Stages of labour and delivery

Reviewed by SickKids Hospital Staff Last updated: September 11th 2009

Read about the three stages of labour. Tips, such as breathing exercises, are
provided for dealing with the pain and exhaustion of labour.

Key points
Labour and delivery is divided into three stages, though every woman experiences
these stages differently.
The first stage of labour lasts from the time when you start having contractions until
your cervix is fully dilated.
Stage one is broken down into the early phase, the active phase and the transition
phase.
The second stage is when the baby is actually delivered, usually lasting from 20
minutes to two hours.
The third stage of labour is the delivery of the placenta.

Roughly speaking, vaginal birth, also called labour and

delivery, is divided into three stages. The first stage of labour
lasts from the time when you start having contractions until
the time that your cervix is fully dilated, or open. The second
stage is the "pushing" stage where the baby is actually
delivered. The third stage of labour is the delivery of the
placenta. Each woman experiences these stages differently,
and the stages may differ from one pregnancy to another.
Sometimes the signs of each stage may overlap.

Stage one of labour and delivery

The first stage of labour lasts from the time when you start having contractions until the time
that your cervix is fully dilated, or open. In the weeks leading up to labour, your cervix starts to

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 soften. The contractions of labour open the cervix wide enough to let the baby through. Stage
one is divided into the early phase, the active phase, and the transition phase.

The early phase

The early phase of stage one is also called the latent phase, and it can last up to 20 hours. A
typical labour might start with contractions coming every five to 20 minutes and lasting 30 to
60 seconds each. Every labour is different, however, and some women might not realize they
are in labour until the contractions are relatively close together, about five minutes apart. The
contractions will become stronger, longer, more frequent, and better coordinated. During the
early phase, your cervix will open to about 3 cm (1 inch).

The pain you may experience during the early phase of stage one will be similar to menstrual
cramps, spreading around your abdomen like a tight band. During a contraction, there is a wave
of pain across the abdomen. The uterus hardens and tightens intensely, and holds this intensity
for a few seconds before relaxing. Some women may feel the pain as a backache instead. The
pain of the contractions in the early phase is generally not as severe as that in the active phase.
You should be able to talk during the contractions. If you are not able to, contact your health-
care provider or proceed to the nearest hospital right away.

During the early phase of labour, try to rest in between contractions, to conserve your energy
for what’s ahead. Try to go to the bathroom as often as possible, because a full bladder can
hinder your uterus from contracting efficiently. An empty bladder leaves more space for the
baby to pass through.

Rupture of the fetal membranes

The fetal membranes often rupture in stage one of labour. This is often referred to as your
"water breaking," and it is painless. Once the fetal membranes are broken, amniotic fluid will
either leak or gush out. Sometimes, if labour is proceeding slowly and the fetal membranes have
not ruptured, the doctor may make a small tear in the membranes with a gadget that looks like a
small crochet hook. This is called artificial rupture of the fetal membranes; it should make the
contractions stronger and help speed labour along.

If your fetal membranes rupture before the onset of labour pains – a condition known as
premature rupture of the fetal membranes – you may need to have labour induced. Call your
health-care provider or proceed to the nearest hospital as soon as possible.

The active phase

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 After your cervix dilates to around 3 cm (1 inch), you will enter the active phase of labour,
where things really start to get rolling. For the next few hours, your contractions will be strong,
painful, and regular. Unlike the early phase, you may no longer be able to talk through these
contractions. Once you have had strong, regular contractions every five minutes for about an
hour, you should call your health-care provider or proceed to your nearest hospital. Some
health-care providers prefer that you contact them before you reach this point, so make sure to
discuss this with them ahead of time.

Usually during the active phase of labour, the contractions will become stronger and more
frequent, occurring about every two to three minutes. However, every labour is different and
some women do not have contractions more often than every five minutes. In the active phase,
your cervix will continue to open, to about 8 cm (3 inches). The baby’s head will descend further
and further into the pelvis.

There is no way to deny that the contractions will be painful, but there are ways to deal with the
pain. Here are a few non-medical ways to cope with the pain:

Try to relax.
Use breathing patterns to help relaxation.
Make releasing noises like chants, hums, and moans when you feel the need to.
Take advantage of gravity to help push the baby along: try standing and leaning against
your partner, sitting and leaning over a chair, kneeling on all fours, walking slowly, or
relaxing in the shower.
Try to walk in between contractions.
Sway, rock, and dance to keep your pelvis mobile.
Consider water therapy: soak in the jacuzzi, bathtub, or shower.
Have your partner or a friend give you a massage.
Urinate frequently.
Distract yourself with music, television, or meditation.

