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What are the stages of labor and birth?
The process of labor and birth is divided into three stages:
- First stage. This begins when you start having contractions. It causes progressive changes in your cervix and ends when your cervix is fully dilated (open).
- Second stage. This begins when you're fully dilated and ends with the birth of your baby. This is sometimes referred to as the "pushing" stage.
- Third stage. This begins right after the birth of your baby and ends with the delivery of the placenta.
How long does giving birth take?
Every pregnancy is different, and there's wide variation in the length of labor. For first-time moms, labor often takes between ten and 20 hours. For some women, though, it lasts much longer, while for others it's over much sooner.
Labor generally progresses more quickly for women who've already given birth vaginally.
First stage of labor
The first stage of labor has three phases:
- Early labor: Your cervix gradually effaces (thins out) and dilates (opens) to about 6 centimeters (cm) by the end of this phase.
- Active labor: Your cervix begins to dilate more rapidly and opens up further to 10 cm. Contractions are longer, stronger, and closer together.
- Transition: During the last part of active labor, contractions are even longer, stronger, and closer together – this can be the most difficult part of your entire labor.
The first stage of labor is the longest stage, especially if you are giving birth for the first time, and can last anywhere from days to a few hours. Early labor usually takes the longest amount of time and transition the shortest.
Phase 1: Early labor
What to expect
- Contractions start. You'll start getting contractions at relatively regular intervals. Note that early labor contractions are sometimes hard to distinguish from irregular Braxton Hicks contractions, also called false labor. True labor contractions get closer together as time goes on and are more regular than Braxton Hicks contractions. (If you aren’t sure whether you are in true labor, see whether you can hold a complete conversation with your labor partner or doula. If you have to stop, especially mid-sentence, to breathe through contractions, you’re probably moving into active labor).
- Contractions get longer, stronger and closer together. Eventually they'll be coming every four to five minutes and lasting 40 to 60 seconds each. (Some women have much more frequent contractions during this phase, but the contractions will still tend to be relatively mild and last no more than a minute.) Early labor ends when your cervix is about 6 cm dilated and your progress starts to accelerate.
- You may feel some pain. Sometimes early labor contractions are quite painful. If your labor is typical, however, your early contractions will be mild enough for you to talk through them and putter around the house, or even doze off between them.
- You may see a mucousy vaginal discharge. This may be tinged with blood – the so-called bloody show. This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver.
- Your water may break. Even if you're not having contractions yet, call your provider if this happens.
- Time contractions periodically. Don't become a slave to your stopwatch just yet – it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead, you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously. You can also ask your labor partner to note when you are no longer able to relax completely between contractions, or unable to complete a sentence or express a thought without having to stop and deal with a contraction.
- Rest. It's important to do your best to stay rested, since you may have a long day (or night) ahead of you. If you're tired, try to doze off between contractions.
- Relax. If you're feeling anxious, you may want to try some relaxation exercises, take a warm bath, or do something to distract yourself a bit – like watching a movie or reading a book.
- Drink plenty of fluids to keep you well hydrated. And don't forget to urinate often, even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
Phase 2: Active labor
What to expect
- Contractions become intense. Active labor is when things really get rolling. Your contractions become increasingly intense – more regular, longer, and stronger – and you'll no longer be able to talk through them.
- Contractions get more frequent. In most cases, the contractions eventually happen every 2 1/2 to 3 minutes, although some women never have them more often than every 5 minutes, even during transition.
- Cervix opens wider. Your cervix dilates more quickly. (The last part of active labor, when the cervix dilates fully from 8 to 10 cm, is called transition, which is described in the next section.)
- Your baby may begin to descend toward the end of active labor, although he might have started to descend earlier, or might not start until the next stage.
- Nausea and vomiting. This is fairly common at this stage, sometimes from epidural anesthesia causing the blood pressure to drop, and sometimes from stimulation of nerves that cause vomiting.
