What are the stages of labor?

The first stage of labor happens in two phases: early labor and active labor. Typically, it is the longest stage of the process.

During early labor:

• The opening of the uterus, called the cervix, starts to thin and open wider, or dilate.
• Contractions get stronger, last 30 to 60 seconds, and come every 5 to 20 minutes.
• The woman may have a clear or slightly bloody discharge, called "show."

A woman may experience this phase for up to 20 hours, especially if she is giving birth for the first time.

During active labor:

• Contractions become stronger, longer, and more painful.
• Contractions come closer together, meaning that the woman may not have much time to relax in between.
• The woman may feel pressure in her lower back.
• The cervix starts dilating faster.
• The fetus starts to move into the birth canal.

At this stage, the cervix reaches full dilation, meaning that it is as open as it needs to be for delivery (10 centimeters). The woman begins to push (or is sometimes told to "bear down") to help the baby move through the birth canal.

During stage 2:

• The woman may feel pressure on her rectum as the baby's head moves through the vagina.
• She may feel the urge to push, as if having a bowel movement.
• The baby's head starts to show in the vaginal opening (called "crowning").
• The health care provider guides the baby out of the vagina.

This stage can last between 20 minutes and several hours. It usually lasts longer for first-time mothers and for those who receive certain pain medications.

Once the baby comes out, the health care provider cuts the umbilical cord, which connected the mother and fetus during pregnancy. In stage 3, the placenta is delivered. The placenta is the organ that gave the fetus food and oxygen through the umbilical cord during the pregnancy. It separates from the wall of the uterus and also comes out the birth canal. The placenta may come out on its own, or its delivery may require a provider's help.

During stage 3:

• Contractions begin 5 to 10 minutes after the baby is delivered.
• The woman may have chills or feel shaky.

Typically, it takes less than 30 minutes for the placenta to exit the vagina. The health care provider may ask the woman to push. The provider might pull gently on the umbilical cord and massage the uterus to help the placenta come out. In some cases, the woman might receive medication to prevent bleeding.^{1,2,3,4,5,6,7}