Your labour partner can also help you to deal with the pain by doing the following:

reassuring you with loving words and slow, steady movements

offering praise, not criticism
trying to distract you
helping you to take one contraction at a time
letting you stand and lean against them (or her), in an effort to have gravity push the
baby along

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 mopping your forehead with a wet cloth
bringing you ice chips to chew on, and other drinks and food if permitted by your health-
care provider
giving you a massage if you want it
encouraging you to rest between contractions if you are able to
encouraging you to resist pushing until your health-care provider says that you should

Some women prefer to receive pain medication during childbirth. Choices for pain relief include
narcotics and tranquilizers, and regional blocks such as epidurals.

The transitional phase

In the transitional phase, your cervix will open from 8 to 10 cm (3 to 4 inches), which is the
diameter that the baby’s head needs to pass through the birth canal. At this point, your
contractions will be intensely strong, occurring about every two to three minutes. Each
contraction may last 60 seconds or more. You may feel shaky or nauseous at this point.
Continue to use the same coping tips you tried during the active phase of labour.

The baby’s head continues to descend further into the pelvis during the transitional phase. By
the end of this phase, a birth canal will have formed. This is a single passage of the open womb,
open cervix, and vagina for your baby to pass through. The time for pushing will soon be at
hand.

Stage two of labour and delivery

This is the "pushing" stage where the baby is actually delivered! The second stage of labour is
very exciting, and it usually lasts from 20 minutes to two hours. For some women, stage two
may last only five minutes; for others, it could last up to three hours. During this stage, you will
still have strong and regular contractions, every one to three minutes. Each contraction will help
to move the baby’s head farther down into the pelvis, along the birth canal.

Some women find the second stage of labour easier to manage than the active phase of the first
stage, because they can bear down, which offers some relief to the pain. When you feel the
unbearable urge to bear down, hold your breath and push like you are having a very large bowel
movement. Go naturally with each contraction. Follow what your body tells you to do.

If you have an epidural in place, you may not be able to feel what is happening, and you will find
it difficult to push effectively. Your health-care provider can help you manage this challenge, by
carefully coaching you through the pushing stage.

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 With each contraction and push, your abdominal muscles put pressure on the baby to move
through the birth canal. When a contraction finishes, the uterus relaxes and the baby’s head
recedes slightly. After a while, the area between your vagina and anus, called the perineum, will
start to bulge and the baby’s scalp will become visible.

The top of the baby’s head will emerge at the end of stage two. This is called "crowning." At
some point, you may be asked to stop pushing, even if you have the overwhelming urge to do
so. This allows the baby’s head to work at its own pace to stretch out your vagina and perineum.
If you can resist the urge to push at this point, it can help to prevent tearing in the perineal area.

The doctor or midwife will gently guide the baby’s head through the birth canal, followed by one
shoulder and then the other. The rest of the body follows easily. There may be a gush of water.
If necessary, your health-care provider may suction the baby’s nose and mouth; baby will take
his dramatic first breath. The umbilical cord will be clamped and your partner may be offered
the opportunity to cut the cord. If there are no complications, the baby will be quickly cleaned
up and placed on your chest so that you can admire them and warm them with your body.

Stage three of labour and delivery

This short, 10-minute to one-hour stage is pretty anticlimactic compared with the previous two
stages. The third stage of labour is the delivery of the placenta. Now that you have your
newborn baby in your arms, you might not even notice the placenta coming out. The placenta is
usually expelled with a few painless contractions. You may be asked to push briefly during this
time. The blood vessels that were supplying your baby in the womb rapidly close down, and the
womb becomes smaller and compact. Your health-care provider may massage your womb to
stop any bleeding.

During the third stage of labour, your focus will be on your newborn baby, and you might not
even notice the contractions that your uterus makes to expel the placenta. If you need stitches
because you had a tear or an episiotomy, you will be given a local anesthetic so that the doctor
can perform the suturing. You can hold your newborn baby while this is being done, if you wish.
Try to cherish the first few moments after your baby is born: get to know your baby and revel in
the miracle of his birth.

Please visit AboutKidsHealth.ca for more child health information.

©2019 The Hospital for Sick Children

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