What to do
As a general rule, if you’re a first-time mom, once you've had regular, painful contractions (each lasting about 60 seconds) every four to five minutes for at least an hour, it's time to call your midwife or doctor and maybe head to the hospital or birth center. Some caregivers prefer a call sooner, so clarify this ahead of time. Some providers will advise you to stay home as long as possible, especially if you are hoping to have a low-intervention, unmedicated delivery.
How long active labor lasts
- If this is your first baby. Active labor will last between five and seven hours on average, although every woman is different. It can be even longer, or as short as an hour.
- If you've had a baby before, expect the active phase to go more quickly, between two to four hours on average.
- If you have an epidural or a big baby, labor may last longer.
- Get pain relief if you need it. Most women opt for pain medication , such as an epidural, at some point during the active phase.
- Try relaxation techniques. Many pain-management and relaxation techniques used in natural childbirth– such as breathing exercises and visualization – can help you during labor, whether or not you're planning to receive medication.
- Enlist a birth partner or hire a labor coach (doula). Your partner, a friend or family member, or a hired doula can be a huge help now. You'll probably appreciate lots of gentle encouragement.
- Move. It may feel good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. You should be able to move around the room freely after your caregiver evaluates you, as long as there are no complications.
- Sit or lie down on your side. If you're tired, try sitting in a rocking chair or lying in bed on your left side.
- Get a massage. This might be a good time to ask your birth partner or doula for a massage to help ease labor pain.
- Take a warm shower or bath if you have access to a tub and your water hasn't broken. Even if your water has broken, a shower is probably okay, as the risk of infection is low. However, don't take a bath if your water has broken.
Phase 3: Transition
The last part of active labor is called the transition period because it marks the shift to the second stage of labor.
What to expect
- Fully dilated cervix. Your cervix dilates from 8 to a full 10 cm.
- Very strong contractions. This is the most intense part of labor. Contractions are usually very strong, coming every two and a half to three minutes or so and lasting a minute or more. You may start shaking and shivering.
- Pressure on your rectum. By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels.
- An urge to push. Some women begin to bear down spontaneously – to "push" – and may even start making deep grunting sounds. Some babies descend earlier and the mom feels the urge to push before she's fully dilated. Other babies descend later and the mom reaches full dilation without feeling pressure. (If you've had an epidural, the pressure you'll feel will depend on the type and amount of medication you're getting and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition. Remember, though, that this will make contractions more painful).
- Discharge. There's often a lot of bloody discharge.
- Nausea. You may feel nauseated or even vomit.
How long transition lasts
Transition can take anywhere from a few minutes to a few hours. It's much more likely to be fast if you've already had a vaginal delivery.
If you're laboring without an epidural, this is when you may begin to lose faith in your ability to handle the pain, so you'll need lots of extra encouragement and support from those around you.
- Consider a massage. Some women appreciate light touch (effleurage), some prefer a stronger touch, and others don't want to be touched at all.
- Change positions. For example, if you're feeling a lot of pressure in your lower back, getting on all fours may reduce the discomfort.
- Cold or warm compresses. A cool cloth on your forehead or a cold pack on your back may feel good, or you may find a warm compress more comforting.
- Get rid of distractions. On the other hand, because transition can take all of your concentration, you may want all distractions – music or conversation or even that cool cloth or your partner's loving touch – eliminated.
- Visualize. It may be useful to focus on the fact that those hard contractions are helping your baby make the journey out into the world. Try visualizing her movement down with each contraction.
- Have a good birth partner or labor coach. The good news is that if you've made it this far without medication, you can usually be coached through transition – one contraction at a time – with constant reminders that you're doing a great job and that your baby's arrival is near.
Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby.
What it feels like
- More spaced out contractions. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them.
- Less intensity as pushing begins. Many women find their contractions in the second stage easier to handle than the contractions in active labor because bearing down offers some relief. Others don't like the sensation of pushing.
