The Stages of Labor

You may think that knowing when you are in labor is obvious, but for many women, it may not be so simple. At times, women may experience symptoms of false labor, including Braxton Hicks contractions (also known as practice contractions) which, although similar to real contractions, are not labor.

Determining what is real labor and false can be accomplished by clocking contractions, timing how long each contraction lasts for and how long it takes from the start of one contraction to the next.

If you are having Braxton Hicks contractions, they will be irregular and go away in time. They may resolve with walking, lying down or through other changes in activity, but true contractions and labor will not resolve and will increase in intensity.

Signs of labor

There are several signs that labor may start in the near future. At times, a woman may notice that the baby is sitting lower in the pelvis; this is referred to as “dropping” or “lightening.”

Cervical changes may become present on physical exam, and “nesting” – a strong desire to tidy and organize the house – may become more evident. The nesting instinct is not experienced by everyone, however.

Additionally, some women may experience a bloody mucus discharge indicating the loss of their mucus plug as labor nears. If your water breaks, labor will likely ensue and your health care team should be notified.

If you have questions about any symptoms you may be having during this time, it is important to speak with your health care provider to determine if there is a need to be seen in the office or hospital.

Stages of labor

There are three stages of labor: the first, second and third stages.

First stage of labor

The first stage of labor describes the time at which labor begins until a woman’s cervix is fully dilated to around 10cm. This period can last anywhere from 12-19 hours in duration. The first stage of labor is divided into three phases: early, active and transition.

The early phase is the time at which labor begins until the cervix is dilated to around 3 cm. This phase lasts for 8-12 hours. Contractions are mild, irregular and last for about 30-45 seconds in duration. There is a 5-30 minute rest period between contractions which cause symptoms such as lower backache, cramping and pelvic pressure or tightness.

These contractions will soon become regular and more intense. During this time, the amniotic sac may rupture (also known as when the water breaks). Most likely, you will be at home during this phase.

The active labor phase is the time from 3-7 cm cervical dilation. When the active labor phase starts, you should head to the hospital. This phase lasts for 3-5 hours. Contractions become stronger, lasting for about 45-60 seconds in duration, and there is 3-5 minute rest period between contractions.

The transition phase is the time from 7 cm to full dilation to 10 cm. This phase is often accompanied by nausea, hot flashes, chills and shaking. The transition phase generally lasts for 30 minutes to 2 hours. Contractions are intense and last 60-90 seconds in duration. There is only 30 seconds to 2 minutes of rest in between contractions.

Second stage of labor

The second stage of labor is the time of full dilation (10 cm) to birth. This is the time when you will push and lasts for 20 minutes to 2 hours.

Third stage of labor

The third stage of labor is the time when the placenta (afterbirth) is delivered and takes around 5-30 minutes. Women will often experience shaking and shivering during this stage of labor.

Rapid or prolonged labor

Labor duration can vary from woman to woman. It may follow the typical stages and times of labor as described above but, in some cases, women may experience rapid or prolonged labor.

During rapid or precipitous labor, a woman experiences only active labor, birth and delivery of the placenta; this type of labor typically lasts anywhere from 3-5 hours in duration.

Alternately, there are some women who experience a prolonged labor or failure to progress. During prolonged labor, the duration lasts from 14-20 hours and is at times a cause for concern, especially in the active phase of birth.

When to go to a hospital

Your health care provider will give you specific instruction on when to present to the hospital. However, you should always speak with your health care team about any concerning symptoms that may be cause for emergent evaluation.

It is important to head to the hospital when:

• You show signs of being in active labor (strong, regular contractions 3-5 minutes apart)
• Lower back pain or cramping develops that does not resolve
• Your water breaks
• Bloody-brown vaginal mucus or discharge is found
• Other concerns arise that may signify an emergency.

Pain relief during labor

All pain is not equal and women may experience pain differently during the labor and delivery process. While some women do not require pain medication, many do. There are various ways to manage pain during labor which include both natural and medicinal methods.

Natural methods

Natural methods of pain management during labor include:

• Breathing and relaxation techniques
• Water
• Massage
• Applying heat or cold – with a cold washcloth, for example
• Support from a loved one or doula
• Positional changes
• Visualization
• Guided imagery
• Aromatherapy
• Listening to music.

Medicinal methods

Medicinal methods of pain management include:

• Opioids: these are injectable medications that can be delivered into a vein or muscle. Medications typically used include morphine, butorphanol, fentanyl, Nubaine and Demerol.
• Epidural and spinal blocks: during an epidural, a catheter is placed in the lower back through which a combination of medications including narcotic and local anesthetics is typically delivered. A spinal block is typically a single injection of pain-relieving medication into the spinal fluid.
• Pudendal block: this form of pain relief requires an injection of medication into the vagina and pudendal nerve. Medications used during this procedure include lidocaine or chloroprocaine.
• General anesthesia: this form of anesthesia is rarely used. However, it is necessary in certain situations. During the administration of general anesthesia, a total loss of consciousness is obtained with a muscle relaxant and nitrous oxide.