The three stages of labor and what to expect during each part

From the moment you learn you’re pregnant, you’re counting.

Counting back to your last period to determine when you became pregnant. Counting kicks. Counting down to your anticipated delivery date. And now you can add to that list: counting the three stages of labor.

The National Institutes of Health (NIH) outlines them in characteristically dry language:

• The first stage starts when labor begins and ends with full cervical dilation and effacement. (We’ll explain what that means below.)
• The second stage commences with complete cervical dilation and ends with the delivery of the fetus.
• The third stage initiates after the fetus is delivered and ends when the placenta is delivered.

Surprised that labor isn’t over once your baby is born? You’re not the first to forget – or not know – about delivering the placenta, also known as the afterbirth.

Let’s take a look at what you can expect during each stage.

Stage I: Early and active labor

The first stage is further subdivided into two stages – early and active labor.

This – the longest stage – begins when you feel persistent contractions, which will become stronger and more frequent with time. They cause the cervix to open, or dilate and soften, shorten and thin (also referred to as efface) which allows baby to move into the birth canal. During labor, your cervix will go from 0% to 100% effacement.

Dilation and effacement are not the same thing. Effacement refers to the cervix (the lowest part of your uterus) stretching and getting thinner. Dilating refers to the process of your cervix opening. When your cervix is dilated to about 10 centimeters (cm.), your baby’s head will be able to pass through the vagina.

During early labor – which can last anywhere from hours to a couple of days – your cervix dilates and effaces. You can expect mild contractions coming at irregular intervals. As your cervix opens, you may see a pink or slightly bloody vaginal discharge. That’s the mucus plug that has blocked the cervical opening during pregnancy.

Early labor tends to last for a shorter duration in second and subsequent pregnancies. Do what you can to make yourself comfortable during early labor. For instance:

• Move around and walk.
• Take a bath or shower.
• Listen to relaxing music.
• Use breathing, mindfulness or relaxation techniques.
• Change positions.

If you’ve had an uncomplicated pregnancy and your baby is moving well, you can spend most of your early labor at home until your contractions increase in frequency and intensity. Consult your doctor or midwife on when to head to the hospital. If your water breaks or you’re having significant vaginal bleeding, call your doctor.

Your cervix must stretch outward and get thinner before your baby can pass through it. Contractions are what cause the stretching and thinning to occur. During active labor – the pushing phase – your cervix will dilate from 6 to 10 cm. Throughout your labor, your doctor, midwife or nurse will do vaginal exams to check how dilated you are.

During this phase, contractions become stronger and closer together. Your legs might cramp, and you might feel sick to your stomach. Your water will probably break, if it didn’t during early labor. (And if your water doesn’t break on its own, your doctor can perform a simple amniotomy to break the amniotic sac.) And you’ll feel pain in your low back. Now’s the time to grab that overnight bag you’ve already packed and head to the hospital.

A note about water breaking: Your fetus grows inside a protective sac that’s filled with amniotic fluid. When the amniotic sac tears, the fluid comes out of your vagina. It may come out in a trickle, or it may come gushing out. Either way, it means you should proceed to the hospital.

Active labor often lasts from four to eight hours or more. Sometimes much more. Every woman is different, and every pregnancy is different.

Remember the breathing and relaxation techniques you probably learned in childbirth classes. They can really help. During active labor, you can change positions; roll on a birthing ball; take a warm shower or bath; walk the hospital corridors, being sure to stop and breathe during contractions; and/or have your birthing partner, doula or midwife give you a massage between contractions.

With cesarean deliveries (C-sections), having food in your stomach can cause complications. If your doctor thinks you may require a C-section, they’ll probably ask you to refrain from eating solid foods, and instead recommend consuming clear liquids, such as water, ice, Popsicles and juice.

As you know, have heard or have seen in the movies, the last part of active labor – “the transition” – is intense. The good news is: That transition typically lasts from 15 minutes to an hour. You'll feel pressure in your lower back and rectum. Contractions, now coming close together, can last up to 90 seconds. While painful, every contraction gets you one step closer to holding your baby.

If you feel ready to push but aren’t fully dilated, your doctor or midwife will probably suggest waiting. Pushing too soon can exhaust you and cause your cervix to swell, which might complicate delivery.

Stage II: The birth of your baby

It may take from a few minutes to a few hours or more to birth your child – and even longer for first-time moms and women who've had an epidural.

Ask your provider about when to keep pushing. You can try different positions until you find one that feels right to you. You may need to try several. What feels OK in one moment may not feel good the next. You can push while squatting, sitting, kneeling or while on your hands and knees.

You may be asked to push more gently or to stop pushing entirely. If your doctor or labor coach tries to slow you down, it’s probably to allow your vaginal tissues time to stretch rather than tear.

After your baby’s head emerges – which you can see if a mirror is held at the correct angle – the rest of the body will follow in short order. How exhilarating! If needed, the doctor will clear baby’s airway.

Within a few seconds to a few minutes of baby’s arrival, the umbilical cord is cut. Delaying clamping and cutting the cord by a few minutes increases the flow of nutrient-rich blood to baby. This increases baby's iron absorption and reduces the risk of anemia.

Stage III: Delivery of the placenta

Nothing compares to the first time you hold your baby. It is a moment to savor – but your work isn’t over just yet. You still need to deliver the placenta, which can take up to 30 minutes.

Your attention is entirely on your baby now – as it should be. You might even try to breastfeed. But there’s still lots of activity going on around you.

And inside you. Mild uterine contractions that help move the placenta into the birth canal are happening now. You'll need to push gently once more to deliver the placenta. You may be given medication before or after the placenta is delivered to help with contractions and to minimize bleeding.

If your placenta isn’t intact, your doctor will remove any remnants from your uterus to prevent bleeding and infection. After you deliver the placenta, your uterus will continue to contract to help it return to its normal size. A gentle abdominal massage can help the uterus contract and minimize bleeding.

After all that pushing, it’s possible there are tears in your vaginal area. Your doctor can repair those while you’re still in the delivery room. If you didn’t get anesthesia earlier, you’ll get an injection of a local anesthetic before the area is stitched.

Congratulations! Few things in life are as exhausting – or as rewarding – as having a baby.