- Urge to push. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. If your baby is very low in your pelvis, you may feel an urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you probably won't have this sensation right away.
Pushing: What to expect
- You might want to take it slow. If everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push. Waiting a while may leave you less exhausted and frustrated in the end.
- You may be instructed to push. In many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent. Let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. This practice, known as “laboring down,” has been shown to be as effective as coached pushing, although delivery may take a little longer.
- Epidurals can reduce pushing feeling. If you have an epidural, the loss of sensation can blunt the urge to push, so you may not feel it until your baby's head has descended quite a bit. Patience often works wonders. In some cases, though, you'll eventually need explicit directions to help you push effectively.
Your baby's descent: What to expect
With each contraction, the force of your uterus – combined with the force of your abdominal muscles if you're actively pushing – exerts pressure on your baby to continue to move down through the birth canal.
- Fast or slow. The descent may be rapid. Or, especially if this is your first baby, the descent may be gradual.
- Your baby's head moves down, then back. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression.
The first glimpse of your baby: What to expect
- Your baby's scalp will appear. After a time, your perineum (the tissue between your vagina and anus) will begin to bulge with each push, and before long your baby's scalp will become visible – a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
- Stronger pushing urge. Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch.
- Instructions to slow down or pant. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vaginal opening and perineum. A slow, controlled delivery can help keep your perineum from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it. Sometimes, gently coughing instead of pushing can result in a slower, easier descent of the baby’s head.
Crowning: How the head emerges
- The whole head appears. Your baby's head continues to advance with each push until it "crowns" – the time when the widest part of her head is finally visible. The excitement in the room will grow as your baby's face begins to appear: her forehead, her nose, her mouth, and, finally, her chin.
- Provider removes any blockages. After your baby's head emerges, your doctor or midwife may suction her mouth and nose and will feel around her neck for the umbilical cord. (If the cord is around your baby's neck, your caregiver will either slip it over her head or, if need be, clamp and cut it.)
- Baby's body gets ready to come out. Your baby's head then turns to the side as her shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as her shoulders emerge, one at a time, followed by her body.
Out at last! What to expect.
Here's what happens once your baby hits the atmosphere:
- He needs to be dried off with a towel and kept warm..
- Your doctor or midwife may quickly suction your baby's mouth and nasal passages if he seems to have a lot of mucus.
- If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket – and perhaps given his first hat – to prevent heat loss.
- Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps – or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long the second stage lasts
The entire second stage can last anywhere from a few minutes to several hours.
- Without an epidural, the average duration is close to an hour for a first-timer and about 20 minutes if you've had a previous vaginal delivery.
- If you've had an epidural, the second stage may last longer.
When pushing, try different positions until you find one that feels right and is effective for you. It's not unusual to use a variety of positions during the second stage.
Third stage: Delivering the placenta
What to expect
Minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall.
When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.
How long the third stage lasts
On average, the third stage of labor takes about five to ten minutes.
What happens after you give birth
- Your uterus contracts. After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that your uterus remains firm, and massage it if it isn't. This is important because the contraction of the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels
- You can try breastfeeding. If you're planning to breastfeed, do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but try holding your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse in the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers the release of oxytocin, the same hormone that causes contractions, which helps your uterus stay firm and contracted.
- You may receive oxytocin or other treatments. If you're not going to nurse or your uterus isn't firm, you'll be given oxytocin to help it contract. (Many providers routinely give it to all women at this point). If you're bleeding excessively, you'll be treated for that as well.
- Contractions will subside. Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. If you've had a baby before, you may continue to feel occasional contractions for the next day or two. These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication such as Ibuprofen, which is very effective against this crampy pain.
- You may also have the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.
- Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to spot any tears in your perineum that need to be stitched.
- If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches – it can be a great distraction. If you're feeling too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
- If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. This takes just a second and doesn't hurt.
Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of birth.
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