hemorrhage or stroke in some cases. It’s also important to know the signs of baby blues or postpartum depression, which include having low mood and depressive symptoms surrounding your birth.

Planning for childbirth

Deciding on your birth plan and knowing what to expect will help you feel prepared for each stage of labor and beyond. Ask questions and communicate with your care team to better understand what your childbirth experience will be like.