Labor and Birth

Labor occurs in three stages. How labor progresses and how long it lasts are different for every woman. But each stage features some milestones that are true for every woman.

Labor and Birth Overview

Reviewed: September 1, 2014

Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). 

The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby's position and station (location in the birth canal). Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother's abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. 

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

The second stage involves pushing and delivery of the baby. It usually lasts 20 minutes to two hours. A woman can give birth in many positions, such as squatting, sitting, kneeling, or lying back. 

When the baby's head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy, to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After the baby is born, the umbilical cord is cut. 

The third stage involves delivery of the placenta (afterbirth). It is the shortest stage, lasting five to 30 minutes. Contractions will begin five to 30 minutes after birth, signaling that it's time to deliver the placenta. Labor is over once the placenta is delivered. 


Labor and Birth Symptoms

Some signs suggest that labor will begin very soon. Call your doctor or midwife if you have any of the following signs of labor. Call your doctor even if it's weeks before your due date — you might be going into preterm labor.

  • Contractions that become stronger at regular and increasingly shorter intervals.
  • Lower back pain and cramping that does not go away.
  • Water breaks (can be a large gush or a continuous trickle).
  • Bloody (brownish or red-tinged) mucus discharge (can be the mucus plug that blocks the cervix).

False labor occurs when mothers-to-be think they are in labor when they're not. "Practice" contractions called Braxton Hicks contractions are common in the last weeks of pregnancy or earlier.

With true labor, contractions become regular, stronger, and more frequent. Braxton Hicks contractions are not in a regular pattern, and they taper off and go away. Some women find that a change in activity, such as walking or lying down, makes Braxton Hicks contractions go away. This won't happen with true labor. Even with these guidelines, it can be hard to tell if labor is real. If you are unsure if contractions are true labor, call your doctor.

Women in labor have many pain relief options that work well and pose small risks when given by a trained and experienced doctor. Doctors also can use different methods for pain relief at different stages of labor.

OpioidsOpioids, also called narcotics, are medicines given through a tube inserted in a vein or by injecting the medicine into a muscle. Sometimes, opioids also are given with epidural or spinal blocks. Opioids can make the pain bearable, and don't affect the ability to push. After getting this kind of pain relief, women can still get an epidural or spinal block later.

Epidural and Spinal BlocksAn epidural involves placing a tube (catheter) into the lower back, into a small space below the spinal cord. Small doses of medicine can be given through the tube as needed throughout labor. With a spinal block, a small dose of medicine is given as a shot into the spinal fluid in the lower back. Spinal blocks usually are given only once during labor. Epidural and spinal blocks allow most women to be awake and alert with very little pain during labor and childbirth. With epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness felt can be adjusted throughout your labor. With spinal block, good pain relief starts right away, but it only lasts 1 to 2 hours.

Pudendal blockA doctor injects numbing medicine into the vagina and the nearby pudendal nerve. This nerve carries sensation to the lower part of the vagina and vulva.

Many natural methods help women to relax and make pain more manageable. Things women do to ease the pain include:

  • Trying breathing and relaxation techniques
  • Taking warm showers or baths
  • Getting massages
  • Using heat and cold, such as heat on lower back and cold washcloth on forehead
  • Having the supportive care of a loved one, nurse, or doula
  • Finding comfortable positions while in labor (stand, crouch, sit, walk, etc.)
  • Using a labor ball
  • Listening to music

Labor and Birth Other Treatments

Sometimes, a doctor or midwife might need to induce (bring about) labor. The doctor or midwife can use medicines and other methods to open a pregnant woman's cervix, stimulate contractions, and prepare for vaginal birth.

Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery.